12-Step Series: Are the Criticisms of 12-Step Programs Appropriate?

12-Step Series: Are the Criticisms of 12-Step Programs Appropriate?

Addiction continues to permeate our society. It affects the lives of individuals and the stability of communities everywhere. Addiction in any form takes a devastating and sometimes deadly turn on people’s lives. For this reason, we see a growing rise in treatment methods. 

One particular approach has swept our culture: 12-Step programs. This model suggests admitting powerlessness over addiction and working the Twelve Steps to connect to a Higher Power to help you recover. However, critics argue that this model fails to account for individual needs and does not address the role of physiological factors in addiction. Yet, evidence-based reports and many recovered members of 12-Step programs show the opposite. 

Should I or Should I Not Attend a 12-Step Program?

You’ve decided to go to 12-step meetings. You’ve told your family, friends, and coworkers about your decision. Yet, they don’t understand why you want to attend these meetings. Your loved ones start offering their input about the matter. You may also check people’s opinions about 12-Steps programs online. By now, you’ve probably heard at least one of these criticisms of 12-step programs:

  • “12-Step groups are too religious.”
  • “12-Step groups are too cultish.”
  • “12-Step groups are too dogmatic.”
  • “12-Step groups are too insular.”
  • “12-Step groups cause harm.”
  • “12-Step groups don’t help everyone who attends them.”
  • “12-Step Programs aren’t evidence-based,”
  • “I’m not powerless over my addiction.”
  • “I don’t have a disease. I’m just bad.”
  • “12-Step programs make you dependent on others.”
  • “12-Step programs are too religious for me.”
  • “God is a crutch for weak people.”
  • “12-Step programs just make drug and alcohol abuse more taboo.”

The critics of 12-Step programs may have some valid concerns regarding their critiques of the program. However, you can also find good counter-arguments to each complaint with further inspection. This article will explore both sides of each argument to help you decide if a 12-Step program will suit your recovery process. 

The Critics of 12-Step Programs

Many people have criticized 12-Step programs like Alcoholics Anonymous and Narcotics Anonymous. These criticisms of 12-Step programs are most often a result of misinformation but can also reflect poor experiences with other program members. Unfortunately, some members of 12-Step programs have abused their role or influence with the following:

  • Some members push that there are no alternatives to 12-Step programs; either you recover using this method, or you never recover at all.
  • Members may use peer pressure to recruit new members into the fold and ostracize those who refuse to join.

12-Step groups have cultivated many critics among its members, other recovery groups, and the medical community. Some members have complained about the group’s purported links to religion, its authoritarian structure, and the fact that it’s not clear what keeps members from relapsing. Hence, many of these critics bore out of poor or misguided actions of these 12-Step members. Like most self-help organizations, 12-Step programs have attracted their share of detractors.

The Medical Community

Some medical professionals and researchers have criticized 12-Step programs for lacking scientific evidence and a controlled study to show their efficacy. Critics have characterized 12-Step programs’ treatment model as an unscientific, outdated model of success. Furthermore, some say 12-Step programs lack any form of empirical validation and are based on a belief that addiction is caused by a spiritual or moral failing rather than a disease.

The reality: the medical community is one of the most vocal critics of 12-Step programs. It is not uncommon to hear doctors, psychologists, and addiction researchers claim that 12-Step programs “don’t work.” The problem with such a blanket statement is that there is no objective evidence to support it. Research has shown that 12-Step programs do work for some people.

Today, you can find increasing evidence that it works for many people who participate. Some researchers say its success stems from the Twelve Steps and the social support provided by fellow members in 12-Step programs, and several factors that may be unique to the program itself. The scientific research that supports 12-Step programs’ effectiveness is as follows:

Moos and Timko

A meta-analysis conducted by Moos and Timko in 2006 found that participation in 12-Step programs was associated with a significant reduction in drinking among individuals diagnosed with substance use disorder. This study compared alcohol abstinence rates among those who participated in Alcoholics Anonymous (AA) and those who did not over 21 years. The results showed that those who attended AA meetings for two years or more had higher rates of long-term sobriety.

