Long considered a key component of recovery, 12-step programs are as popular as ever. But that doesn’t mean they work for everyone.
As a teen, Dave Marlon had friends, but he wasn’t part of his school’s “cool crowd.”
When he was 16, he got a keg of beer. “Beer made me cool,” Marlon says. Soon, Marlon went on to college, where he drank more.
After graduation, he found himself with a job, wife, and child. In his mind, though, they were getting in the way of his drinking.
“Gradually, my drinking started squeezing all three of those out of my life,” Marlon says.
Marlon checked into a 30-day treatment facility, where he learned more about Alcoholics Anonymous (AA). He bought into the program and the idea of a fellowship where people helped one another.
The day he was discharged, he left the facility at 4 a.m. so he could get to an AA meeting in Las Vegas at 8 a.m.
“I was 100 percent sure I wasn’t drinking again after this 30-day experience, but on my ride back to Vegas, I started getting a craving,” Marlon says. “I remember fighting my steering wheel and sweating while I came to a fork in the road.”
Marlon’s AA meeting was to the left. Downtown Vegas was to the right.
He went left — barely.
“When I got to the meeting, I was like, ‘You have no idea how close it was,’” he says. “It turns out, everyone had an idea of how close it was.”
Marlon stuck with AA and went on to work in drug and alcohol treatment and recovery. He’s now a licensed alcohol and drug counselor and CEO of both the nonprofit Vegas Stronger and rehab CrossRoads of Southern Nevada.
Even 15 years into his recovery, Marlon still attends AA meetings about five times per week.
Not everyone’s a fan, though, and AA is far from being the only option for finding peer support.
Bill W. and Dr. Bob S. founded AA in 1935. As of 2019, AA estimated it had more than 2 million active members worldwide.
AA uses a 12-step model that begins with a person admitting that they’re powerless over alcohol and that their lives had become unmanageable.
Other programs, like Narcotics Anonymous (NA), which started in 1953, have used similar models.
AA’s most recent membership survey of more than 6,000 members, done in 2014, said 22 percent of its members stayed sober for 20 or more years.
Those figures from the survey are impressive, but not everyone buys them.
In “The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry,” Lance Dodes, MD, and Zachary Dodes claim the 22 percent is actually only 5 to 10 percent.
The truth is, it can be hard to measure the effectiveness of a recovery program.
“Anything in the addiction space is hard to measure,” says Eric Patterson, LPC, a contributing writer to Choosing Therapy. “How are we measuring it? A week of sobriety? A year? A lifetime?”
But a 2020 review of research on recovery options sheds some light on AA’s effectiveness.
Researchers analyzed 27 studies involving 10,565 participants, finding that attendance at AA and similar twelve-step facilitation programs, delivered according to standard procedures, leads to longer lengths of sobriety than other treatments, such as cognitive behavioral therapy (CBT).
But that doesn’t mean it’s always going to work, or that other options aren’t viable.
“Is it for everyone? Absolutely not,” Marlon says. “All humans are unique, and we need to find our own path.”
Patterson and Marlon agree that it’s more important to find something that works for the individual than it is to debate the effectiveness of a recovery tool.
There’s no straight answer, but weighing the pros and cons of AA is a good place to start.
AA and NA provide a sense of structure and community that can be hugely beneficial.
In Marlon’s first year of recovery, he left his job, got a divorce, and moved. All three major life changes could have triggered him to start drinking again.
Instead, Marlon leaned on his new AA community and found a purpose: He had a standing commitment to get the coffee ready for a 6:45 a.m. meeting.
“Sometimes, at 8:00, I’d think, ‘I’m done with all my responsibilities. I could sneak out and have a beer, but if I do that, I won’t wake up at 6 a.m.,’” Marlon recalls. “This little commitment was really significant.”
AA and NA literature, like the Big Books, are full of the reasoning behind the 12 steps and tools to help navigate sobriety.
The books cost money, but the program is free. And joining is easy — all you have to do is walk in the door.
Addiction is complex, so it makes sense that there wouldn’t be a one-size-fits-all approach to recovery.
“The biggest cons are trying to address a really individualized, personalized issue like addiction with a universal approach,” Patterson says. “Once you try to paint so many people with a broad brush, there are so many people who won’t fit in.”
For one, if you’re undergoing medication-assisted treatment for opioid use disorder, NA may not be the best option.
While NA says it doesn’t have a stance on the issue, it does acknowledge that some meetings may be less welcoming than others.
The structure is also rigid, with steps generally done in a specific order.
