Twelve-Step Programs

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Twelve-Step Programs

Addiction-recovery treatments modeled on the techniques of Alcoholics Anonymous (AA), Twelve-Step programs are manifestations of the nineteenth-century self-help and social collectivist movements. AA and similar organizations also represent a form of secularized religion, involving both Christian and Eastern philosophical principles, that became popular in the twentieth century. The Twelve Steps are a series of behavior-modification principles that appeal to a higher power, take action through personal inventories, make amends to others, and spread the message. Beginning with alcoholism, the treatment philosophy has been applied to gambling, eating disorders, drug addictions, sexual disorders, physical health problems, and a variety of other damaging compulsive behaviors, with varying degrees of success and not without some controversy.

The industrialization and resulting prosperity of mid-nineteenth-century Victorian Britain encouraged a renewed belief in restraining moral attributes such as hard work, respectable behavior, and personal responsibility. These values were not only embraced by the new, growing middle class in England, but appealed to other classes as well. Author Samuel Smiles enshrined what he called his "gospel of work" in a series of best-selling books including the 1859 Self-Help. This book, which was based on a series of self-improvement lectures that Smiles gave to young men, taught that financial success and personal happiness were based entirely on individual initiative and faith in God. Smiles' self-help movement spread across the Atlantic to the rapidly industrializing United States and influenced a generation of American self-help activists including physician John Harvey Kellogg. Kellogg was hired to supervise the Seventh Day Adventists' Health Reform Institute, located in Battle Creek, Michigan, in 1876. Beyond the breakfast cereal he helped invent as a health food, Kellogg became the most prominent self-help health advocate in the world until his death in 1943. He spread, popularized, and helped make nearly universal the Adventist notion that individuals are responsible for and can do something about their physical and spiritual health.

During the early twentieth century, a Protestant evangelist named Frank N. D. Buchman established the Oxford Group, a religious movement that encouraged conversion experiences through confession, restitution, and self-survey. Before the group became involved with Fascism in the late 1930s, it attracted two converts with severe drinking-related problems, New York City stockbroker William Griffith Wilson, or "Bill W." as he was known to his AA friends, and Akron, Ohio physician Robert Holbrook Smith, or "Dr. Bob." The pair adapted the principles and practices of the Oxford Group in tandem with the well-known self-help health dogma of Kellogg to the problem of controlling drinking. Previously, alcoholism had been treated as a matter for moral persuasion, institutionalization, or law enforcement. Bill W. and Dr. Bob's new program consisted of helping, talking to, or otherwise maintaining contact with other drunkards to engage in spiritual activity. On June 10, 1935, Dr. Bob had his last drink, marking the official start of Alcoholics Anonymous.

The circles of recovering alcoholics in AA grew slowly at first. The noble experiment of Prohibition, which ended in 1933, had changed the culture of alcoholism in American society. All-male saloons died with the introduction of Prohibition in 1920, replaced by mixed-sex drinking that continued after 1933. Gone was the fraternity of men supporting each other in and out of alcoholism. Prohibition forced drinking undercover, into homes, hotel rooms, and other places where it had not been common previously. Bootleg beverages, especially beer, were often weak or reduced with other substances so that they could be consumed in greater quantities.

The end of Prohibition meant the return of alcoholic beverages to their traditional strengths, a reality to which many drinkers could not adjust. Coupled with enticing stories in the press, advertisements promoting drinking as sophisticated and glamorous, and the abundant use of alcohol in Hollywood movies, alcoholism gradually increased in the years during and after the Great Depression. There were over 100 members of AA by 1939, the same year the basic Twelve-Step program, Alcoholics Anonymous, or the "Big Book" as it was known in the movement, was published. A national AA service office was established in New York City in 1940 and the Saturday Evening Post gave the AA and the Twelve-Step program its first extensive national publicity in 1941.