Project MATCH

In 1993, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) funded the most extensive study ever conducted on the treatment of alcoholism. Project MATCH involved 1,726 people at three sites across the United States. Each of them received one of three different treatments: cognitive-behavioral therapy (CBT), motivational enhancement therapy, or a 12-Step facilitation approach. 

The study revealed that all three treatments were equally effective at reducing drinking over nine months, but only 12-Step facilitation appeared effective after 18 months. In other words, the benefits of 12-Step programs lasted longer than those of different approaches. The study’s authors suggested that 12-Step programs foster a sense of belonging and community, which helps participants avoid relapse. Ultimately, though some studies showed mixed results, others came to similar conclusions: 12-Step programs work best when combined with other treatment methods such as medication or psychotherapy.

Former or Current Members of 12-Step Programs

Many former members describe 12-Step programs as a hierarchical, organized movement that imposes a priestly caste on its members. As such, they find this approach incompatible with the concepts of equality and individualism. Some deem it a “cult-like” organization with many techniques designed to control individuals and keep them in the program. They say that the priestly caste of members imposes strict rules throughout the organization. Former and even current members mention being shunned by other members when they speak out at meetings. 

Reality: 12-Step programs have no elected officials or people who run meetings. They make every attempt to make sure to bring in new members into service positions. Notably, members regard these positions as opportunities to serve others, not dominate. 

Members also encourage newcomers to explore meetings or alternative programs if they find 12-Step programs are not beneficial for their recovery. The Big Book even urges you to seek outside help; it suggests that you might work with a therapist, a spiritual counselor, or attend a treatment facility. If a 12-Step program isn’t helping you stay clean and sober, there’s no requirement that you return to meetings any more than you would be required to attend a church service if it wasn’t helping your recovery.

Women, LGBTQ, and People of Color

Women, LGBTQ, and minorities criticize 12-Step programs for lacking inclusivity and openness. Yet, addiction is a disease that doesn’t discriminate. It can affect anyone, regardless of their gender identity or sexual orientation. However, when it comes to addressing the problem, many in the same groups find 12-Step programs less than welcoming. To them, it’s fair to say that the Twelve Steps – the program’s solution for overcoming addiction – upholds the male perspective.

Women

Women in 12-Step programs have criticized the organization for being dominated by men and lacking safeguards against sexual harassment. Some allege they have been sexually exploited by male members, especially during their vulnerable state. Some women also claim 12-Step programs focus too heavily on male experiences of addiction. Some women also claim the literature of 12-Step programs is sexist and promotes patriarchal values.

LGBTQ

The message of 12-Step programs can alienate members of the LGBTQ community. Some members have commented that 12-Step programs are heteronormative, with prayers and readings that refer to God as a “He” or “Father.” The program uses male pronouns, making it easy for women and transgender people to feel overlooked or devalued. 

Research indicates that members of the LGBTQ community are disproportionately affected by substance use disorders compared with the general population. As a result, some gay rights activists argue that 12-Step programs should take special steps to reach out to potential members of this community by offering more gay-friendly meetings. 

Proponents of increased outreach say that although the Twelve Steps and Principles are not inherently transphobic or homophobic, there are too many meetings that aren’t accepting. Some people say they’ve been told not to bring up their sexual orientation at meetings because others might feel uncomfortable. These critics say that many will stop attending without safe spaces for gay people.

People of Color

Despite attempts to diversify 12-Step programs, many meetings remain overwhelmingly white. According to an AA 2014 membership survey, white people made up 89% of the population, while black people only made up four percent. Some people of color deem 12-Step meetings often very unwelcoming or accepting. Due to the sense of alienation some members of 12-Step programs feel, they choose not to return. 

The reality is that today, many 12-Step programs have changed the wording in their literature and meetings to make them more inclusive. There are also 12-Step programs for people who identify as LGBTQ+, women, and people of color throughout the country. Gay people do not need to hide their identities at these meetings, and they can find support from others who share their experiences. Women and people of color can also find a sense of camaraderie in such meetings.

