The Problematic Twelve-Step Approach to Recovery

When considering treatment options for addiction, the twelve-step approach to recovery is nearly always among the options. We’re taught that the anonymity and steps to healing are redemptive and effective in combatting addiction. In every community, twelve-step meetings are taking place and bringing in those desperate for a solution to the addiction endangering their lives.

The idea is appealing—popping into a meeting, anywhere in the world, to answer that point of weakness with a boost of self-confidence and affirmation from other members fighting similar battles. The group has drop-ins who come sporadically and the consistent crowd who show up weekly and forge a familial bond. 

The meetings encourage members to follow a 12-step path to their own redemption and recovery, including forgiving themselves, making amends to those they’ve wronged, and ultimately, seeking support from a higher power. Relapses are expected and forgiven, and people are encouraged to keep on—whether they’ve been clean and sober 10 years or one day.

The approach is intrinsically problematic. Some point out that the concept of regular group therapy is useful for general social reinforcement and general good feelings, but it may not treat or directly address addictions such as alcoholism or substance abuse in a manner that leads to lasting recovery. Many experts in recovery believe medical intervention, such as an in-patient or outpatient facility, is the better path to a healthy, sustainable recovery. 

Programs like this are steeped in medical research examining the brain’s reaction to alcohol, drugs, and other addictive substances. Physical challenges resulting from addiction are addressed in a clinical setting—an important treatment mechanism unavailable in the 12-step, social model to recovery.

Steven Yohay, former CEO of ACI Health Care Group, understands the path to recovery from both sides—the patient’s struggle and a clinician within the recovery process. Once crippled by a $100/day heroin habit, Mr. Yohay entered a revolutionary treatment program in the 1970s and would stay on as a trainee, counselor, and later CEO—supporting others grappling with addiction.

 “When you study the typical 12-step program,” says Yohay, “the promise and excitement of restoring your hope and repairing relationships is appealing. It’s great to be supported and have what appears to be a clear path to plod in the lifelong journey to recovery. Yet, the goal of recovery is healing, and healing happens internally, supported by clinicians and staff who understand recovery is more than a meeting—it’s a mapped out medical plan for treatment.”

Examining twelve-step programs analytically brings their flaws into focus. Some of the challenges to successful recovery in a twelve-step program include:

• Reliance on a higher power. Not everyone believes in God or that God (or a God-like being) has the power to get you to resist the substance. Or some people don’t like the idea of submitting and giving your will to anyone, human or divine.
• Difficulty finding a meeting. People are encouraged to find a meeting, anywhere, especially if they feel a craving for whatever they’re trying to beat. This may mean visiting some sketchy neighborhoods, often alone (part of the anonymous aspect.) This could go beyond someone’s comfort and safety level, especially if their brain is simultaneously looking for reasons not to attend.
• Logistical concerns. It may be challenging for some to reach any meeting. They may have jobs where they can’t break away when they feel bad, or they may have transportation challenges and can’t find a location within walking distance.
• Multiple issues. Addiction is not always clear-cut, or at least the origins for them aren’t. Someone may drink because of diagnosed or undiagnosed mental health conditions. They may have physical, mental, or emotional trauma that also has led them to seek relief from substances. So, a meeting that only focuses on trying to stop drinking won’t treat these underlying or co-existing conditions.
• Lack of structure. You may feel good during an hour-long meeting. But the feeling can wear off fast.

In comparison, many structured addiction recovery programs offer a clinical approach that addresses addiction as a diagnosis and treats accordingly. With a focus on physical, mental and emotional health, treatment focuses on the function of the body and brain while addressing behavioral changes and emotional support. 

Often, programs require separation from family, friends, work, and their daily environment for part of treatment. Integration back into daily life happens once treatment is underway and positively progressing. The lengths of these programs vary, but the goal is the same—provide intensive support from highly-trained clinicians and substance abuse experts to address addiction. 

The longer, structured intervention and treatment process provides tools and support to bring course correction and change to the life of an addict. Recovery is less a communal meeting space and more an intensive, customized journey through treatment of both the mind and the body.