12-Step Approaches: Pros and Cons for Alcohol and Substance Use Disorders

12-Step

Success of 12-Step Approaches

Most people are familiar with AA (Alcoholics Anonymous), NA (Narcotics Anonymous), and other 12-Step (self-help) groups. In fact, many treatment providers, when learning of a client’s alcohol or substance misuse, will immediately suggest that the client begin attending 12-step meetings. But do these meetings work?

AA, the largest and most well-known 12-step group, seems to have a varying success rates,  depending on who you ask. In 2014, AA reported the following about its membership:

  • Sober 20+ years: 22%
  • Sober 10-20 years: 14%
  • Sober 5-10 years: 13%
  • Sober 1-5 years: 24%
  • Sober less than a year: 27%

These statistics are misleading, though, as they do not capture those who have tried AA and dropped out. Were the numbers to include this subset of individuals, the success rates would likely be significantly lower. Peer-reviewed studies typically indicate that AA has a 5-10% success rate. In 2006, the Cochrane Collaboration, conducted a large meta-analysis examining the efficacy of AA and concluded, “No experimental studies unequivocally demonstrated the effectiveness of AA or TSF* approaches for reducing alcohol dependence or problems.”

As success rates might be equivocal, we can also take a look at some of the pros/cons of attending self-help meetings. Members might still benefit from attending, even if they cannot demonstrate long-term abstinence.

Pros of 12-Step Meetings

  1. Community: This might be one of the biggest benefit to participating in 12-step meetings. The fellowship is a remarkable source of community and support. Members can rely on each other when struggling, when approaching difficult situations, and when celebrating their victories.
  2. Modeling: It helps to know that others have struggled in similar ways and overcome similar challenges. Moreover, for some folks who have difficulty imagining what a sober life would look like, being with others in the rooms helps them understand that sober life is possible – and can even be fun.
  3. Helping others: Many members of self-help groups report that their sobriety is reinforced when they reach out to struggling newcomers or take on a sponsee. Helping others strengthens their sobriety muscles.

Cons of 12-Step Meetings

  1. Higher Power: Some people might have trouble with the “Higher Power” concept, no matter how creatively they are encouraged to define this for themselves. For these individuals, the concept of a Higher Power becomes a sticking point that clouds further engagement.
  2. Groupthink: Some people object to the rituals and messaging in AA. While some find them helpful, others complain that the sayings, the teachings from the Big Book, etc. are difficult to stomach.
  3. The shame of a slip: For those who slip or experience a lapse or full-blown relapse, picking up another white chip can be a shameful experience and might even discourage honesty or continued meeting attendance. Some do not like the concept of “starting all over” after a relapse, which seemingly negates the work they’ve already put in.
  4. Meetings are not therapy: Self-help meetings are community run without professional oversight. Members might choose to work the steps with a sponsor, but moving through the steps is not a substitute for therapy.

Summary

Some individuals who struggle with alcohol or substance problems might benefit from attending 12-step meetings, especially as an adjunct to individual therapy. In cases where treatment is not an option, participation in meetings can offer an alternative, rich in community and support. Still, it is important to keep in mind that self-help meetings do not constitute treatment and that groups are not equipped to address co-occurring mental health concerns.

*TSF = 12-Step Facilitation Therapy