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{{Short description|Organizations for recovery from addiction}}
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{{Use mdy dates|date=October 2020}}
{{Use American English|date=October 2020}}
'''Twelve-step programs''' are international [[mutual aid]] programs supporting recovery from substance [[wikt:addiction|addiction]]s, [[behavioral addiction]]s and [[Compulsive behavior|compulsion]]s. Developed in the 1930s, the first twelve-step program, [[Alcoholics Anonymous]] (AA), founded by [[Bill W.|Bill Wilson]] and [[Bob Smith (doctor)|Bob Smith]], aided its membership to overcome [[alcoholism]].<ref name="APA">{{cite book | last = VandenBos | first = Gary R. | title = APA dictionary of psychology | publisher = American Psychological Association | year = 2007 | location = [[Washington, DC]] | edition = 1st | isbn = 978-1-59147-380-0 | oclc = 65407150 | url = https://archive.org/details/apadictionaryofp00vand }}</ref> Since that time [[List of twelve-step groups|dozens of other organizations]] have been derived from AA's approach to address problems as varied as [[Substance abuse|drug addiction]], [[Problem gambling|compulsive gambling]], [[sex addiction|sex]], and [[overeating]]. All twelve-step programs utilize a version of AA's suggested twelve steps first published in the 1939 book ''[[The Big Book (Alcoholics Anonymous)|Alcoholics Anonymous: The Story of How More Than One Hundred Men Have Recovered from Alcoholism]].''<ref name="BIGBOOK">{{cite book | title = Alcoholics Anonymous | publisher = Alcoholics Anonymous World Services |date=June 2001 | edition = 4th |isbn = 978-1-893007-16-1 | oclc = 32014950 | url = http://www.aa.org/pages/en_US/alcoholics-anonymous |ref=BIGBOOK | author = Bill W.}}</ref>

As summarized by the [[American Psychological Association]] (APA), the process involves the following:<ref name="APA"/>
* admitting that one cannot control one's alcoholism, addiction, or compulsion;
* coming to believe in a [[Higher Power]] that can give strength;
* examining past errors with the help of a sponsor (experienced member);
* making amends for these errors;
* learning to live a new life with a new code of behavior;
* helping others who suffer from the same alcoholism, addictions, or compulsions.

==Overview==
Twelve-step methods have been adapted to address a wide range of [[alcoholism]], [[substance abuse]], and [[Substance dependence|dependency]] problems. Over 200 mutual aid organizations—often known as [[List of Twelve-Step groups|fellowships]]—with a worldwide membership of millions have adopted and adapted AA’s 12 Steps and 12 Traditions for [[Recovery model|recovery]]. [[Narcotics Anonymous]] was formed by addicts who did not relate to the specifics of alcohol dependency.<ref name="NABIGBOOKCHAP8">{{cite book | author = Narcotics Anonymous | title = Narcotics Anonymous | chapter-url = https://archive.org/details/narcoticsanonymonarc | chapter-url-access = registration | chapter = Chapter 8: We Do Recover | edition = 4th | isbn = 0-912075-02-3 | oclc = 14377415| location = Van Nuys, CA | publisher = Narcotics Anonymous World Service Office | year = 1987}}{{page needed|date=September 2017}}</ref>

Demographic preferences related to the addicts' drug of choice has led to the creation of [[Cocaine Anonymous]], [[Crystal Meth Anonymous]] and [[Marijuana Anonymous]]. Behavioral issues such as compulsion for or addiction to [[gambling]], [[crime]], [[food]], [[Human sexual activity|sex]], [[compulsive hoarding|hoarding]], getting into [[debt]] and [[workaholism|work]] are addressed in fellowships such as [[Gamblers Anonymous]], [[Overeaters Anonymous]], [[Sexaholics Anonymous]] and [[Debtors Anonymous]].

Auxiliary groups such as [[Al-Anon]] and [[Nar-Anon]], for friends and family members of alcoholics and addicts, respectively, are part of a response to treating addiction as a disease that is [[Alcoholism in family systems|enabled by family systems]].<ref name="CRNKOVIC1998">{{cite journal |last1=Crnkovic |first1=A. Elaine |last2=DelCampo |first2=Robert L. |title=A Systems Approach to the Treatment of Chemical Addiction |journal=Contemporary Family Therapy |volume=20 |issue=1 |date=March 1998 |pages=25–36 |doi=10.1023/A:1025084516633 |issn=1573-3335 |publisher=Springer Science&nbsp;+&nbsp;Business Media|s2cid=141085303 }}</ref> [[Adult Children of Alcoholics]] (ACA or ACOA) addresses the effects of growing up in an alcoholic or otherwise dysfunctional family. [[Co-Dependents Anonymous]] ({{abbr|CoDA|Co-Dependents Anonymous}}) addresses compulsions related to relationships, referred to as [[codependency]].

==History==
{{Further|History of Alcoholics Anonymous}}

Alcoholics Anonymous (AA), the first twelve-step fellowship, was founded in 1935 by [[William Griffith Wilson|Bill Wilson]] and [[Bob Smith (doctor)|Dr. Robert Holbrook Smith]], known to AA members as "Bill W." and "Dr. Bob", in [[Akron, Ohio]]. In 1946, they formally established the twelve traditions to help deal with the issues of how various groups could relate and function as membership grew.<ref name="HARTIGAN2001">{{cite book|title=Bill W.: A Biography of Alcoholics Anonymous Cofounder Bill Wilson|last=Hartigan|first=Francis|year=2001|isbn=0-312-28391-1|pages=161–162|publisher=Macmillan |oclc=42772358}}</ref><ref>{{cite web|url=http://www.barefootsworld.net/aatraditions-gv1946.html|title=Barefoot's World|website=barefootsworld.net|access-date=24 March 2018}}</ref> The practice of remaining anonymous (using only one's first names) when interacting with the general public was published in the first edition of the AA Big Book.<ref name="TRADITIONS1949"/>

