Prevention, Treatment and Recovery

Twelve Steps, The
In 1939 the basic text for Alcoholics Anonymous was published and included, in
its fifth chapter, 12 steps suggested as a program for recovery from alcoholism. Since
then, “The Twelve Steps” have become synonymous with the term “self-help or support
group program” and their concepts have been applied to a variety of addictive maladies
including: gambling, narcotics, overeating, and sex. What are “the steps” and the ideas
behind them? How do they address addictive problems? The information below will
review the steps individually and collectively and see how they are applied to various
The Twelve Steps of Recovery
Alcoholics Anonymous allows the reprinting of the Twelve Steps of
recovery with this caveat: “The Twelve Steps are reprinted with the permission of
Alcoholics Anonymous World Services, Inc. Permission to reprint this material does not
mean that A.A. has reviewed or approved the contents of this publication, nor that A.A.
agrees with views expressed herein. A.A. is a program of recovery from alcoholism
only—use of the Twelve Steps in connection with programs and activities that are
patterned after A.A., but that address other problems, does not imply otherwise.

  1. We admitted we were powerless over alcohol-that our lives had become
  2. Came to believe that a Power greater than ourselves could restore us to
  3. Made a decision to turn our will and our lives over to the care of God as
    we understood Him.
  4. Made a searching and fearless moral inventory of ourselves.
  5. Admitted to God, to ourselves, and to another human being the exact
    nature of our wrongs.
  6. Were entirely ready to have God remove all these defects of character.
  7. Humbly asked Him to remove our shortcomings.
  8. Made a list of all persons we had harmed, and became willing to make
    amends to them all.
  9. Made direct amends to such people whenever possible, except when to
    do so would injure them or others.
  10. Continued to take personal inventory and when were wrong promptly
    admitted it.
  11. 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.
  12. Having had a spiritual awakening as a result of these steps, we tried to
    carry this message to alcoholics, and to practice these principles in all
    our affairs.
    Analysis of the Twelve Steps
    The initial driving concept of the steps – and to many people the most
    objectionable – is personal powerlessness. Persons seeking to practice the steps first
    admit they are powerless over their malady, and that their life has become unmanageable.
    This is counter-intuitive for many people who have been socialized to value and believe
    that self-control and will power will solve most problems. With the first step, admission
    of one’s own essential limitations is seen as key to overcoming difficulties. Persons using
    the steps will let go of the idea that they will personally and willfully be in control of
    their addictive behavior. Evidence for the truth of this conclusion will be drawn from the
    previously out of control addictive behavior – usually marked by repeated failed attempts
    at self-control. The acceptance of personal powerlessness, that the addiction is in fact
    beyond self-control, is often liberating for individuals. For others, it is just too bitter of a
    pill to swallow.
    When the basic text for Alcoholics Anonymous first advanced this concept as part
    of a larger program of recovery many saw it as radical, particularly with regards to
    alcoholism. The idea had, however, been around in various forms for a long time,
    perhaps having its base in diverse religions that suggested all overwhelming human
    foibles were best addressed by powers greater than themselves.
    Coming to believe that a power greater than oneself could restore sanity of mind
    is, in fact, the second step. Participants in this suggested program of recovery are invited
    to consider the idea of a ”higher power” (a term frequently used in support group
    meetings) that will do for them what they cannot do for themselves, namely, overcome
    the seemingly insane obsessive and compulsive nature of addiction. While the word
    ”sanity” often draws the most attention and controversy in this step, leading to arguments
    about whether or not addiction is a form of insanity, the more important operative term
    here is ”believe”. While step one encourages an often dismaying admission of personal
    powerlessness, step two softens the blow by indicating that recovery, while contingent
    upon belief in a higher power, is possible. This affords hope – something many addicted
    individuals have not experienced in a long time.
    Step three: “Made a decision to turn our lives and wills over to the care of God as
    we understood him” introduces the term ”God” and throughout most of the original
    Twelve Step writings, the term is used almost interchangeably with ”Higher Power”. For
    this reason, and others, many consider the Twelve Steps a form of religion. A subtle
    difference is that while various religious doctrines define the nature of God for an
    individual, this step leaves that definition up to the individual. Moreover, while religious
    injunctions, like the Ten Commandments, tell the reader what they shall and shall not do,
    the steps are all worded in terms of reporting the successful experiences of the authors,
    and simply suggest that if the reader chooses to do what they did, they may have the same
    results. Note the use of the terms “we”, not “you” and “our”, not “your”. By accepting
    the invitation to do as others have done, individuals are “joining” the program_(i.e.,
    joining with those who went before them and learning from their experience).
    Intriguingly, it is not only the addictive problem that one “turns over” to a higher power,
    it is the entire life and will. This indicates that addiction is seen not in terms of a
    condition that one has, but as an existential state. Addiction encompasses the entire being
    and sanity may result from surrender to the will of a self-defined God.
    Steps four and five take a different turn, encouraging a process of moral
    introspection – an inventory, admission, and reconciliation with a higher power of past
    wrongs relative to self-defined moral standards. The A.A. Big Book outlines some fairly
    detailed suggestions of how this may be accomplished and a plethora of popular press
    self-help books offer further suggestions, usually based on the experiences of the authors.
