Rehab is designed to provide structure as you begin the process of recovery. There are countless ways to heal, and it’s important to choose a framework that meets your specific needs. While many people benefit from 12-Step rehab programs, others prefer a more holistic approach to addiction treatment.
Recent research shows that 12-Step programs have a hugely positive impact1, and may even be “the most effective path to abstinence.” However, there is some question as to why this is true. For example, 12-Step programs offer social support, which is essential during recovery2, but is not unique to this philosophy. At most inpatient rehab programs, you’ll be able to build community with or without following the 12 Steps.
It’s also important to note that spirituality is a component of every 12-Step program. If you’re not interested in faith-based recovery, these groups may not be right for you. Various rehab facilities offer different 12-Step groups, such as A.A. and N.A., as well as non-12-Step programs. Before choosing which residential rehab you’ll attend, it’s best to learn as much as you can about the available options.
Alcoholics Anonymous is the most well-known 12-Step program3. A.A. is “an international fellowship of men and women who have had a drinking problem. It is nonprofessional, self-supporting, multiracial, apolitical, and available almost everywhere. There are no age or education requirements. Membership is open to anyone who wants to do something about his or her drinking problem.”
Members of A.A. attend group meetings4, most of which have a similar format: initial announcements are followed by a reading of the 12 Steps5 and the 12 Traditions6. Then a member will share their story. This may be followed by a group conversation, or more structured time for other members to describe their experiences. This structure is simple but effective. As one member writes, “I always feel a little better after it’s over.”
There are many 12-Step groups that follow similar formats, such as Narcotics Anonymous7, Cocaine Anonymous8, Marijuana Anonymous9, and Al-Anon10, which is intended for people who love someone who struggles with substance misuse. These groups define the 12 Steps slightly differently, but all share a similar philosophy.
The 12 Steps are a list of actions that group members undertake during the process of recovery. In this process, members normally begin by admitting they have a problem. Then, you’ll connect to a higher power, sometimes called “God as we understand him.”5 Although 12-Step groups are historically rooted in Christianity, they welcome people of all faiths, including people who don’t ascribe to a specific religion. Nevertheless, the spiritual aspect of this philosophy isn’t right for everyone.
In the process of connecting with a higher power, members then make “a searching and fearless moral inventory” of themselves and their lives5. This ruthless honesty lays the groundwork for the great changes that come with recovery. By admitting your struggles to yourself, to another person, and to your version of a spiritual source, you may come to a new understanding of your emotional experience.
In Step 9, participants seek to make amends5 to any people they may have hurt, “except when to do so would injure them or others.” Through this process, members begin to consider the effects their actions have on their communities. There is a difference between intent and impact. As you learn more about yourself, you’ll also learn how to meet your needs in a healthy way, while participating in a supportive community.
One goal of the 12 Steps is to achieve a spiritual awakening. Step 12 refers to this directly: “Having had a spiritual awakening as the result of these steps5, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.” Members are encouraged to meditate, pray, and cultivate an ongoing spiritual practice.
In these groups, you’ll be encouraged to “work the steps” throughout the process of recovery. As you encounter new challenges, you may return to the steps again and again, not always in numerical order. In stressful times, these strategies can help you focus on your goals, avoid relapse, and make the healthiest choices available. The 12 Steps are more than a checklist; they can become a way of life. However, the steps themselves are just one component of recovery. The social aspect of 12-Step groups is also an essential part of the process.
Experts agree that social support—or a lack thereof—has an extremely significant impact upon people with substance use disorders11. Some researchers have even postulated that “opioid addiction serves as a substitute for social attachment.” In one study, a subgroup of substance users exhibited “severe negative affect and intense craving” when exposed to perceived social rejection.
This evidence suggests that without community, people in recovery may be especially vulnerable to cravings. Whether or not those cravings lead to relapse, one thing is clear: strong interpersonal relationships are an important part of healing. Because 12-Step groups include a built-in community of people on a similar journey, they may help members get the support they need. Programs like A.A. even encourage members to become sponsors12, actively supporting people at earlier points in the healing process.
In most residential rehabs, you’ll be in a cohort of people who share some of your life experiences. If your program is based in the 12 Steps, you’ll have even more structured opportunities to give and receive peer-to-peer support. For example, the program at Genesis House is firmly rooted in this philosophy. They treat substance misuse as “a three-fold disease: spiritual, physical, and emotional.” Residents are introduced to the 12 Steps as soon as they arrive. They continue to engage with the steps in individual therapy, and in the evenings they “are transported to local AA/NA meetings…where they will network with others in recovery and learn more about how to stay sober.”
Although 12-Step groups are extremely valuable for some, they’re not the only way to get community support. One study found that “social networks that support recovery lead to enhanced treatment outcomes and sobriety13 regardless if this support stems from family, peer groups or 12-Step programs.”
Non-12-Step programs are ideal for people who don’t ascribe to a spiritual practice, or those who simply want a different kind of structure. There are countless approaches to recovery from substance misuse, such as evidence-based treatment, individualized treatment, and experiential therapy. And even without faith in a higher power, it’s possible to heal in a holistic way.
For example, The Holistic Sanctuary, in Baja California, is a rehab facility with a “natural holistic healing program.” Clients do yoga, receive daily massages, and eat an organic diet. This approach “involves healing the patient’s spiritual health through meditation, catering to their physical health through exercise and improving their psychological wellbeing through counseling.”
There are as many ways to heal as there are people with substance use disorders. Many clients benefit from a combination approach, attending 12-Step groups while also participating in different therapeutic modalities. As Dr. Thomas Gazda, a medical doctor at Soberman’s Estate, explains, “in the same way that medicines and psychotherapy can go together, AA and 12-Step can go together with in-depth psychotherapy and medications when indicated.”
If you’re not sure whether 12-Step treatment is the right fit, you can talk to the admissions team at a rehab center to learn more. These questions may help you find out whether a program aligns with your specific goals for recovery:
If at all possible, it’s best to know the answers to these questions before you begin residential treatment. The more information you have, the better you can plan for life during and after rehab.
By design, 12-Step programs are extremely accessible. They’re free, they take place internationally, and they’re open to people at every stage of recovery. A.A., in particular, offers both open and closed meetings14. Open meetings are available to anyone, including friends and loved ones of alcoholics, who do not have substance use disorders themselves. Closed meetings are only open to people who have substance use disorders, or those who believe that they might and want to learn more.
This accessibility can be especially important for people who have recently completed rehab. When you first graduate from a residential program, you may be in a vulnerable emotional state. Rehab is only the first chapter of a much longer healing process. When you arrive home afterward, you’ll begin establishing new routines, returning to some parts of your life, and letting go of others. Attending group meetings can help you stay grounded, while encouraging you to form new relationships with people who live nearby.
Whether or not 12-Step recovery is right for you, there’s a great deal to learn from this philosophy. For example, the process of healing from substance misuse is not a solitary one. There are certain aspects of recovery that must be your responsibility, but no one lives in a vacuum. By connecting with the people around you and finding peers who have survived similar struggles, you can learn a great deal about what it means to live a healthy life.
Like any other healing process, the 12 Steps can be alinear. As you begin recovery, be patient with yourself. There are some lessons you may have to learn more than once, in new contexts or at different times of your life. That type of repetition is normal, and even healthy. As you continue to change and grow, it can be helpful to ground yourself with a list of goals or strategies that you’d like to focus on throughout recovery. There may be 12 of them, or 2, or 37. The important thing is to find a way of healing that aligns with your unique values.
Reviewed by Lisa Misquith