As AA chapters were increasing in number during the 1930s and 1940s, the guiding principles were gradually defined as the Twelve Traditions. A singleness of purpose emerged as Tradition Five: "Each group has but one primary purpose—to carry its message to the alcoholic who still suffers".<ref name="12AND12">{{cite book |title=Twelve Steps and Twelve Traditions |publisher=Hazelden |date=February 2002 |isbn=978-0-916856-01-4 |oclc=13572433|page=150}}</ref> Consequently, [[drug addicts]] who do not suffer from the specifics of alcoholism involved in AA hoping for recovery technically are not welcome in "closed" meetings unless they have a desire to stop drinking [[alcohol (drug)|alcohol]].<ref name="AANEWREFERRING">{{cite web |title=For Anyone New Coming to A.A.; For Anyone Referring People to A.A. |url=http://www.alcoholics-anonymous.org/en_information_aa.cfm?PageID=11 |archive-url=https://web.archive.org/web/20080117042442/http://www.alcoholics-anonymous.org/en_information_aa.cfm?PageID=11 |archive-date=2008-01-17 |publisher=Alcoholics Anonymous World Services, Inc. |access-date=June 15, 2006}}</ref>

The principles of AA have been used to form numerous other fellowships specifically designed for those recovering from various [[pathologies]]; each emphasizes recovery from the specific malady which brought the sufferer into the fellowship.<ref name="VAILLANT2002">{{cite journal |title=Singleness of Purpose |first=George E. |last=Vaillant |author-link=George Eman Vaillant |journal=About AA: A Newsletter for Professionals |year=2002 |issue=Fall/Winter |url=http://www.aa.org/assets/en_US/f-13_fall-winter02.pdf }}</ref>

==Twelve Steps==
<!-- A number of terms redirect here! Please do not change this section header without either adding an anchor of {{Anchor|Twelve Steps}} (see [[WP:ANCHOR]]) or updating all of the redirects (https://en.wikipedia.org/w/index.php?title=Special:WhatLinksHere/Twelve-step_program&hidelinks=1) -->
{{redirect-several|text=ending in "step"|dab=off|Scale (music)|The Fifth Step|Eighth Step Coffee House|Ninth Step Station}}
{{Further|List of Twelve Step alternate wordings}}
<!-- Please do not add alternative wordings. This is the official AA-version, there is a [[List of Twelve Step alternate wordings]] linked. -->
The following are the twelve steps as published in 2001 by Alcoholics Anonymous:<ref name="BIGBOOKHOWITWORKS">{{cite book |title=Alcoholics Anonymous |publisher=Alcoholics Anonymous World Services |date=June 2001 |edition=4th |isbn=978-1-893007-16-1 |oclc=32014950 |chapter=Chapter 5: How It Works |chapter-url=http://www.aa.org/pages/en_US/alcoholics-anonymous |chapter-format=PDF |author=Bill W.|pages=59–60}}</ref>
# We admitted we were powerless over alcohol—that our lives had become unmanageable.
# Came to believe that a power greater than ourselves could restore us to sanity.
# Made a decision to turn our will and our lives over to the care of [[God]], ''as we understood Him''
# Made a searching and fearless moral inventory of ourselves.
# Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
# We're entirely ready to have God remove all these defects of [[Moral character|character]].
# Humbly asked Him to remove our shortcomings.
# Made a list of all persons we had harmed, and became willing to make [[wikt:amends|amends]] to them all.
# Made direct amends to such people wherever possible, except when to do so would injure them or others.
# Continued to take personal inventory, and when we were wrong, promptly admitted it.
# Sought through [[prayer]] and [[meditation]] to improve our conscious contact with God, praying only for knowledge of His will for us and the power to carry that out.
# Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics and to practice these principles in all our affairs.
<!-- Please do not add alternative wordings. This is the official AA-version, there is a [[List of Twelve Step alternate wordings]] linked. -->
Where other twelve-step groups have adapted the AA steps as guiding principles, step one is generally updated to reflect the focus of recovery. For example, in Overeaters Anonymous, the first step reads, "We admitted we were powerless over compulsive overeating—that our lives had become unmanageable." Variations in the languaging of the third step (which once spoke of making "a decision to turn our will and our lives over to the care of God as we understand Him"<ref>
{{cite book
 |last1                = Wilson
 |first1               = William Griffith
 |author-link1         = Bill W.
 |date                 = 4 September 2014
 |orig-date            = 10 April 1939
 |chapter              = How It Works
 |title                = Alcoholics Anonymous: The Original Text of the Life-Changing Landmark, Deluxe Edition
 |url                  = https://books.google.com/books?id=Q2ZVAwAAQBAJ
 |publication-place    = New York
 |publisher            = Penguin
 |isbn                 = 9780698176935
 |access-date          = 5 October 2024
 |quote                = Made a decision to turn our will and our lives over to the care of God as we understand Him
}} 
</ref>)
sometimes occur<ref name="NABULLETIN13">{{cite web |publisher=Narcotics Anonymous World Services |title=World Service Board of Trustees Bulletin #13: Some thoughts regarding our relationship to Alcoholics Anonymous |date=February 23, 2007 |access-date=October 7, 2007 |url=http://www.na.org/bulletins/bull13-r.htm | quote = [...] Bill W. frequently wrote and spoke about [...] what he called the 'tenstrike' of AA - the wording of the Third and Eleventh Steps. The whole area of spirituality versus religion was as perplexing for [AA] as unity was for [Narcotics Anonymous]. Bill liked to recount that the simple addition of the words 'as we understand Him' after the word 'God' killed that controversy in one chop. An issue that had the potential to divide and destroy AA was converted into the cornerstone of the program by that simple turn of phrase.|archive-url =https://web.archive.org/web/20071006094719/http://www.na.org/bulletins/bull13-r.htm <!-- Bot retrieved archive --> |archive-date=October 6, 2007}}</ref><ref name="NACHRONOLOGY">{{cite web |url=http://www.na-history.org/NA_History_Chronology.html |title=NA History Chronology |access-date=October 7, 2007 |date=January 13, 2006 |url-status=dead |archive-url=https://web.archive.org/web/20090303172307/http://na-history.org/NA_History_Chronology.html |archive-date=March 3, 2009 |quote=1953:&nbsp;... this committee met regularly&nbsp;... From the beginning&nbsp;... 12 Steps&nbsp;... 12 Traditions&nbsp;... All Steps had ‘We’ }}</ref><ref name="CMASTEPS">{{cite web |url=http://www.crystalmeth.org/cma-documents/cma-twelve-steps.html |archive-url=https://web.archive.org/web/20121105053511/http://www.crystalmeth.org/cma-documents/cma-twelve-steps.html |archive-date=2012-11-05 |title=The 12 Steps of Recovery |access-date=August 28, 2010 | quote = The 12 Steps of Crystal Meth Anonymous[:] We [...] made a decision to turn our will and our lives over to the care of a God of our understanding.}}</ref><ref name="MASTEPS">{{cite web |url=https://www.marijuana-anonymous.org/how-it-works/twelve-steps |title=The Twelve Steps of Marijuana Anonymous |access-date=September 28, 2012 | quote = The Twelve Steps of Marijuana Anonymous{:] We [...] made a decision to turn our will and our lives over to the care of God, as we understood God.}}</ref>
to avoid gender-specific pronouns{{cn|date=October 2024}} or to accommodate non-theistic beliefs.<ref>
{{cite book
 |last1                = Hornbacher
 |first1               = Marya
 |author-link1         = Marya Hornbacher
 |date                 = 21 April 2011
 |title                = Waiting: A Nonbeliever's Higher Power
 |url                  = https://books.google.com/books?id=4F7ce-4gvLIC
 |publication-place    = Center City, Minnesota
 |publisher            = Hazelden Publishing
 |page                 = 41
 |isbn                 = 9781592858255
 |access-date          = 5 October 2024
 |quote                = The upside of Step Three - Made a decision to turn our will and our lives over to the care of God ''as we understand Him'' - is that the Step explicitly says that it is our own understanding of God that's required. The language does seem to assume a deity, a Him, of some kind, but if our understanding of spiritual sustenance is other than theistic, there is still room for us, and our beliefs, in this program.
}} 
</ref>
Some Twelve-steppers may adapt references to "God" to refer to a "higher power" or to "HP".<ref>
{{cite book
 |last1                = Roos
 |first1               = Stephen
 |year                 = 1992
 |chapter              = Step 11
 |title                = A Young Person's Guide to the Twelve Steps
 |url                  = https://books.google.com/books?id=-12HgabkIWIC
 |publication-place    = Center City, Minnesota
 |publisher            = Hazelden Publishing
 |page                 = 101
 |isbn                 = 9780894868511
 |access-date          = 5 October 2024
 |quote                = Many people [...] consider prayer just a way of talking to their higher power - even if they're still not very comfortable with the higher power concept. [...] 'I tell my higher power how I'm feeling that day,' says Janine. 'I tell HP first how my body is feeling. [...] Then I ask HP to lift all the barriers that keep me from feeling really good, and then I ask HP to help me and everyone else. Sometimes, just before I meditate, I ask HP to let me see myself and others through Her eyes rather than my own. [...]' 
}} 
</ref>