    Directly examining, facing, and reconciling the “wreckage of the past” in collaboration
    with God, self, and another human being are crucial steps in recovery.
    The next steps of the program are remarkable for their lack of specific reference
    to addiction, as they concern themselves with the rehabilitation and development of
    moral character and an increasingly intimate relationship with God as understood and
    defined by the step-taker. Idiosyncrasies, defects, and personal shortcomings are
    scrutinized and examined with a goal of making progress toward soundness of character
    and a spiritual way of life. God is relied on to remove defects and shortcomings.
    Instincts for sex, economic security, and social status and other needs are perceived as
    having often run amok in the addicted individual’s life and these steps encourage a rebalancing of wants, desires, and needs. Persistently undesirable impulses and behaviors
    are surrendered to the same higher power that the step-taker’s life and will were turned
    over to in step three. The work involved in these steps is often seen as (is that the word
    you want here?) extraneous by newer adherents to the steps, but the original authors of
    Alcoholics Anonymous found them absolutely essential to the achievement of long term
    recovery from addiction.
    The importance of the eighth and ninth steps is often more readily grasped by
    members of various self help programs. Still using non-dictatorial and inclusive terms
    like “we”, persons taking step eight make a list of all people they think they have harmed
    and at the same time work to become willing to make amends to them all. It is often
    easier to construct the list than it is to become willing to let go of old relational hurts.
    Interestingly, the term “apology” is not used in the language of the step. Perhaps because
    to apologize is to excuse, justify, or rationalize; whereas to amend is to improve, make
    better, remedy, or ameliorate. The difference is more than semantic, given that
    circumstantial apologies on the fly for past wrongs in relationships may have been
    previously issued and not followed by a sincere change in behavior or life perspective.
    By taking time to become willing to make amends, the whole process of reconciliation is
    slowed down – it is bigger than a hastily issued “I’m sorry” and follows the moral
    inventory and examination of character engaged in during previous steps. Primed with
    this new knowledge of self, a list of past relational harms and a humble willing heart, step
    takers then make direct amends, except when doing so would further hurt people. Having
    achieved a degree of healing themselves, recovering addicted persons now begin the
    process of helping others to heal.
    Step ten reiterates the earlier work as adherents continue to take personal
    inventory and promptly admit when they are wrong. The parallels to steps four and nine
    are clear and step ten amplifies their importance, suggesting that examination of self and
    humility in relationships are ongoing processes.
    Support group participants taking step eleven are again re-doubling their earlier
    efforts, as the turning over to God of one’s life and will (as decided in step three)
    advances even further here. Prayer, meditation, improved awareness, and conscious
    contact with a self-defined higher power are determined desirable, with the focus being
    on seeking both the will of God and the power to carry that out; the step indicates that
    these are the only things sought. This leaves aside all specific concerns about particular
    situations regarding life, death, work, and family, and yet includes them as a lump sum
    package, described in step three as ”life” and “will”. The original descriptions of the
    steps by Alcoholics Anonymous are very specific that there is no piecemeal process here,
    no half-way measures, when it comes to this surrendering of self will. The care and
    protection of a loving, self-defined higher power is to be sought with complete abandon
    and step eleven is clearly designed to further this spiritual process.
    Step twelve indicates that a spiritual awakening was the result of previous steps
    and that adherents tried to bring the message of it all to still suffering addicts and to
    practice the principles of the steps in all their affairs. It was actually this practice – of
    trying to reach out and help another addict achieve and maintain abstinence – which Bill
    Wilson, the co-founder of Alcoholics Anonymous, credits with repeatedly insuring his
    own sobriety and the sobriety of many other alcoholics. “Twelfth stepping” or reaching
    out to the addict who still suffers is a longstanding tradition of support group programs,
    most of whom maintain a phone line and telephone listing specifically for this purpose.
    But it is mostly by word of mouth that addicts in recovery who are seeking to help others
    are able to connect with them.
    Application to Other Addictive Behaviors
    While the original Twelve Steps specifically addressed alcohol, their simple yet
    seemingly powerful message was soon applied to other maladies. Persons addicted to
    gambling and to narcotics centralized their twelve step program efforts, with many early
    self-helpers being recovering alcoholics who found the steps effective for their other
    problems. Over time, people with overeating problems, sexual compulsivity, and other
    compulsive behaviors successfully applied the principles.
    While widely popular, the Twelve Steps are not for everyone. The initial driving
    concepts of the steps – personal powerlessness, the rejection of self-control and will
    power, reliance on a higher power or self defined God – are not beliefs that all are willing
    to subscribe to. Agnostics and atheists may find the invitation to a God-centered spiritual
    life unappealing, and this is addressed in a specific chapter in the original text of
    Alcoholic Anonymous, the Big Book. But for many, living the Twelve Steps is a
    remarkable healing and living process, freeing them from the misery of diverse
    Timothy B. Conley, Ph.D.
    See also Alcoholics Anonymous, Big Book, Bill W., Support Groups, Twelve
    Further Reading
    Alcoholics Anonymous (2007). Alcoholics Anonymous. Retrieved May 22, 2007,
    White, W.L. (1998). Slaying the dragon: The history of addiction treatment and
    recovery in America,, Chapter 16: The program of alcoholics anonymous.
    Bloomington, IL: Chestnut Health Systems

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