What is the role of the 12-step recovery program in addiction hospital programs/recovery centres?

What is the role of the 12-step recovery program in addiction hospital programs/recovery centres? I’ve been exposed to a number of inpatient and outpatient recovery facilities over the years, and without exception every single one of them has used the 12 steps of recovery as a basic backdrop to all they do.  Here, in this fourth part of this 5-part series of articles in which I discuss various aspects of 12-step recovery programs, and how you may utilise counselling alongside them, I will try to do some justice to the question as to why this is. Across the whole of this series however, I will also:

  • Explain where AA and the 12 steps come from (Part 1)
  • Explain what the 12 steps are, and how they work (Part 2)
  • Explain the difference between the 12-steps of recovery, and the various 12-step fellowships that accompany it (Part 3)
  • Describe how counselling can help with working the 12-step program (Part 5)

As with the other articles in this series, I must make absolutely clear that what follows is not sanctioned by Alcoholics Anonymous (AA), Narcotics Anonymous (NA), Cocaine Anonymous (CA) or any other 12-step fellowship. Instead, what follows are my own thoughts having been involved with the 12-step recovery and its associated fellowships both personally and professionally for over 30 years.

So, just why do all of these recovery facilities use the 12 steps of recovery as the basis for their programs? The short answer is because they tend to work. Importantly, they tend to work whether or not you’ve chosen a spiritual power to turn your will and your life over to in step three. Having said this, it would be very unfair (and overly gracious to the 12 steps) to either say that they are the ONLY solution to recovering from alcoholism, or that hospital programs are only relying on somebody else’s ideas to help their patients.

Since 1939 and the publishing of the text book Alcoholics Anonymous, psychology has come a long way. At the time the book was published, psychologists/psychiatrists really only had the theories of Sigmund Freud and Carl Jung to chose from. In fact, Carl Jung is actually referenced in the book Alcoholics Anonymous as being unsuccessful in treating an active alcoholic he worked with personally and extensively for over a year!

Bill Wilson didn’t know this, but when he took the Oxford Group’s 5 steps to salvation and expanded them to the 12 steps of recovery, he was also setting out a series of steps that enable an individual to examine themselves both spiritually as well as cognitively and behaviourally. The steps don’t just guide you to a spiritual experience. Even if you choose to largely forego step three, they still provide a practical method of having a good look at yourself. They provide an opportunity to take a good look at your thinking, and to have a good look at some of the ideas you’ve been following your whole life. Most importantly, working through the steps (even without a higher power) provides one an opportunity to decide which aspects one’s self are worth keeping, and which things are outdated and unhelpful to feeling calm and contented in one’s own being.

Today’s inpatient/outpatient institutions dedicated to assisting those with addictions utilise a number of more modern psychological techniques alongside the 12 steps of recovery. There are various classes, individual and group therapy sessions and a variety of other exercises where people are encouraged to discover those things within themselves that are blocking them from being all they can and want to be. These are designed to restructure people’s thinking about their own particular addiction, how they see themselves, and how they approach life in general. Using the 12 steps alongside these efforts provides people with a backdrop to use in their lives when they leave the facility. The hope is that patients will leave the centre and continue with their own outpatient treatment in 12 step fellowship meetings. Having spent a month or so working on these ideas within a treatment centre, the hope is they’re now equipped to go out and apply them within their particular fellowship (see part 3 of this series).

It was the belief of the Oxford Groups, and also of the early sober alcoholics when the book Alcoholics Anonymous was written, that the only way a person could experience a cognitive restructuring of the type one experiences through working the 12 steps was through the direct input of a higher power. Certainly, there are a couple of million people who have worked the steps and found this to be the case for them. At the same time however, there are also a great many who have experienced this cognitive restructuring without the direct input of a higher power, or even without believing in one. Again, this author will stay out of the debate as to whether a higher power is required to experience the type of psychic change needed to recover from alcoholism and generally speaking, hospital treatment facilities stay out of the argument as well. Nonetheless, they all work to ensure patients have a solid understanding of the steps so that when they leave the facility, they can decide for themselves what is right for them.