==Twelve Traditions==
{{Main|Twelve Traditions}}
The Twelve Traditions accompany the Twelve Steps. The Traditions provide guidelines for group governance. They were developed in AA in order to help resolve conflicts in the areas of publicity, politics, religion, and finances.<ref name="BILLW1946">{{cite journal |journal=The A.A. Grapevine |publisher=Alcoholics Anonymous |author=Bill W. |date=April 1946 |volume=2 |issue=11 |title=Our A.A. Experience Has Taught Us That |issn=0362-2584 |oclc=50379271|author-link=Bill W }}</ref> Alcoholics Anonymous' Twelve Traditions are:<ref name="TRADITIONS1949">{{cite journal |journal=The A.A. Grapevine |publisher=Alcoholics Anonymous |date=November 1949 |volume=6 |issue=6 |title=The Twelve Traditions |issn=0362-2584 |oclc=50379271}}</ref>
# Our common welfare should come first; personal recovery depends upon AA unity.
# For our group purpose there is but one ultimate authority—a loving God as He may express Himself in our group conscience. Our leaders are but trusted servants; they do not govern.
# The only requirement for AA membership is a desire to stop drinking.
# Each group should be autonomous except in matters affecting other groups or AA as a whole.
# Each group has but one primary purpose—to carry its message to the alcoholic who still suffers.
# An AA group ought never endorse, finance, or lend the AA name to any related facility or outside enterprise, lest problems of money, property, and prestige divert us from our primary purpose.
# Every AA group ought to be fully self-supporting, declining outside contributions.
# Alcoholics Anonymous should remain forever non-professional, but our service centers may employ special workers.
# AA, as such, ought never be organized; but we may create service boards or committees directly responsible to those they serve.
# Alcoholics Anonymous has no opinion on outside issues; hence the AA name ought never be drawn into public controversy.
# Our public relations policy is based on attraction rather than promotion; we need always to maintain personal anonymity at the level of press, radio, and films.
# Anonymity is the spiritual foundation of all our traditions, ever reminding us to place principles before personalities.

