Twelve Step Groups

Nature of Twelve Step Groups

The network of twelve step groups has been described as a sociocultural movement. As distinct communities, twelve step groups provide a specific set of meanings, suggestions, and social-support avenues to guide members in understanding and overcoming addiction. Twelve step groups view addiction as both a spiritual and moral concern best addressed in a communal context. In their own terminology, twelve step groups provide members with “fellowship,” offering encouragement and role modeling from peers who share a focal problem, and a “program,” consisting of twelve suggested action steps to promote recovery. The steps emphasize abstinence, acceptance of one's addiction, self-examination, atonement, spiritual transformation, and spreading the twelve step message as a sponsor to other members. Twelve step teachings consider recovery a lifelong process and stress the importance of overcoming self-centeredness to attain a sober life of humility and spiritual serenity. Although self-help groups are distinct from professionally administered services, many addiction treatment programs have adopted twelve step principles.

Participation in Twelve Step Groups

As discussed by Thomas J. Powell (1987) as well as Harold Neighbors and colleagues (1990), some academics [Page 1415]and helping professionals fear that twelve step programs are biased toward the needs of Euro-American middle-class men. However, research suggests that substance abusers who attend AA and NA are usually not significantly different from those who do not, in terms of race, gender, education, or employment. Persons with co-occurring mental illness and substance-abuse problems attend AA and NA at rates similar to those without co-existing disorders. Mankowski and colleagues found that twelve step group participation can be predicted on the basis of the degree to which beliefs held by an individual and a referring treatment program are compatible with twelve step views. Other studies suggest that twelve step groups are more likely to be used by substanceabuse treatment clients with more severe histories of drug use and criminal activity than they are by others. Similarly, Kingree and Thompson (2000) found that individuals with high ACOA attendance were generally older, with lower self-esteem at baseline, compared with those who attended less frequently. These findings indicate that twelve step groups are particularly attractive to individuals with severe problems.

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