In step 7, you ask God to remove your shortcomings. In step 8, you make a list of people you’ve harmed and become willing to make amends. That may not always be the best order for someone.
“Depending on the rigidity of a home group or sponsor, they may not offer a modified approach,” Patterson says.
There’s also a spiritual aspect to AA and NA that may make people uncomfortable: God is mentioned in 4 of the 12 steps.
While AA and NA emphasize that they aren’t religious groups, “if you don’t consider yourself a Christian or fit into that mindset, even if the literature says it’s welcoming, it may seem it is closed off to you,” Patterson says.
Finally, though AA and NA are meant to help people through discussions and readings, Patterson says meetings can become triggers for some people.
In some meetings, attendees are invited to share burning desires. Other times, speakers may share their journeys with a major focus on their previous drug or alcohol use.
“Even as people are sharing their personal information, they can frame [using] as a really positive way and the highlight of their life to go on this binge,” Patterson says. “Hearing people talk about their previous experiences with alcohol and other substances can be a huge trigger to people at any stage of recovery.”
If the cons discussed above are giving you second thoughts, don’t fret. You have other options.
If you like the idea of a structured group meeting but find that 12-step groups don’t feel like a great fit, SMART Recovery may be a great alternative.
It uses a four-point program that focuses on:
- staying motivated to change
- learning how to deal with urges to use
- managing uncomfortable thoughts, feelings, and behaviors
- living a balanced, healthy life
Unlike AA, it doesn’t ask people to admit they’re powerless. There aren’t any higher powers involved, and addiction tends to be considered a habit rather than a disease.
A recent but limited
“It has more of a mental health approach,” Patterson says. “It’s more flexible. It doesn’t have the rigidity of the steps.”
But Patterson concedes the flexibility can be a drawback.
“There is going to be more freedom, which some people are going to like, and some people are going to drown in that freedom,” Patterson says.
It’s also not as well known or accessible (for now, at least).
“There are thousands of AA meetings a week in Las Vegas,” says Marlon, who does use SMART Recovery in his facility. “There are one or two SMART Recovery meetings.”
As the COVID-19 pandemic pushes things to go virtual, you can now find a calendar of virtual meetings if you want to give SMART Recovery a try.
Though that 2020 review found AA was more effective than CBT, that won’t hold true for everyone.
CBT focuses on changing and challenging unhelpful thoughts and patterns. It can be done in one-on-one sessions with a therapist or in small groups.
Patterson believes CBT can be a helpful tool when done in conjunction with a 12-step program or SMART Recovery, though plenty of people find CBT helpful on its own.
You might feel more comfortable (and have more time) addressing these issues in an individual or smaller group setting, Patterson notes. But therapy costs money and requires insurance, which not everyone has.
Sometimes, Patterson notes, you may meet someone at a 12-step or SMART meeting who is simply attending these meetings and not getting professional treatment.
While that certainly works for some people, it’s important to remember that you’re not “weaker” or “less” of a person for needing (or simply wanting) some additional help.
This is especially important if you need to taper off a substance to avoid potentially harmful withdrawal symptoms.
Don’t assume that you have to white-knuckle it.
“I’m a big fan of, if you have cancer, you should go see an oncologist,” Marlon says. “If you have a plumbing problem at your house, you should get a plumber. If you have a substance use disorder, you should see a licensed alcohol or drug counselor. Nobody has to know. It’s confidential.”
Plans and treatment maps can change. If one AA meeting isn’t working, try attending a different meeting or group altogether. Because it’s so accessible, you likely won’t have problems finding other meetings.
“Each group can have its own culture,” Patterson says.
Some meeting groups may be for men only, others for women, and others for young adults.
Even if someone doesn’t put it in your treatment plan, Patterson advises people to try a few different options, including CBT and SMART Recovery, at least once if possible. This can help you find your place in recovery.
“It doesn’t have to be either/or,” he says. “Over time, you may decide to do both or stick with one.”
Recovery isn’t a one-size-fits-all journey. What works for the majority may not work for an individual. It’s important to consider and try other options, particularly if AA and NA aren’t working.
Some people may find the 12 steps too rigid or spiritual. SMART Recovery is less rigid, but it’s also less commonly found in communities. CBT costs money and often requires insurance, but some people may benefit from its more holistic and individualized approach.
You can try several options at once if time and money allow, and stick with all of them or pick the best one for you over time.
Beth Ann Mayer is a New York-based writer. In her spare time, you can find her training for marathons and wrangling her son, Peter, and three furbabies.