==Process==
In the twelve-step program, the human structure is symbolically represented in three dimensions: physical, mental, and spiritual. The problems the groups deal with are understood to manifest themselves in each dimension. For addicts and alcoholics, the physical dimension is best described by the allergy-like bodily reaction resulting in the compulsion to continue using substances even when it's harmful or the addict wants to quit.<ref name="KURTZ1987"/><ref name="RONEL2000"/> The statement in the First Step that the individual is "powerless" over the substance-abuse related behavior at issue refers to the lack of control over this compulsion, which persists despite any negative consequences that may be endured as a result.<ref>{{cite book | last = Alcoholics Anonymous | title = Alcoholics Anonymous | publisher = Alcoholics Anonymous World Services | date=2001-06-01 | edition = 4th | isbn = 978-1-893007-16-1 | oclc = 32014950 | chapter = Chapter 2: There Is a Solution | chapter-url = http://www.aa.org/bigbookonline/en_bigbook_chapt2.pdf | page=21 |quote=At some stage of his drinking career, he begins to lose all control of his liquor consumption, once he starts to drink.}}</ref>

The mental obsession is described as the cognitive processes that cause the individual to repeat the compulsive behavior after some period of abstinence, either knowing that the result will be an inability to stop or operating under the delusion that the result will be different. The description in the First Step of the life of the alcoholic or addict as "unmanageable" refers to the lack of choice that the mind of the addict or alcoholic affords concerning whether to drink or use again.<ref>{{cite book | last = Alcoholics Anonymous | title = Alcoholics Anonymous | publisher = Alcoholics Anonymous World Services | date = 2001-06-01 | edition = 4th | isbn = 978-1-893007-16-1 | oclc = 32014950 | chapter = Chapter 2: There Is a Solution | chapter-url = http://www.aa.org/bigbookonline/en_bigbook_chapt2.pdf | page=21 |quote=These observations would be academic and pointless if [he] never took the first drink, thereby setting the terrible cycle in motion. Therefore, the main problem...centers in his mind....The fact is that most alcoholics...have lost the power of choice in drink...unable, at certain times, to bring into [his] consciousness with sufficient force the memory of the suffering and humiliation of a month or even a week ago. [He] is without defense against the first drink.}}</ref>
The illness of the spiritual dimension, or "spiritual malady," is considered in all twelve-step groups to be self-centeredness.<ref name="KURTZ1987">{{cite journal |author=Kurtz LF, Chambon A |title=Comparison of self-help groups for mental health |journal=Health & Social Work |volume=12 |issue=4 |pages=275–83 |year=1987 |pmid=3679015 |doi=10.1093/hsw/12.4.275}}</ref><ref name="RONEL2000">{{cite journal | last = Ronel | first = Natti| year = 2000 | title = From Self-Help to Professional Care: An Enhanced Application of the 12-Step Program | journal = The Journal of Applied Behavioral Science | volume = 36 | issue = 1 | pages = 108–122 | issn = 1552-6879 | oclc = 1783135 | doi = 10.1177/0021886300361006| s2cid = 144471066}}</ref> The process of working the steps is intended to replace self-centeredness with a growing moral consciousness and a willingness for self-sacrifice and unselfish constructive action.<ref name="RONEL2000"/> In twelve-step groups, this is known as a "spiritual awakening."<ref name="ROEHE2004">{{cite journal | last = Roehe | first = Marcelo V. | date = 2004 | title = Religious Experience in Self-Help Groups: the neurotics anonymous example | journal = Psicologia Em Estudo | volume = 9 | issue = 3 | pages = 399–407 | issn = 1413-7372 | language = pt | doi = 10.1590/S1413-73722004000300008| doi-access = free }}</ref> This should not be confused with [[abreaction]], which produces dramatic, but temporary, changes.<ref name="MARMOR1980">{{cite journal |author=Marmor J |title=Recent trends in psychotherapy |journal=The American Journal of Psychiatry |volume=137 |issue=4 |pages=409–16 |date=1980-04-01 |pmid=6987904 |doi=10.1176/ajp.137.4.409 }}</ref> As a rule, in twelve-step fellowships, spiritual awakening occurs slowly over a period of time, although there are exceptions where members experience a sudden spiritual awakening.<ref name="BIGBOOKAWAKENING">{{cite book | last = Alcoholics Anonymous | title = Alcoholics Anonymous | publisher = Alcoholics Anonymous World Services | date = 1976-06-01 | isbn = 0-916856-59-3 | oclc = 32014950 | chapter = Appendix II. Spiritual Experience | chapter-url = http://www.aa.org/bigbookonline/en_appendiceii.cfm | archive-url = https://web.archive.org/web/20081205154352/http://www.aa.org/bigbookonline/en_appendiceii.cfm | archive-date = 2008-12-05 | url-status = dead }}</ref>

In accordance with the First Step, twelve-step groups emphasize self-admission by members of the problem they are recovering from. It is in this spirit that members often identify themselves along with an admission of their problem, often as "Hi, I’m {{bracket|first name only}}, and I’m an alcoholic".<ref name="HAYES2000">{{cite journal |title=Stigmatizing Indebtedness: Implications for Labeling Theory |last=Hayes |first=Terrell |journal=Symbolic Interaction |volume=23 |issue=1 |date=February 2000 |pages=29–46 |doi=10.1525/si.2000.23.1.29 }}</ref>

==Sponsorship==
A sponsor is a more experienced person in recovery who guides the less-experienced aspirant ("sponsee") through the program's twelve steps. New members in twelve-step programs are encouraged to secure a relationship with at least one sponsor who both has a sponsor and has taken the twelve steps themselves.<ref name="AASPONSORSHIPQA">{{cite web |title=Sponsorship Q&A (pamphlet) |publisher=Alcoholics Anonymous World Services |location=New York, NY |url=https://www.aa.org/sites/default/files/literature/p-15_0524.pdf |access-date=May 15, 2024 |date=2022-06-01 |archive-date=2024-05-15 |archive-url=https://web.archive.org/web/20240515205508/https://www.aa.org/sites/default/files/literature/p-15_0524.pdf }}</ref> Publications from twelve-step fellowships emphasize that sponsorship is a "one on one" nonhierarchical relationship of shared experiences focused on working the Twelve Steps.<ref name="CMASPONSORSHIP">{{cite web |title=NYCMA: What is a Sponsor? |publisher=New York Crystal Meth Anonymous Intergroup |url=http://www.nycma.org/sponsor.html |archive-url=https://web.archive.org/web/20160303223130/http://www.nycma.org/sponsor.html |archive-date=2016-03-03 |access-date=October 8, 2007 |url-status=dead }}</ref><ref name="SLAASPONSORSHIP">{{cite web |url=http://slaaonline.org/sponsor/ |title=#SLAA Online Group of Sex and Love Addicts Anonymous: Sponsorship Online |date=February 5, 2007 |access-date=December 19, 2015 |url-status=live |archive-url=https://web.archive.org/web/20150608010134/http://slaaonline.org/sponsor/ |archive-date=June 8, 2015 }}</ref><ref name="OASPONSORSHIP">{{cite web |url=http://www.overeaters.org/#sponsorship |title=Overeaters Anonymous Unity Intergroup Website: Sponsorship |date=September 19, 2007 |access-date=October 8, 2007}}</ref> According to Narcotics Anonymous:

<blockquote>Sponsors share their experience, strength, and hope with their sponsees... A sponsor's role is not that of a legal adviser, a banker, a parent, a marriage counselor, or a social worker. Nor is a sponsor a therapist offering some sort of professional advice. A sponsor is simply another addict in recovery who is willing to share his or her journey through the Twelve Steps.<ref name="NASPONSORSHIP">{{cite web | title = Sponsorship, Revised (pamphlet): What does a sponsor do? | publisher = Narcotics Anonymous |location = Van Nuys, CA |access-date=May 15, 2024 |date = 2004-01-01 | url = https://www.na.org/admin/include/spaw2/uploads/pdf/litfiles/us_english/IP/EN3111.pdf | archive-url = https://web.archive.org/web/20090608000729/https://www.na.org/admin/include/spaw2/uploads/pdf/litfiles/us_english/IP/EN3111.pdf | archive-date = 2009-06-08 }}</ref></blockquote>

Sponsors and sponsees participate in activities that lead to spiritual growth. Experiences in the program are often shared by outgoing members with incoming members. This rotation of experience is often considered to have a great spiritual reward.<ref>{{Cite web|url=http://www.aa.org/assets/en_US/p-16_theaagroup.pdf|title=The A.A. Group…Where it all begins How a group Functions How to get started|website=P-16 The A.A. Group ... where it all begins|publisher=Alcoholics Anonymous World Services, Inc.|access-date=26 September 2016}}</ref> These may include practices such as [[literature]] discussion and study, meditation, and writing. Completing the program usually implies competency to guide newcomers which is often encouraged.<ref>{{Cite web|url=http://www.aa.org/assets/en_US/p-15_Q&AonSpon.pdf|title=Questions & Answers on Sponsorship|website=P-15 Questions & Answers on Sponsorship|publisher=Alcoholics Anonymous World Services, Inc|access-date=26 September 2016}}</ref> Sponsees typically do their Fifth Step, review their moral inventory written as part of the Fourth Step, with their sponsor. The Fifth Step, as well as the Ninth Step, have been compared to [[Confession (religion)|confession]] and [[Penance|penitence]].<ref name="KRIZ2002"/> [[Michel Foucault]], a French philosopher, noted such practices produce intrinsic modifications in the person—exonerating, redeeming and purifying them; relieves them of their burden of wrong, liberating them and promising salvation.<ref name="KRIZ2002">{{cite book |last=Kriz |first=Kerri-Lynn Murphy |title=The Efficacy of Overeaters Anonymous in Fostering Abstinence in Binge-Easting Disorder and Bulimia Nervosa |date=May 2002 |publisher=Virginia Polytechnic Institute and State University |url=https://theses.lib.vt.edu/theses/available/etd-05092002-143548/}}</ref><ref name="MORENBERG2004">{{cite thesis |last=Morenberg |first=Adam |title=Governing Wayward Consumers: Self-Change and Recovery in Debtors Anonymous |location=Tampa, Florida |publisher=University of South Florida |date=July 2004 |url=http://etd.fcla.edu/SF/SFE0000449/thesis.final.pdf |oclc=56564118 |type=Master of Arts, Sociology |url-status=live |archive-url=https://web.archive.org/web/20151219032939/http://scholarcommons.usf.edu/cgi/viewcontent.cgi?context=etd&article=2167 |archive-date=December 19, 2015 |access-date=December 19, 2015 }}</ref>

The personal nature of the behavioral issues that lead to seeking help in twelve-step fellowships results in a strong relationship between sponsee and sponsor. As the relationship is based on spiritual principles, it is unique and not generally characterized as "friendship". Fundamentally, the sponsor has the single purpose of helping the sponsee recover from the behavioral problem that brought the sufferer into twelve-step work, which reflexively helps the sponsor recover.<ref name="AASPONSORSHIPQA"/>

A study of sponsorship as practiced in Alcoholics Anonymous and Narcotics Anonymous found that providing direction and support to other alcoholics and addicts is associated with sustained abstinence for the sponsor, but suggested that there were few short-term benefits for the sponsee's one-year sustained abstinence rate.<ref name="CRAPE2002">{{cite journal |first1=Byron L. |last1=Crape |first2=Carl A. |last2=Latkin |first3=Alexandra S. |last3=Laris |first4=Amy R. |last4=Knowlton |title=The effects of sponsorship in 12-step treatment of injection drug users |journal=Drug and Alcohol Dependence |volume=65 |issue=3 |pages=291–301 |date=February 2002 |pmid=11841900 |doi=10.1016/S0376-8716(01)00175-2}}</ref><ref>{{cite web |url=https://www.ncjrs.gov/App/publications/Abstract.aspx?id=196100 |title=NCJRS Abstract: National Criminal Justice Reference Service |publisher=Ncjrs.gov |date=February 1, 2002 |access-date=March 5, 2009}}</ref>

==Effectiveness==
{{See also|Effectiveness of Alcoholics Anonymous|Effectiveness of Crystal Meth Anonymous|Effectiveness of Gamblers Anonymous|Effectiveness of Narcotics Anonymous|Effectiveness of Neurotics Anonymous|Effectiveness of Nicotine Anonymous|Effectiveness of self-help groups for mental health}}

