TWELVE STEP AND MUTUAL HELP SUPPORTS
The most widely available self-help groups (also called mutual help groups) are based on the 12-
step approach, originally embodied in AA, which emphasizes the concept of substance
dependence as an incurable, progressive disease that has physical, emotional, and spiritual
components. The 12-step programs firmly endorse the need for abstinence and consider themselves lifelong programs of recovery, even though initial success is attained one day at a time. The importance of recognizing and relying on a "higher power" or a power greater than the individual is a central element of these programs. Also key are the 12 steps of recovery, which focus first on surrender and acceptance of one's disease, second on a personal inventory, third on making amends and personal change, and finally on bringing the message to others. In addition, 12-step groups help members with relapse prevention by providing role models, social support, social strategies for maintaining a sober lifestyle, and opportunities for structured and unstructured substance-free social events and interactions. Members of self-help groups can attend meetings on a self-determined or prescribed schedule, which, if necessary, could be every day or even more than once a day. Periods associated with high risk for relapse (e.g., weekends, holidays, evenings) are particularly appropriate for attendance. A sponsor who is compatible with the patient can provide important guidance and support during the recovery process, particularly when the patient is facing periods of emotional distress and increased craving. The straightforward advice and encouragement about avoiding relapse from a recovering sponsor as well as his or her personalized support are important features of 12-step groups. For clinicians who are treating patients who report involvement in self-help groups, it is useful to ask if they are attending meetings, if they have obtained a sponsor, and if they are attending other activities associated with the self-help group (e.g., self-help group-sponsored social gatherings, retreats).
Another significant advantage to 12-step groups is their broad availability. AA is a worldwide
organization with an estimated 2.2 million members in 150 countries, and 12-step
groups have expanded to include treatment of nearly every type of substance use (Cocaine
Anonymous, Marijuana Anonymous, Methadone Anonymous, Narcotics Anonymous, Nicotine
Anonymous, "Crystal Meth" Anonymous). Self-help groups based on the 12-step model
are also available for family members and friends (e.g., Al-Anon, Alateen, Nar-Anon) and provide
group support and education about the disorder, with the goal of reducing maladaptive
enabling behavior in family and friends.
In general, active participation in self-help groups has been correlated with better outcomes. AA has been effective for both men and women and appears to be particularly useful for those with more severe alcohol dependence. Other recent research has suggested that 12-step groups may also benefit patients dependent on substances such as cocaine. For patients concurrently receiving professional substance abuse treatment, there is growing empirical evidence that improved treatment outcomes are associated with participation in self-help groups. Furthermore, several studies support the efficacy of professional treatment, including TSF therapy and individual drug counseling, that enhances a patient's motivation to participate in 12-step programs. These findings have important clinical implications, given that these approaches are similar to the dominant model applied in most community treatment programs. Thus, for many patients, even those who may still be actively using substances, referral to a 12-step program can be helpful at all stages in the treatment process.
An individual's refusal to participate in a self-help group is not synonymous with his or her
resistance to treatment in general. Despite their many potential benefits, self-help groups are
not useful for all patients. Some individuals' apparent resistance to self-help group participation
can be addressed by individualizing the choice of a group to the patient's needs. For example,
young people generally do better in groups that include age-appropriate peers in addition to
some older recovering members. Patients who require psychotropic medications for co-occurring
psychiatric disorders should be directed to groups in which this activity is recognized and
supported as useful treatment rather than as another form of substance abuse. The spiritual tenets of traditional 12-step programs can be a deterrent to participation for individuals who do
not embrace these ideas. Although not widely available, alternative self-help groups such as
Women for Sobriety, Secular Organizations for Sobriety, and Self-Management and Recovery Training have been developed to address this problem and may be an option for some patients.
If you have questions whether you or a loved one has a problem with drug use or alcohol use or if you believe you or a loved one may be an addict please click here.
Return to Glossary
Contact Us