Support Group Guide: What are the Options?
Substance abuse is a major public health concern. In 2019, about 140 million people ages 12 and older reported alcohol use and about 36 million of people in this age group reported illicit drug use.9 Additionally, about 9 million people ages 12 and older reported using prescription drugs in 2019.9 Chronic drug and alcohol abuse can lead to substance addiction, a progressive condition characterized by continued use despite significant impairment in a person’s life.
It can be challenging to quit drugs on your own, but substance abuse treatment programs are available to aid you in the process. There are many types of treatment programs, the two major categories being inpatient and outpatient. Inpatient programs, which provide patients with intensive, 24-hour care, adopt various philosophies surrounding substance abuse treatment, allowing individuals to choose a well-suited and financially feasible program.
A number of treatment programs incorporate the 12 steps of recovery as part of their approach. In fact, 12-step programs (e.g., Alcoholics Anonymous and Narcotics Anonymous) are the most widely accessible recovery tool in the U.S., with 12-step meetings available both during and after treatment.2 When researching treatment programs, it’s important to find a treatment program that matches your clinical needs, values, and beliefs.
What Are 12-Step Programs?
Twelve-step programs are based on the foundational principles of Alcoholics Anonymous (AA), a community-based support group for recovery from alcohol abuse, and are a popular choice for those looking to get clean and sober. Other programs, such as Narcotics Anonymous (NA) and Cocaine Anonymous (CA), are founded on the 12 step-model to help members address their drug addictions.
The 12-step philosophy has three main components: unity, service, and recovery.2 The 12 steps are a set of principles grounded in spirituality whereby the individual is encouraged to rely on a Higher Power of his or her own belief, although no religious affiliations are involved. Further, some program members will initially adopt the fellowship to fill the role of a Higher Power. The Higher Power concept is unique to the individual and all variations are welcomed in 12-step programs.
Members of AA, NA, CA and other fellowships are encouraged to find a sponsor, someone who ideally takes the individual through the 12 steps. Many people benefit from the guidance and support of a sponsor who is further along in the recovery process. Attending meetings, working the steps with a sponsor, and service work are all predictors of increased abstinence from drug use.3 Systematically working the 12 steps of recovery is a cornerstone of the 12-step program. Generally, a member will look for a sponsor with whom they feel comfortable being honest with, as part of the step work requires admission of past actions while abusing drugs or alcohol. The only requirement for membership of AA, NA, and other fellowships is a desire to remain sober.
The following is a list of some of the most common 12-step substance abuse recovery programs:
- Alcoholics Anonymous
- Cocaine Anonymous
- Narcotics Anonymous
- Heroin Anonymous
- Crystal Meth Anonymous
- Marijuana Anonymous
- Pills Anonymous
- Nicotine Anonymous
What Are the 12 Steps?
You can work through the requirements of the 12-steps list at your own pace or as negotiated by you and your sponsor. The 12 Steps of AA are as follows:5,6,7
- We admitted we were powerless over alcohol—that our lives had become unmanageable: In this step, an individual looks at how his or her life has been adversely affected by the addiction. Step 1 helps in breaking free from denial.
- We came to believe that a Power greater than ourselves could restore us to sanity: This step is about hope, a Higher Power, and facing reality. In this step, individuals begin to cultivate a relationship with a power greater than themselves by examining their concept of a Higher Power.
- We made a decision to turn our will and our lives over to the care of God as we understood Him: Although step 3 mentions “God,” current 12-step programs have a liberal view and allow you to interpret your Higher Power in whatever way suits your needs. Step 3 involves forming a relationship with the Higher Power of your choosing. This step requires a decision to turn your will over rather than self-managing one’s life.
- We made a searching and fearless moral inventory of ourselves: This step involves a personal housecleaning via a written inventory. The individual looks at people, places, things, and institutions that are a source of anger and resentment. The purpose of this step is to identify character defects or negative traits that lead to actions that caused pain and suffering. Once identified and confronted, the past can be released.
- We admitted to God, to ourselves, and to another human being the exact nature of our wrongs: This step is taken immediately after completion of the previous step and involves reading the written inventory to another human being, not necessarily your sponsor. This step is an effort to see clearly what it is about yourself that you need to change.
- We were entirely ready to have God remove all these defects of character: This step addresses the issue of your readiness to have removed the defects of character that were identified in step 4 and that were admitted to God, to yourself, and to another human being in step 5.
- We humbly asked Him to remove our shortcomings: This step asks your Higher Power to remove the defects of character identified in the previous steps.
- We made a list of all persons we had harmed and became willing to make amends to them all: This step is concerned with your personal relationships and requires listing all people you may have potentially harmed during your drug or alcohol abuse. This step is the basis for developing a more productive and satisfactory way of relating to others.
- We made direct amends to such people wherever possible, except when to do so would injure them or others: This step is conceptually the second part of step 8, in which you make amends to each individual on your list. Before making each amend, the individual determines whether it is beneficial to do so and if so, the best method.
- Continued to take personal inventory and when we were wrong promptly admitted it: This step is a continuation of step 4, in which the individual monitors resentments throughout the day, taking prompt corrective action as needed to keep the slate clean, character defects in check, and negative emotions at bay. Step 10 means adopting a way of life that requires continuous effort and growth.
- We sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out: This step involves two key components: prayer and meditation. Step 11 increases self-introspection through connecting with your chosen Higher Power.
- Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics/addicts, and to practice these principles in all our affairs: This step is a cornerstone of the 12-Step program and involves being of service to other struggling individuals.
What Is a Non-12-Step Program?