Alcoholics Anonymous is the largest of all of the twelve-step programs (from which all other twelve-step programs are derived), followed by Narcotics Anonymous; the majority of twelve-step members are recovering from addiction to alcohol or other drugs. The majority of twelve-step programs, however, address illnesses other than substance addiction. For example, the third-largest twelve-step program, [[Al-Anon/Alateen|Al-Anon]], assists family members and friends of people who have alcoholism and other addictions. About twenty percent of twelve-step programs are for substance addiction recovery, the other eighty percent address a variety of problems from [[debt]] to [[Clinical depression|depression]].<ref name="MAKELA1996">{{cite book |last=Makela |first=Klaus |title=Alcoholics Anonymous as a Mutual-help Movement: A Study in Eight Societies |url=https://archive.org/details/alcoholicsanonym00mkel |url-access=registration |year=1996 |publisher=[[University of Wisconsin Press]] |isbn=0-299-15004-6}}{{page needed|date=September 2017}}</ref> It would be an error to assume the effectiveness of twelve-step methods at treating problems in one domain translates to all or to another domain.<ref name="SAULNIER">{{cite journal |doi=10.1177/002204269602600107 |title=Images of the Twelve-Step Model, and Sex and Love Addiction in an Alcohol Intervention Group for Black Women |journal=Journal of Drug Issues |volume=26 |issue=1 |pages=95–123 |year=1996 |last1=Saulnier |first1=Christine Flynn |s2cid=147097398 }}</ref>

A 2020 [[Cochrane Library#The Cochrane Database of Systematic Reviews|Cochrane review]] of Alcoholics Anonymous showed that participation in AA resulted in more alcoholics being abstinent from alcohol and for longer periods of time than [[cognitive behavioral therapy]] and [[motivational enhancement therapy]], and as effective as these in other measures.<ref name="Cochrane2020">{{cite journal|doi=10.1002/14651858.CD012880.pub2|pmid=32159228|title=Alcoholics Anonymous and other 12-step programs for alcohol use disorder|year=2020|last1=Kelly|first1=John F.|last2=Humphreys|first2=Keith|last3=Ferri|first3=Marica|journal=Cochrane Database of Systematic Reviews|volume=3|issue=3 |pages=CD012880|pmc=7065341}}</ref><ref name="NYTCochrane2020">{{cite news|url=https://www.nytimes.com/2020/03/11/upshot/alcoholics-anonymous-new-evidence.html|title=Alcoholics Anonymous vs. Other Approaches: The Evidence Is Now In| last1=Frakt | first1=Austin | last2=Carroll | first2=Aaron | newspaper=[[The New York Times]]|date=March 11, 2020 }}</ref> The 2020 review did not compare twelve step programs to the use of [[disulfiram]] or [[naltrexone]], though some patients did receive these medications.<ref name="Cochrane2020"/> These medications are considered the standard of care in alcohol use disorder treatment among medical experts and have demonstrated efficacy in randomized-controlled trials in promoting alcohol abstinence.<ref name="ChengMcGuinnessElbers2020">{{cite journal | last1 = Cheng | first1 = Hung-Yuan | last2 = McGuinness | first2 = Luke A | last3 = Elbers | first3 = Roy G | last4 = MacArthur | first4 = Georgina J | last5 = Taylor | first5 = Abigail | last6 = McAleenan | first6 = Alexandra | last7 = Dawson | first7 = Sarah | last8 = López-López | first8 = José A | last9 = Higgins | first9 = Julian P T | last10 = Cowlishaw | first10 = Sean | last11 = Lingford-Hughes | first11 = Anne | last12 = Hickman | first12 = Matthew | last13 = Kessler | first13 = David | title = Treatment interventions to maintain abstinence from alcohol in primary care: systematic review and network meta-analysis | journal = BMJ | date = 25 November 2020 | volume = 371 | page = m3934 | eissn = 1756-1833 | doi = 10.1136/bmj.m3934 | pmid = 33239318 | pmc = 7687021 | url = }}</ref><ref name="NICE_MCCMH2011">{{cite journal |title=Alcohol-Use Disorders: Diagnosis, Assessment and Management of Harmful Drinking and Alcohol Dependence |journal=National Collaborating Centre for Mental Health (UK) |date=2011 |pmid=22624177 |url=https://pubmed.ncbi.nlm.nih.gov/22624177/ |publisher=British Psychological Society (UK) |author1=National Collaborating Centre for Mental Health (UK) |series=National Institute for Health and Care Excellence: Guidelines |isbn=978-1-904671-26-8 }}</ref> A systematic review published in 2017 found that twelve-step programs for reducing illicit drug use are neither better nor worse than other interventions, though the researchers behind the review noted the weakness of most of the studies analyzed, which may lead to interpretations of their results that did not accurately reflect the actual picture.<ref>{{Cite journal |last1=Bøg |first1=Martin |last2=Filges |first2=Trine |last3=Brännström |first3=Lars |last4=Jørgensen |first4=Anne-Marie Klint |last5=Fredrikksson |first5=Maja Karrman |date=January 2017 |title=12-step programs for reducing illicit drug use |journal=Campbell Systematic Reviews |volume=13 |issue=1 |pages=1–149 |doi=10.4073/csr.2017.2 |issn=1891-1803|doi-access=free }}</ref>

==Criticism==
{{See also|Alcoholics Anonymous#Criticism|Gamblers Anonymous#Criticism|Narcotics Anonymous#Controversies|Overeaters Anonymous#Criticism|Self-help groups for mental health#Criticism|Sexaholics Anonymous#Criticism}}

