Why 12 Step Programs Don’t Work for Everyone—And What Might
Since its inception in 1939, the 12-step approach has become perhaps one of the most commonly turned to methods of recovery from drug and alcohol addiction. There are a wide variety of 12-step groups, including ones such as Debtors Anonymous, Overeaters Anonymous, and Crystal Meth Anonymous, which are all designed to help individuals dealing with these issues. However, perhaps the most well-known of these is Alcoholics Anonymous (AA), which is estimated to have more than 3 million members as of 2017.
For some people, the 12-step model is the gold standard catalyst they need for positive change. But for many others, 12-step involvement may simply not be the right approach. Understanding why 12-step engagement in programs doesn’t work for everyone—and what alternatives might work better for you or your loved one—can help you make an informed decision about how to move forward with recovery.
Why 12 Step Programs Don’t Always Work
The structured simplicity of 12-step meetings and programs can come as a great comfort to those struggling with the unpredictable ups and downs of addiction recovery. Follow these steps one-by-one, and you will recover—or so some 12-step fellowships and groups seem to promise. For those who find them helpful, this is one of the benefits. But for those for whom 12-step treatment doesn’t work, it can feel as if the problem lies with them, like having defects of character, rather than with the program—as if it is their fault for not being able to follow the instructions properly.
This isn’t the case, however. If you or a loved one have had active involvement in 12-step groups or programs only to fall back into addictive patterns and compulsive behaviors, this isn’t an indication of a personal fault or a moral failing. Rather, it is a sign that something more is needed in terms of treatment in order to support your personal recovery process. Any of the following may be a factor contributing to a lack of progress:
- Faith. The spiritual principles of Alcoholics Anonymous and other 12-step groups can be a huge barrier for many seeking treatment. After all, the founders themselves have a spiritual foundation as devout Christians and the fifth step of Alcoholics Anonymous explicitly prescribes confiding in/having conscious contact with a higher power and going through spiritual growth—often, God or some form of spiritual awakening is specifically named here. People belonging to non-Christian faiths or who identify as nonreligious may feel uncomfortable attending 12-step meetings, even though the doors may be open to people of all beliefs.
- Safety. If your local Alcoholics Anonymous meeting, or other self-help group meeting, is hosted in a neighborhood with a negative reputation, you may feel unsafe walking or parking there alone—especially at night. A single woman may feel uncomfortable attending an otherwise all-male group, and people of color or who identify as LGBTQIA+ may be wary of attending 12-step meetings in a town or neighborhood that is known not to be particularly welcoming to these groups.
- Personal circumstances. Many people struggling with addiction may not be able to drive themselves to meetings, especially ones that require or heavily recommend frequent attendance, meaning they will rely on others or on public transportation. This can be difficult if the nearest Alcoholics Anonymous group is an hour away, or meets at a time that does not work with your schedule (or that of the person from your social network giving you a ride). Diverse logistical or personal circumstances may get in the way.
- Underlying issues. 12-step recovery programs have one focus: addiction. They are not a suitable method for addressing any underlying issues that may be driving or exacerbating your addiction, such as trauma, co-occurring psychiatric disorders, or chronic physical illnesses. This is particularly problematic for people who may require prescription medications to help address these issues, as such prescriptions cannot be legally provided via a 12-step program.
- Lack of structure. Even if none of the above apply, the reason a 12-step program may not work for you or a loved one may simply be that a higher level of structure, and more intensive treatment, may be necessary. While 12-step programs can provide some structure to your life, you may spend only about an hour a week in the 12-step meetings themselves—and they typically provide little to no framework for what to do with the rest of your time. For some, inpatient or residential treatment can provide a much-needed sense of structure and clarity—and aftercare programs with behavioral health providers can help create that structure in everyday life following treatment as well.
It can be tempting to give up after an initial attempt at rehab hasn’t worked. But just because a 12-step treatment and other self-help groups hasn’t helped you or your loved one doesn’t make it a hopeless case. There are many other options for treatment for substance use disorders—any of which may provide the way forward that you’ve been searching for.
Other Addiction Treatment Options
Thanks to modern advancements in the medical field, there are now a wide variety of therapies and formal treatments available for treating both addiction and related disorders that might work better for you or your loved one than 12-step self-help group involvement. These include options such as cognitive-behavioral therapy, group therapy, and family therapies, as well as more recent innovations such as Active in Recovery. These therapies may be used singularly or in conjunction with one another as part of a larger treatment plan in one of the following types of care:
- Inpatient, or residential treatment is often a good first step in establishing long-term recovery. Inpatient treatment involves an extended stay of days or months in a rehab facility, where round-the-clock care is available in addition to multiple therapeutic approaches. This type of care provides the highest level of support and structure and offers a safe, drug-free environment in which to stabilize and dig deep into the recovery process.
- Partial hospitalization programs (PHPs) are less intensive than residential programs. PHP may still involve living either in the facility or in nearby housing and engaging in therapy daily; however, fewer sessions may be scheduled, and more time may be spent off-campus during evenings and weekends.
- Outpatient treatment may be offered as a standalone approach or as part of an aftercare program following inpatient treatment. Outpatient treatment programs typically offer many of the same therapeutic approaches as inpatient treatment, but as the name suggests, patients do not stay on the premises. Rather, they are asked to attend regular therapy sessions while building positive habits and relationships in their everyday lives outside of therapy. This type of care offers less structure than inpatient or partial hospitalization programs, placing more emphasis on independently building a lifestyle that can support sustained recovery.
Unlike 12-step programs, all of the above programs typically include therapies and formal treatment that can address issues such as substance abuse, like alcohol use disorder, drug addiction, as well as other mental health issues. Working with licensed psychiatrists and/or behavioral health professionals offers the added benefit that medications for these issues can be prescribed if needed to bolster the recovery process, and a patient’s success with these medications can be carefully monitored.
Finding an Addiction Treatment Program That Works for You
When deciding what type of treatment program is best, keep in mind that the most effective programs will not only include multiple possible therapeutic approaches but also offer enough flexibility to offer a treatment plan given to you by a treatment provider that can adapt to you or your loved one’s unique recovery needs. There is no one-size-fits-all answer to addiction (one reason why the rigid structure of 12-step programs does not work for everyone); rather, the most effective treatment plan is the one designed to address addiction on an individual level.
If traditional 12-step groups haven’t worked for you, don’t give up on recovery just yet—there are alternatives available that may better suit your needs and your life and lead to positive outcomes. And if you’d still like your 12-step program to be a part of your recovery journey, you may simply need to combine it with another approach to create a system that will work better for you than relying on a 12-step program alone.
Whatever the case, know that recovery is possible. If you or your loved one has relapsed following treatment, this is not a failure—it simply means that more support is needed for now to help create lasting recovery. You can find that support by contacting a reputable rehab center for answers, guidance, or to begin a new treatment program.