It is important to remember that 12-step programs aren’t your only option. There are many non-12-step programs available for people seeking a different approach.
Non-12-step programs offer evidence-based scientific approaches to addiction treatment. Rather than adhering to any one static treatment model, non-12-step programs are constantly evolving to incorporate advances in scientific and addiction research. While many people benefit from 12-step programs, the programs themselves are not scientifically-based. Instead, 12-step programs are founded on a spiritual component. Alternatives to 12-step programs are more secular, which can better suit the needs of non-religious people.
Non-12-step programs are similar to Alcoholics Anonymous and Narcotics Anonymous in that they are free and open to anyone who is committed to sobriety. Although they are often conducted in a group environment, these AA alternatives focus less on the sharing of personal experiences. Instead, the group members work to help one another develop new skills and strategies for maintaining sobriety. Alternative support groups take confidentiality and anonymity as seriously as AA and NA, and all participants agree to keep what they learn in group to themselves. Much like 12-step meetings, non-12-step meetings can be integrated into the treatment plan of someone enrolled in an inpatient or residential addiction treatment program.
SMART Recovery is the leading addiction recovery support group program based on self-empowerment. SMART Recovery is a global recovery community that includes free support groups based on the latest scientific research. Participants learn the newest tools and techniques for maintaining long-term sobriety. The SMART Recovery 4-Point Program helps people recover from issues such as:
- Drug abuse.
- Drug addiction.
- Substance abuse.
- Alcohol abuse.
- Gambling addiction.
- Cocaine addiction.
- Prescription drug abuse.
- Sexual addiction.
- Other behavioral addictions.
SMART Recovery offers face-to-face meetings along with daily online meetings.
Secular Organizations for Sobriety
Secular Organizations for Sobriety (SOS) is a nonprofit group founded on the principles of secular addiction treatment. For more than 30 years, they have helped people recover from alcohol, drug, and food addictions. They maintain a network of autonomous peer-run local support groups.
LifeRing Secular Recovery
LifeRing Secular Recovery is an international organization of people who support one another’s recovery by sharing practical experiences and skills for sober living. LifeRing emphasizes positive, practical, and mindful steps to successful sobriety. They believe that you can overcome your addiction by strengthening your Sober Self. Through in-person and online meetings, people in recovery share advice and encouragement to support their Sober Selves.
Women for Sobriety
Women for Sobriety (WFS) is an abstinence-based self-help program for women with drug or alcohol addictions. For many women, these groups offer a much-needed alternative to 12-step programs, which are often mixed-gender. WFS acknowledges the special needs of women in recovery and aims to nurture feelings of self-worth. WFS offers several recovery tools that help women develop coping skills and personal growth strategies.
Who Might Benefit from Non-12-Step?
Not everyone feels at home in 12-step programs, which is why there are so many viable alternatives. Instead of the one-size-fits-all 12-step approach, you might find that you need a more targeted approach. Many people benefit from non-12-step programs that are designed to meet their unique needs and belief systems. You may benefit from non-12-step programs if:
- You are uncomfortable with the religious or spiritual elements of 12-step programs.
- You don’t enjoy sharing personal details with your support group.
- You prefer a scientific, evidence-based approach to addiction treatment.
- You want a program that empowers you and strengthens your self-worth.
- You want to learn about the science of addiction.
Considerations for Non-12-Step Programs
Alternatives to 12-step programs vary greatly in terms of their treatment approach and methods. To find a non-12-step program that will work for you, consider some of the following questions when you evaluate your options:
- Does it use group therapy or peer-to-peer support groups?
- What is the treatment approach?
- Is there a certain structure that members are required to follow?
- Are members required to participate in discussions?
- Is there an opportunity to meet with a therapist one-on-one?
- Are people encouraged to find a sponsor in the group?
- Does the group have structures in place to support you in a crisis, such as during an intense craving?
- Does the program work well as an aftercare plan following an inpatient treatment program?
- What is the primary strategy for maintaining life-long sobriety?
So, whether it’s a traditional 12-step program or a variation of non–12-step meeting you’re interested in, just connecting with others pursuing recovery is a great step toward sobriety.
- National Institute on Drug Abuse. (2011). Treatment Statistics.
- Laudet, A. Morgen, K. & White, W. (2006). The role of social supports, spirituality, religiousness, life meaning and affiliation with 12-step fellowships in quality of life satisfaction among individuals in recovery from alcohol and drug problems. Alcohol Treatment Quarterly, 24 (1–2): 33–73.
- Greenfield, B. L., & Tonigan, J. S. (2013). The general Alcoholics Anonymous tools of recovery: The adoption of 12-step practices and beliefs. Psychology of Addictive Behaviors, 27 (3), 553–561.
- Dossett, W. (2013) Addiction, Spirituality and Twelve Step Programmes. International Social Work special edition “Social Work, Religion and Spirituality.” 56 (3). 369–383.
- Hamilton, B. (1996). Twelve Step Sponsorship: How It Works. Minnesota: Hazelden Publishing.
- Alcoholics Anonymous, (2002). The Twelve Steps and Twelve Traditions. New York, NY: Alcoholics Anonymous World Services, Inc.
- Wilson, B. (2002). Alcoholics Anonymous: The Big Book. New York, NY: Alcoholics Anonymous World Services, Inc.
- Witbrodt, J., & Kaskutas, L. (2005). Does Diagnosis Matter? Differential Effects of 12-Step Participation and Social Networks on Abstinence. The American Journal of Drug and Alcohol Abuse, (31), 685-707.
- National Institute on Drug Abuse. (2020). National Survey of Drug Use and Health.