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’s 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’m 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:
- Social support from others with similar circumstances
- Accountability in sobriety
- A safe space for open, honest sharing
The 12 Steps emphasize a higher power, the importance of a sponsor and “working the steps.” Non 12-step recovery programs take a secular approach that is grounded in self-empowerment. They don’t 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’s 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’s 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 “rules of recovery.” That being said, there’s a misconception that groups like SMART Recovery, Refuge Recovery and others don’t teach abstinence. In reality, these groups do recognize abstinence as the only way to long-term sobriety. They’re 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’t 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 – not yet ready to give up all of their “vices” for instance. The non 12-step recovery programs are more open to these types of situations. They may be more flexible about a person’s non-traditional choice of substance abuse treatments.
Why Meeting People Where They Are Is Important
I don’t 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’s 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, “When can I drink again? Can I ever be a social drinker?” I tell them, “No, you crossed that line. You drink or do a drug, and you go back into active addiction.” People don’t 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’t turn someone away from the ER who’s in cardiac arrest just because they don’t want to go to cardiac rehabilitation. We don’t 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’re 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 “fix” 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’t 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’re ready to give up alcohol, but they’re not coming to drug rehab if they can’t take Xanax, I say come on in. I won’t strip a client of their meds if they’re legally prescribed. Yes, I’ll explain to them why those meds are harming them in similar ways as alcohol. I’ll try to start a slow taper. But it’s 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’s 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’s going to get them sober. For people who’ve relapsed, we make sure they explore the “whys” and learn from those lessons. It isn’t 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’s 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:
- Practicing healthy self-care
- Attending therapy
- Participating 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) – 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) – 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 – Peer-to-peer support network that encourages personal growth and empowerment. It also offers education and coping tools. Abstinence is required. Women for Sobriety – 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 – 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’t 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.