Some medical professionals have criticized twelve-step programs as "a cult that relies on God as the mechanism of action" and as lacking any experimental evidence in favor of its efficacy.<ref name="Kaskutas2009">{{cite journal | last1 = Kaskutas | first1 = Lee Ann | title = Alcoholics Anonymous Effectiveness: Faith Meets Science | journal = Journal of Addictive Diseases | date = 2 April 2009 | volume = 28 | issue = 2 | pages = 145–157 | issn = 1055-0887 | eissn = 1545-0848 | doi = 10.1080/10550880902772464 | pmid = 19340677 | pmc = 2746426 | url = }}</ref><ref name="Lilienfeld2015">{{cite book |last1=Lilienfeld |first1=Scott O. |last2=Lynn |first2=Steven Jay |last3=Lohr |first3=Jeffrey |last4=Tavris |first4=Carol |title=Science and pseudoscience in clinical psychology |date=2015 |publisher=The Guilford Press |location=New York |isbn=9781462505814 |edition=Second |url=https://scottlilienfeld.com/wp-content/uploads/2021/01/Science-and-Pseudoscience-in-Clinical-Psychology-Second-Edition-by-Scott-O.-Lilienfeld-PhD-Steven-Jay-Lynn-PhD-Jeffrey-M.-Lohr-Phd-Carol-Tavris-PhD-z-lib.org_.pdf |access-date=27 January 2023}}</ref><ref name="White2008">{{cite book | title = Recent Developments in Alcoholism | last1 = White | first1 = William L. | last2 = Kurtz | first2 = Ernest | chapter = Twelve Defining Moments in the History of Alcoholics Anonymous | date = 2008 | volume = 18 | pages = 37–57 | publisher = Springer New York | issn = 0738-422X | doi = 10.1007/978-0-387-77725-2_3 | pmid = 19115762 | isbn = 978-0-387-77724-5 | url = }}</ref> Ethical and operational issues had prevented robust [[randomized controlled trial]]s from being conducted comparing twelve-step programs directly to other approaches.<ref name="Lilienfeld2015"/> More recent studies employing non-randomized and [[Quasi-experiment|quasi-experimental]] studies have shown twelve-step programs provide similar benefit compared to motivational enhancement therapy (MET) and cognitive behavioral therapy (CBT), and were more effective in producing continuous abstinence and remission compared to these approaches.<ref name="Kelly2020">{{cite journal | last1 = Kelly | first1 = John F | last2 = Abry | first2 = Alexandra | last3 = Ferri | first3 = Marica | last4 = Humphreys | first4 = Keith | title = Alcoholics Anonymous and 12-Step Facilitation Treatments for Alcohol Use Disorder: A Distillation of a 2020 Cochrane Review for Clinicians and Policy Makers | journal = Alcohol and Alcoholism | date = 6 July 2020 | volume = 55 | issue = 6 | pages = 641–651 | issn = 0735-0414 | eissn = 1464-3502 | doi = 10.1093/alcalc/agaa050 | pmid = 32628263 | pmc = 8060988 | url = }}</ref><ref name="pmid33316028">{{cite journal |vauthors=Heather N |title=Let's not turn back the clock: Comments on Kelly et al., "Alcoholics Anonymous and 12-step facilitation treatments for alcohol use disorder: A distillation of a 2020 Cochrane review for clinicians and policy makers" |journal=Alcohol and Alcoholism (Oxford, Oxfordshire) |volume=56 |issue=4 |pages=377–379 |date=June 2021 |pmid=33316028 |doi=10.1093/alcalc/agaa137 |url=https://www.researchgate.net/publication/347836811}}</ref><ref name="Cochrane2020"/>

===Confidentiality===
The [[Twelve Traditions]] encourage members to practice the [[Spirituality|spiritual]] principle of [[anonymity]] in the public media and members are also asked to respect each other's [[confidentiality]].<ref name="LEVINE2000">{{cite book |title=I shop, therefore I am: compulsive buying and search for shelf |editor1=Benson, April Lane |chapter=Chapter 18: Debtors Anonymous and Psychotherapy |pages=431–454 |year=2000 |isbn=0765702428 |oclc=301650820 |author=Levine, Betsy; Kellen, Bonnie|publisher=Jason Aronson }}</ref> This is a group [[Norm (sociology)|norm]],<ref name="LEVINE2000"/> however, and not legally mandated; there are no legal consequences to discourage those attending [[List of twelve-step groups|twelve-step groups]] from revealing information disclosed during meetings.<ref name="COLEMAN2005"/> [[Statute]]s on [[group therapy]] do not encompass those associations that lack a professional [[therapist]] or [[clergyman]] to whom confidentiality and privilege might apply. Professionals and [[paraprofessional]]s who refer patients to these groups, to avoid both [[civil liability]] and [[licensure]] problems, have been advised that they should alert their patients that, at any time, their statements made in meetings may be disclosed.<ref name="COLEMAN2005">{{cite journal |author=Coleman P |title=Privilege and confidentiality in 12-step self-help programs. Believing the promises could be hazardous to an addict's freedom |journal=The Journal of Legal Medicine |volume=26 |issue=4 |pages=435–74 |date=2005-12-01 |pmid=16303734 |doi=10.1080/01947640500364713|s2cid=31742544 }}</ref>

