12 Step Recovery Programs

     Alcoholics Anonymous is perhaps the most famous (and the first) of a series of what have become known as 12 Step Programs because of their reliance on a series of 12 Steps.  The programs now include Narcotics Anonymous and Cocaine Anonymous as well as a dozen others.
     The central features of all of the 12 step programs include:

 - an emphasis on "letting go" and admitting powerlessness over the use of a substance;
 - reliance on a "Higher Power" which does not have to be in a religious context, but is cast in spiritual terms ("God as we undertand him");
 - nonaffiliation with any religion, political movement, or professional organization  - nonprofessional membership and leadership;
 - no requirements for membership except a desire to stop using a substance (no fees or dues are required)
 - anonymity;
 - focusing on accepting personal responsibility for one's substance use and not blaming it on others, life circumstances, etc. (although these might have contributed);
 - fellowship with other recovering addicts (replacing drinking buddies);
 - abstinence as a goal with even minimal use of the substance considered to lead to a complete relapse; most 12 Step Programs eschew the idea of ever being able to control one's use of a substance, even after years of abstinence;
 - helping other recovering and actively using substance abusers.

     There are few scientific studies of Alcoholics Anonymous or other groups, but some longitudinal data suggest that affiliation with Alcoholics Anonymous is associated with abstinence at 5 and 10 years after cessation of drinking.   Unless a patient cannot tolerate groups, all substance dependent patients should be strongly encouraged to attend meetings.  Give them an assignment, then ask them how it went.  Encourage them to attend different meetings if they don't like the first few, and to obtain a "sponsor" - someone with a year or so of sobriety whom they can call 24 hours a day.  Simply telling a patient to "stop drinking" is unlikely to be helpful; getting them into a program of recovery is far more helpful.