12 Step Programs

Drug Rehab Programs Using the 12-Step Approach

Approximately 85% of the alcohol and drug rehab centers in the US and Canada use the 12-Step Recovery Model. These are rehab centers that use the clinical methods of Alcoholics Anonymous, Cocaine Anonymous and Narcotics Anonymous. Two alcoholics who wanted to find a way to stay sober by sharing their experiences with another alcoholic developed the 12-Step model in 1934. The principles of the 12-Steps were codified into a book, called the Big Book of Alcoholics Anonymous, so that others could start support groups using their established spiritual principles to help them find happiness without the use of alcohol. They never intended for these methods to be used in a treatment facility, in fact, strict advocates of the 12-Step approach to recovery have disapproved of residential treatment from its inception, but in light of insurance and government funding in the 1970’s, many centers adopted this method as their major clinical focus. It was available, inexpensive to operate and had the potential to be very profitable for the owners of these 12-step based rehab centers. No one really questioned their existence until a generation of graduates had proven that they are very ineffective.

The 12-Step approach states that alcoholism is a chronic and progressive disease, which means that you have this “disease” all of your life and, even if you quit using, the morbidity of the “disease” continues to progress and your addiction gets worse in spite of your years of sobriety.

When someone enters a 12-Step program, they are told that they have this disease and that they are powerless over alcohol and other drugs. By the time that these rehab centers started using these methods, drugs were a bigger problem than alcohol, so the official text on the 12-Step method was changed to include drugs as well as alcohol. In time, many of these programs have added sex, gambling, eating and codependency disorders to alcohol and other drugs, claiming that all of these disorders are “diseases” and that the original 12-Steps of Alcoholics Anonymous treats them all.

Because of the immediate funding available for treatment and because of the tremendous need for some type of help for those with these problems, these centers multiplied rapidly until the insurance companies began to question the efficacy of this approach since the success of these programs equaled the success of those persons that got well on their own; about 5-8% success. The 12-Step treatment community then changed the definition of “disease” into a “disease of relapse”, meaning that many episodes of treatment may be needed to keep a person in recovery. Note that they do not speak about a cure, but only that a person is in remission or in recovery from their disease.

Almost all of the State funded facilities operate on the 12-Step approach, but they also have the disadvantage of not being in control of those that they might not want to admit into treatment, which causes state-funded programs to have the least success of any other types of treatment, with many being less than 5% success.

One must also consider the impact of telling someone that they have an incurable disease after they have brutalized themselves with alcohol and other drugs and are now finally beginning to confront their problem and seek help. Needless to say, this is hardly the message that inspires hope and a willingness to go through the consequences of their withdrawals and other emotional repair needed to recover from months and/or years of abuse. This, in itself, is a major factor in building denial and resistance to seeking help. It has been found that many people continue their destructive use and abuse because they have been told that they have an incurable disease and they begin to feel that there isn’t’t any help that really works and that there is little hope that they will ever be free of addiction….so why not?

Everyone that uses alcohol and other drugs does so to handle some physical, emotional or social pain and since these drugs temporarily relieved them of these problems, they soon become addicted emotionally and physical addiction happens with the daily use of these substances.

12-Step programs do not remove the effects of the drugs from the body to ease the physical addiction and they are very ineffective at treating the emotional problems that may have been medicated through the use of alcohol and other drugs. Therefore, many 12-Step programs violate the major principle of the original program by prescribing psychotropic medications to “handle” the original problem, which also feeds into the idea that chemicals are an answer to one’s pain which is an obvious outpoint when treating addiction.

If given the choice of medicating their pain with pharmaceuticals or street drugs, most addicts will choose the latter, and so it is obvious, with a little thought, that these programs are not best choice when looking for effective treatment. The only reason for their popularity, which is waning, is the fact that there are many centers using this approach and they are able to offer treatment in a few number of days and for less cost than effective programs, but remember, in matter of human potential, compromising for something where one-out-of-twenty find success is a gamble leading to inevitable disappointment.

Long Term Treatment

With the repeated failures of the 12-step approach, which has been packaged in a 28 to 30 day program, many people felt that if a person stayed in the program longer, they would be better prepared to deal with the “real” world without relapsing. Originally Long-Term Treatment was centered around boot-camps that were one to two years in length, but it is now defined as any program that is more than 30-days in length. Most of the long-term treatment options are 12-step based program, with about 10% being TC’s or Therapeutic Communities. TC’s are usually a year or more in length and they are based on the mode of group behavior modification, with harsh consequences for anyone that doesn’t obey and strictly adhere to the programs’ rules. Most of these programs have earned their poor reputations and are mostly seen in programs that are support by the criminal justice community.

A 12-step program that last 90-days vs. the traditional 30-days, may have a slightly better outcome, but still nothing close to what one finds in biophysical programs.

A common question asked to our counselors is: What can I expect of a short-term program?


Within the alcohol and drug treatment profession, short-term residential treatment has always been defined as treatment of 30-days or less.  These programs are usually considered to be 14 to 30 days of care, as opposed to long-term treatment which has traditionally been 90-days or more.

As the money for treatment has become tighter, the alcohol and drug rehab field has compromised their better wisdom by redefining long-term treatment as 30 days or more, but regardless of the change in labels, short term treatment is always thirty days or less.

At least nine out of ten short-term programs in the U.S. are patterned after the 12-step recovery model that was originated with the Big Book of Alcoholics Anonymous.

If you attend a shot-term program, it will probably be a 12-step based program.  Even if you are attending treatment for drugs, the Alcoholic Anonymous principals have been adopted to fit all addictions.  Since your days in treatment are limited to a maximum of thirty, you will usually be required to finish the first three steps of the 12-step program.  These first three steps are as follows:

  1. We admitted we were powerless over alcohol (or other drugs) that our lives had become unmanageable.
  2. Came to believe that a Power greater than ourselves could restore us to sanity.
  3. Made a decision to turn our will and our lives over to the care of God, as we understood Him.

As you can see, the first three steps are designed to change your perception of your addiction.  Most people feel that they are physically addicted because they hurt physically when they don’t have their drug of choice, but they usually believe that they are making the decision to use or not to use these drugs.

Under this philosophy, you are taught that you are powerless of the decision making process of whether you should drink or drug.  After you believe that is the case, then you are taught that only a Higher Power, which for most people is defined as God, can keep you from destroying your life.

All treatment programs do NOT hold this attitude as their basic belief about addiction.  Some of the most successful programs teach you that you are responsible for everything in your life and to stop your addictive behaviors, you have to learn to be more capable and to handle your urges and emotions rather than turning this ability over to God.

If you thinking of attending a short-term treatment program and you feel that being taught to turn your troubles over to God isn’t part of your worldview, then you should enquire whether the programs is based on the 12-steps or if it uses another philosophy.  The 12-step philosophy is based on the idea that addiction is a chronic and progressive disease, like diabetes.  This is difficult for many to follow and not believing in this disease model of addiction and being in a 12-step program will lead to poor outcomes and a continuation of your addiction.

If you are currently involved in 12-step support either in AA, NA or any of the other support groups, you are certainly doing the correct actions, but you may need more than you can get from these groups. The founders of AA clearly stated that their philosophy and support groups were NOT alcohol or drug treatment. They even went so far as to say that their program should NEVER be institutionalized, which has not been followed. Most of the alcohol and drug rehab centers use the 12-steps of AA as a major part of their “treatment” program. Is it any wonder why their outcomes are so poor? Call us and we will help you suppliment what you are doing with your 12-step work.

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