The Most Common Criticisms of 12-Step Programs

The growing criticism of 12-Step programs reflects many points of contention. However, many of these criticisms lack validity or complete understanding of 12-Step programs. Common criticisms of 12-Step programs include:

Religion and Usage of “God”

Some critics of 12-Step groups believe the emphasis on spirituality puts too much focus on God, which may not sit well with many staunchly atheist or agnostic participants. For the following reasons, it’s important to note that 12-Step programs are not Christian organizations:

  • The group’s name was initially “The Oxford Group,” and six of the Twelve Steps refer directly to God. Still, these are all references to a “Higher Power” instead of any specific deity. AA literature states explicitly that members may interpret this term in their way.
  • The organization currently refers to God as a “Higher Power” and even offers an alternative interpretation (“Good Orderly Direction”) for those who are uncomfortable with spirituality.
  • An agnostic named Bill Wilson co-founded AA and penned the Twelve Steps with the original members of AA. He and the original members never intended AA to be deemed a religious group. He wanted it to be a spiritual way of life. He describes his experience as an Agnostic in a 12-step program in AA’s Big Book.
  • The actual Twelve Steps include terms like “a Power greater than ourselves.” This leaves room for members’ interpretation of Higher Power without forcing them into any specific belief system.
  • There is no mention of Christianity in the Twelve Steps of Twelve Traditions. Although some people interpret them in religious terms, there are no specific references to Christianity or other organized religions throughout any 12-Step literature.
  • The only requirement for membership is the desire to stop using drugs or drinking alcohol. Given that 12-Step programs have no official affiliation with any particular religion, there’s no reason why atheists or agnostics shouldn’t join — as long as you’re willing to make an effort toward sobriety and follow the Twelve Step process for recovery.

Sponsorship

Some critics worry about a sponsor’s influence on those recovering from addiction. However, sponsors play an essential role in a person’s recovery. They can help others through difficult times and celebrate with you when you’re doing well. The most critical piece of having a sponsor is that they are the person to walk you through the Twelve Steps. But a sponsor is not your doctor or therapist, so they shouldn’t give you medical advice or mental health advice. If you’re ever uncomfortable with something your sponsor has said, speak up or find a new sponsor.

People can choose a sponsor with whom they feel comfortable and who has similar interests or backgrounds. The guidelines emphasize that sponsors be cautious. The program calls for sponsors to avoid becoming too involved in the lives of their sponsees, especially romantically.

Outdated, Ineffective, or Harmful

Some critics assert finding more effective and advanced treatment techniques. However, one should note that the original Twelve Steps were developed in 1935 — decades before the so-called “newer” treatments. Some of these newer treatments borrow from 12-Step programs or use them as a foundation for developing their techniques.

The Twelve Steps outline a path to spiritual growth and freedom from addiction as a guide to recovery from addiction. The program is simple but not simplistic – it requires an enormous amount of personal reflection and effort and, in this way, is deeply profound. Thus, 12-Step programs should be thought of as the foundation of recovery, upon which one can add other treatment modalities to help aid in the healing process. For example, therapy and medication management may benefit individuals with a substance use disorder. Overall, one can use 12-Step programs alone, while others can use them in conjunction with other forms of treatment.

12-Step Programs and White House Recovery and Detox

At White House Recovery and Detox, we combine 12-Step programs and group therapy, detox, and therapy counseling to save the lives of individuals with addiction. We believe in the power of the Twelve Steps because we have seen its effect on our clients and our own lives. We are not just clinicians; we are people in recovery who have worked the Twelve Steps ourselves and experienced the freedom and joy that this program offers to all – including you!

While critics may find fault with 12-Step programs, research reveals the model’s effectiveness. However, critics of 12-Step programs are right in one respect: the model is not a perfect fit for all people looking to recover from addiction. Some individuals will pursue other forms of treatment that work better for them and help them achieve long-term sobriety. The fact that many people believe in the beneficial effects of 12-Step programs speaks volumes — but this alone is not enough proof. To determine whether or not this type of program is an effective means of treatment, we must look at evidence and facts. And by this standard, 12-Step approaches bear out as a practical option for achieving recovery from substance use disorder. At White House Recovery and Detox, we combine 12-Step programs, detox, and therapeutic counseling to help you recover from addiction. To learn more about our treatment program, call us at (800) 510-5393.

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