Twelve-step alternatives are just as effective as the 12 Steps, according to a recent study by the Alcohol Research Group. The study looked at over 600 people\u2019s support group involvement and substance use over 12 months. We need more research to make any definitive claims about alternatives to AA and similar groups. But I\u2019m not surprised these initial findings showed similar outcomes between 12-step groups and 12-step alternatives. 12 Steps vs. 12-Step Alternatives At their core, mutual help groups have more similarities than differences. Both approaches offer things that help people in recovery such as: \tSocial support from others with similar circumstances \tAccountability in sobriety \tA safe space for open, honest sharing The 12 Steps emphasize a higher power, the importance of a sponsor and \u201cworking the steps.\u201d Non 12-step recovery programs take a secular approach that is grounded in self-empowerment. They don\u2019t have sponsors or steps. Overarching philosophies and fundamental principles are interwoven in their teachings, exercises and groups. The 12-step alternatives also change their guidelines as new research on substance use disorders and mental health issues surfaces. There\u2019s no right or wrong way. Whatever approach helps each person stay sober and live a healthy life is the right way for them. What Attracts People to 12-Step Alternatives? Mutual help groups like Alcoholics Anonymous and Narcotics Anonymous are tried-and-true recovery programs. We know they work. They have a specific protocol for battling drug addiction and alcohol addiction. They also have a reputation for being rigid and strict. Whether that\u2019s warranted or not, some people prefer a different approach to sobriety. They may be turned off by the higher power aspect of the 12 Steps. Or they might want more tolerance around the \u201crules of recovery.\u201d That being said, there\u2019s a misconception that groups like SMART Recovery, Refuge Recovery and others don\u2019t teach abstinence. In reality, these groups do recognize abstinence as the only way to long-term sobriety. They\u2019re just more flexible about meeting people where they are in any particular moment in time. They may not require immediate and total abstinence in order to participate. For instance, some 12-step groups aren\u2019t as accepting of people using medication-assisted treatment for opioid use disorders. Other groups may not welcome those who are in one of the earlier stages of change \u2013 not yet ready to give up all of their \u201cvices\u201d for instance. The non 12-step recovery programs are more open to these types of situations. They may be more flexible about a person\u2019s non-traditional choice of substance abuse treatments. Why Meeting People Where They Are Is Important I don\u2019t advocate for one approach over the other. But I do believe that being more accepting of where people are on their way to abstinence is a big draw for the 12-step alternatives. It\u2019s important to look at the endpoint. Is the goal to be abstinent and miserable and unable to function, or is the goal to live a healthy life? Often the thought of never using substances again is too overwhelming to grasp at the beginning of recovery. Time and time again patients ask me, \u201cWhen can I drink again? Can I ever be a social drinker?\u201d I tell them, \u201cNo, you crossed that line. You drink or do a drug, and you go back into active addiction.\u201d People don\u2019t like that answer. A lot of them still hold out the hope that they can drink again. They cannot see themselves as someone who never drinks or uses again. Faced with staying away from drugs and alcohol forever, they may not seek help at all. A non-12-Step treatment option might get some people in the door for help. Some people with substance abuse issues are looking for harm reduction, and sometimes addiction and healthcare professionals must consider that. I always like to compare substance use disorders to other medical conditions. We don\u2019t turn someone away from the ER who\u2019s in cardiac arrest just because they don\u2019t want to go to cardiac rehabilitation. We don\u2019t refuse to treat someone with diabetes because they want to have their dessert. Some people are the same way with addiction. In these cases, we need to get them to wherever they\u2019re willing to start. If we can get them focusing on recovery options and behavioral health it may lead to greater motivation. Alternatives to AA and other programs could be the key to healing. We always want to \u201cfix\u201d people to perfection, whether that be cancer, diabetes, addiction or other chronic conditions. My personal opinion is the goal should be abstinence, but know that realistically people may relapse. Some research indicates heroin relapse rates around 90%. The odds are that people with an alcohol use disorder will experience at least one relapse in the four years after getting sober. Methamphetamine relapse rates hover around 60% within a year of treatment. We can\u2019t ignore the possibility of relapse. The hope is that people learn from those relapses. I find that far more often than not, providers are doing much more work than the patient is willing to do. For example, if I have a client who says they\u2019re ready to give up alcohol, but they\u2019re not coming to drug rehab if they can\u2019t take Xanax, I say come on in. I won\u2019t strip a client of their meds if they\u2019re legally prescribed. Yes, I\u2019ll explain to them why those meds are harming them in similar ways as alcohol. I\u2019ll try to start a slow taper. But it\u2019s difficult for a patient to understand why they must give up a legally prescribed medication. In many cases, as they go through treatment and talk to other clients, they realize on their own why it\u2019s necessary to stop use of a medication. We work with them though, because at the end of the day, some addiction treatment is better than none. Choosing Between 12-Step and Non 12-Step Only the individual knows whether a 12-step approach or one of the alternative 12-step approaches is best for them. At my work, we meet clients where they are and let them decide the path that\u2019s going to get them sober. For people who\u2019ve relapsed, we make sure they explore the \u201cwhys\u201d and learn from those lessons. It isn\u2019t that the 12 Steps or another group is better or to blame. If a client comes in who has been sober for 20 years and relapsed, it\u2019s not necessarily time to quit AA meetings or to quickly seek alternatives to AA. Obviously, a lot about AA was working for them. Treating addictions and relapses is about getting to the root causes of the symptoms. The symptoms show up as substance abuse and other destructive behaviors. Next is putting the work into maintaining recovery by doing the things we know support it such as: \tPracticing healthy self-care \tAttending therapy \tParticipating in support groups like the 12 Steps or a 12-step alternative Alternatives to 12-Step Programs Some people have success with local NA or AA meetings. Others seek alternatives to Alcoholics Anonymous and other 12-step programs. There are several options for non-12-step drug and alcohol support groups. Some have local meetings as well as online meetings. These groups for alcohol abuse and drug abuse may help on your path to addiction recovery: SMART Recovery (Self Management and Recovery Training) \u2013 Offers addiction recovery tools based on the latest scientific research. This worldwide community is based on self-empowerment and mutual support. SOS (Secular Organizations for Sobriety) \u2013 An umbrella term for a network of local groups headed by non-professional members. The aim is sobriety from alcohol and drug addiction as well as other addictions. SOS was featured in the documentary "No God at the Bottom of a Glass." LifeRing Secular Recovery \u2013 Peer-to-peer support network that encourages personal growth and empowerment. It also offers education and coping tools. Abstinence is required. Women for Sobriety \u2013 Dedicated to helping women recover from substance use disorders. This group is geared toward empowering women and those who identify as female. Groups are led by certified moderators and chat leaders and are based on 13 acceptance statements. Rational Recovery \u2013 Abstinence-based recovery program founded by a clinical social worker. This group bills itself as the opposite of Alcoholics Anonymous and traditional alcohol treatment. It does not view addiction as a disease. There is no-cost material on the internet but this program also sells books, audio and other products. Which is right for you: 12-step programs or alternatives to AA? It doesn\u2019t matter which option you choose. What matters is that you choose the program that best supports you and commit to making changes to improve your health and your life.