===Cultural identity===
One review warned of detrimental [[iatrogenesis|iatrogenic]] effects of twelve-step philosophy and labeled the organizations as [[cult]]s,<ref name="ALEXANDER1984">{{cite journal |last=Alexander |first=F. |author2=Rollins, M. |year=1985 |title=Alcoholics Anonymous: the unseen cult |journal=California Sociologist |volume=17 |issue=1 |pages=33–48 |issn=0162-8712 |oclc=4025459 |location=Los Angeles |publisher=California State University}}</ref> while another review asserts that these programs bore little semblance to religious cults and that the techniques used appeared beneficial to some.<ref name="WRIGHT1997">{{cite journal |last=Wright |first=Kevin B. |title=Shared ideology in Alcoholics Anonymous: a grounded theory approach |journal=Journal of Health Communication |volume=2 |issue=2 |pages=83–99 |year=1997 |pmid=10977242 |doi=10.1080/108107397127806}}</ref> Another study found that a twelve-step program's focus on self-admission of having a problem increases deviant [[social stigma|stigma]] and strips members of their previous [[cultural identity]], replacing it with the deviant identity.<ref name="LEVINSON1983">{{cite book |last=Levinson |first=David |chapter=Current Status of the Field: An Anthropological Perspective on the Behavior Modification Treatment of Alcoholism |title=Genetics Behavioral Treatment Social Mediators and Prevention Current Concepts in Diagnosis |volume=1 |pages=255–61 |year=1983 |pmid=6680227 |doi=10.1007/978-1-4613-3617-4_14 |series=Recent Developments in Alcoholism |isbn=978-1-4613-3619-8}}</ref> Another study asserts that the prior cultural identity may not be replaced entirely, but rather members found adapted a [[Biculturalism|bicultural]] identity.<ref name="WILCOX1998">{{cite book |last=Wilcox |first=D.M. |title=Alcoholic thinking: Language, culture, and belief in Alcoholics Anonymous |year=1998 |location=[[Westport, CT]] |publisher=Greenwood Publishing Group |isbn=0-275-96049-8 |pages=[https://archive.org/details/alcoholicthinkin00wilc/page/109 109–124] |chapter=Chapter 7: Language, Culture, and Belief |chapter-url=https://archive.org/details/alcoholicthinkin00wilc/page/109 }}</ref>

==See also==
* [[Addiction recovery groups]]
* [[Drug rehabilitation]]
* [[Effectiveness of Alcoholics Anonymous]]
* [[Group psychotherapy]]
* [[List of twelve-step groups]]
* [[Self-help groups for mental health]]
* [[Recovery model]]

==References==
{{Reflist|30em}}

==Further reading==

===Scholarly publications===
{{Refbegin|30em}}
<!-- Please do not add external links to a twelve-step group. These are given under a different topic: [[List of twelve-step groups]], not here. If they are inserted, they will be deleted. -->
* {{cite journal |author=Borman, P. D., & Dixon, D. N. |date=Fall 1998 |title=Spirituality and the 12 steps of substance abuse recovery |journal=[[Journal of Psychology & Theology]] |volume=26 |issue=3|pages=287–291 |doi=10.1177/009164719802600306|s2cid=148676117 }}
* {{cite journal |author=Freimuth, M. |year=199 |title=Psychotherapists' beliefs about the benefits of 12-step groups |journal=[[Alcoholism Treatment Quarterly]] |volume=14 |issue=3 |pages=95–102 |doi=10.1300/J020V14N03_08}}
* {{cite journal |author=Freimuth, M. |date=July 2000 |title=Integrating group psychotherapy and 12-step work: A collaborative approach |journal=[[International Journal of Group Psychotherapy]] |volume=50 |issue=3|pages=297–314 |doi=10.1080/00207284.2000.11491011 |pmid=10883547|s2cid=43254982 }}
* {{cite journal |author=Harris, J., Best, D., Gossop, M., Marshall, J., Man, L.-H., Manning, V. |date=March 2003 |title=Prior alcoholics anonymous (AA) affiliation and the acceptability of the twelve steps to patients entering UK statutory addiction treatment |journal=Journal of Studies on Alcohol |volume=64 |issue=2|pages=257–261 |doi=10.15288/jsa.2003.64.257 |pmid=12713200|display-authors=etal}}
* {{cite journal |author=Humphreys, K. |date=May 2006 |title=The trials of Alcoholics Anonymous |journal=Addiction |volume=101 |issue=5|pages=617–618 |doi=10.1111/j.1360-0443.2006.01447.x |pmid=16669879|doi-access=free }}
* {{cite journal |author=Kurtz, L. F., & Fisher, M. |date=May 2003 |title=Twelve-step recovery and community service |journal=[[Health & Social Work]] |volume=28 |issue=2|pages=137–145 |doi=10.1093/hsw/28.2.137|pmid=12774535 }}
* {{cite journal |author=Lile, B. |year=2003 |title=Twelve step programs: An update |journal=Addictive Disorders & Their Treatment |volume=2 |issue=1 |pages=19–24 |doi=10.1097/00132576-200302010-00004|s2cid=74842059 }}
* {{cite journal |author=Morgenstern, J., Bux, D., Labouvie, E., Blanchard, K. A., & Morgan, T. J. |date=November 2002 |title=Examining mechanisms of action in 12-step treatment: The role of 12-step cognitions |journal=[[Journal of Studies on Alcohol]] |volume=63 |issue=6|pages=665–672 |doi=10.15288/jsa.2002.63.665 |pmid=12529066}}
* {{cite journal |author=Sheehan, T. |year=2004 |title=Twelve Step Facilitation: A Necessary Treatment for Offenders |journal=[[Journal of Forensic Psychology Practice]]|volume=4 |issue=3 |pages=71–81 |doi=10.1300/J158v04n03_05|s2cid=145564061 }}
* {{cite journal |author=Sias, S. M., & Goodwin, L. R. Jr. |date=Apr 2007 |title=Students' reactions to attending 12-step meetings: Implications for counselor education |journal=[[Journal of Addictions & Offender Counseling]] |volume=27 |issue=2 |pages=113–126|doi=10.1002/j.2161-1874.2007.tb00025.x}}
* {{cite journal |author=Simkin, D. R. |date=January 1996 |title=Twelve-step treatment from a development perspective |journal=Child and Adolescent Psychiatric Clinics of North America |volume=5 |issue=1|pages=165–175|doi=10.1016/S1056-4993(18)30391-2 }}
<!-- Please do not add external links to a 12-step group. These are given under a different topic: [[List of twelve-step groups]], not here. If they are inserted, they will be deleted. -->
{{Refend}}

{{Addiction}}
{{Authority control}}

[[Category:Twelve-step programs| ]]
[[Category:Alcohol abuse]]
[[Category:Drug rehabilitation]]
[[Category:Spiritual practice]]
[[Category:Support groups]]