Bill W. wrote The Twelve Steps in a burst of inspiration during 1938 and 1939, but they were based on debate among members and reflected the collective nature of the organization and its religious underpinnings. Though the original version was written in the stilted language of the day, subsequent editions of the "Big Book" have kept the original wording. The founders described themselves as "average Americans," but most were male, Protestant, white, and middle class. Their perspective reflected their environment, although the group had made efforts to distance itself from the earlier temperance movement that had flourished among the same social-economic class by stressing that alcohol was not in itself bad, only that some individuals were unable to drink in moderation. The first tenet of the Twelve-Step program was that members had to admit their powerlessness in their addiction. AA maintained that a person had to "hit bottom" and find him or herself in a totally powerless situation before redemption was possible. After members were introduced on the anonymous, first-name basis pioneered by AA (every member is greeted with "Hi" and their AA name), Twelve-Step meetings were built around the near-destruction testimonials of new and old members.

Next, the member had to express the crucial element of belief: adherence to a power greater than him or herself. Only with faith could the member move on to Step Three, turn his or her life over to God, Step Six, be ready to have God remove defects of character, and Step Seven, ask Him to remove shortcomings. Steps Four to Nine, including the making of a moral inventory, the admission of past wrong-doings to another person, and the listing and making of amends to people who had been wronged, were called the action Steps. The action Steps said nothing about drinking, for in AA parlance, "liquor was but a symptom." Steps Ten to Twelve continued inventory taking and wrong-doing admission, the improvement of one's knowledge of God through prayer and meditation, and the undergoing of a conversion experience. A "spiritual awakening" as the result of these Steps, which permitted the member to spread the Twelve-Step method to other addicts and practice the principles in everyday life, was considered to represent the continuance or maintenance of the Steps. In AA's conception, helping other alcoholics was considered the best means by which to maintain an individual's own continued sobriety. It also perpetuated the AA organization and spread the Twelve-Step concept.

From its modest beginnings, AA has grown into a worldwide organization with hundreds of thousands of members. Fellowship continues to be organized on a local level with no dues payable. Contributions for expenses are accepted from those attending meetings only. Affiliation of the AA or its local groups with churches, political organizations, or other official institutions is barred by the AA Twelve Traditions, another seminal document. More than 200 other organizations have developed their own versions of the Twelve-Step program, including Al-Anon, the organization for members of the families of alcoholics founded in 1951, Narcotics Anonymous, Gamblers Anonymous, Overeaters Anonymous, Debtors Anonymous, Augustine Fellowship Sex & Love Addicts Anonymous, Survivors of Incest Anonymous, and more recently, Cocaine, Nicotine, and Co-Dependents Anonymous.

The Twelve-Step program continues to be a focus of debate. Experts argue that it is difficult to evaluate recidivism rates of Twelve-Step program participants because of their anonymity. AA's insistence that alcoholism is a disease counters more recent research that alcoholism is a behavior without physical cause. The first continuing female member of AA, Marty Mann, joined in 1937, but feminists and minorities argue that AA is oppressive through language in the Twelve Steps, which they perceive as constraining, repressive, and fostering co-dependence. They hold also that AA literature does not allow for discussion of social issues, such as discrimination and poverty, which often affect individual drinking patterns. The Twelve-Step's insistence in God or a "Higher Power" has run afoul of the doctrine of the separation of church and state, especially when the AA cooperates with law enforcement officials in mandating AA treatment for convicted offenders. And AA's Protestant Christian roots has led to criticism that it is in itself a form of religion, or at least a quasi-religious organization like Transcendental Meditation or Scientology, an allegation AA denies.

The Twelve-Step program has been borrowed by numerous, less serious behaviors such as shop and fish-o-holics. The AA meeting format, with members' accounts of desperate experiences and the "Hi, I'm so-and-so" introduction, have been the object of lampoons and parodies. In an episode of the popular 1990s television sitcom Seinfeld, the character George harassed a new AA member friend for failing to properly complete Step Eight, making amends to persons harmed, to the extent that the friend was driven to binge on liquor-flavored ice cream. Still, most experienced therapists agreed that any form of treatment for addictive behavior is most likely to show a higher rate of success if the patient joins Alcoholics Anonymous or another Twelve-Step Organization. In the face of the omnipresent social problem of alcoholism and its detrimental effects on children and families, the growing social acceptance of gambling and tolerance of compulsive gamblers, and an ever-increasing variety of other addictive behaviors, Twelve-Step programs provide adequate substitutes for a dependent way of life.

—Richard Digby-Junger