12-Step and Peer Intervention

What is a 12-step or peer recovery group?

There are many paths to recovery from substance abuse, and one that has been used by many people in their journey to recovery is 12-Step and mutual/self-help groups. These groups include Alcoholics Anonymous (AA), Narcotics Anonymous (NA), Cocaine Anonymous (CA), Smart Recovery and a number of other faith-based or independent peer-led support groups.

These groups have served as a primary source of support, but they have also been used as an addition to formal treatment options. That means that people can join a 12-step or peer support group at any time in their treatment journey and may benefit from adding a group like this to their medication assisted treatment program and / or formal therapy or counseling.

What are the benefits of a 12-step or peer-led group?

Accessibility and cost is low: These groups are highly accessible and are available at no cost in communities throughout the world. This means that for many people in recovery, a 12-step or peer-led group is available, free, and convenient. For example, the AA General Service Office estimates that there are nearly 64,000 groups across the United States and Canada with 1.4 million members (Alcoholics Anonymous [AA], 2012).

In addition, AA, NA, and CA all have Internet-based “chat” rooms and online meetings that can be found easily by doing an online search (e.g., “online NA meetings”). This allows people to access support at any time 24/7, and can be a useful supplement to attending in-person meetings or other therapeutic activities.

Fellowship and support: A major factor that appears to be most helpful with 12-step, faith-based, or other peer-led groups is the “fellowship” or sense of community and support experienced by members. By participating in meetings, members are able to give and get support to each other – a powerful experience in helping people make positive changes in their behavior. Members are also able to meet others who are struggling with similar issues, as well as members who are more established in their recovery. This creates an environment where people further along in their recovery can help those just starting out.

Often, people who abuse substances for a while begin to primarily interact with people who also abuse substances. Fellowship offers members a chance to meet and interact with sober people (or those who have a goal of sobriety). This expands a person’s social network and allows for new experiences, like interacting in a social setting or celebrating a milestone without using substances.

What can I expect from one of these groups?

12-step groups like AA, NA, CA or faith-based groups that use the 12-step model follow a specific format and have certain traditions and perspectives on recovery, such as:

  • The only requirement for membership in 12-step group is a desire to stop using drugs.
  • There is a strong emphasis placed on service and helping other members get and stay sober.
  • The 12-step philosophy emphasizes the importance of accepting addiction as a disease that can be treated but never eliminated. That means that 12-step groups have the belief that addiction is a disease that requires a lifetime commitment to fighting.
  • 12-step groups focus on getting and maintaining sobriety by agreeing not to use drugs, to go to meetings, to ask for help, to get a sponsor, and get active in working through the 12-steps. These steps are intended to help members:
    • Enhance maturity and spiritual growth
    • Minimize self-centeredness and provide help to other individuals who are addicted (e.g., sharing recovery stories in group meetings, sponsoring new members, etc.
    • Admit powerlessness over drugs and ask for help from a higher-power of their choosing
    • Take a moral inventory of their wrongs / regrets
    • Make a list of individuals that the member’s substance use and behavior has harmed, and make amends to those people
    • Stay involved in substance free activities and find a social network that supports sobriety

If a 12-step program sounds right for you, search for meeting in your area at: SEARCH HERE

Smart Recovery is a different type of peer-led support group from AA or NA. It is a recovery program that uses a 4-point system to help people get and maintain sobriety.

  • Smart Recovery is based on Cognitive Behavioral theory and focuses on providing group members concrete skills, while also providing support and helping individuals increase their sense of empowerment and self-reliance.
  • Unlike 12-step groups, members do not have to admit to being powerless over their drug use or believe in a higher-power of their choosing.
  • Unlike 12-step groups, “cross-talk” and discussion is encouraged during meetings.
  • Groups are held in-person but they also include and encourage daily online meetings and participation in a 24/7 message board or Smart Recovery chart room where people in Smart Recovery can discuss struggles, successes, and ask questions of other people in recovery around the world.
  • Because Smart Recovery is based on Cognitive Behavioral Therapy (CBT) there are peer facilitators in each meeting, and every meeting has a specific topic or agenda that is followed.
  • Facilitators can be anyone who has completed a Smart Recovery facilitator training.
  • Groups are set-up to provide education, support and open discussion around the following core areas:
    • Building and maintaining motivation to change
    • Coping with urges to use
    • Managing thoughts, feelings and behaviors
    • Living a balanced life

If a Smart Recovery group sounds right for you, search for meeting in your area : SEARCH HERE

How effective are 12-step and peer-led groups?

Many research studies have been conducted to look at the effectiveness of 12-step and peer-led groups. In general, more positive outcomes have been found when people attend at least one meeting per week, and greater effects have been found for people who attend 2-4 meetings per week.

Positive effects appear to be closely tied to attendance and group involvement. In other words, the more meetings attended and the more involved in the “fellowship” a person is, the more likely they are to achieve and maintain sobriety. In general, studies have indicated that those who attend at least one group per week achieve an average amount of sobriety of 5 years. Other effects of peer-led group membership have included:

  • Improved social and psychological functioning
  • Improved sense of empowerment and skills for coping with urges to use (Smart Recovery)
  • Greater levels of self-efficacy (feeling capable and able to cope with life stressors effectively)
  • Larger social circle of sober peers and greater commitment to and sense of community

Who may need something other than a 12-step or peer-led group?

These types of programs may not benefit everyone as fully, or in the same way, as others. For example, women, youth, ethnic minorities, and those diagnosed with a substance use and a psychiatric disorder may not benefit from 12-Step and peer-led group participation in the same way.

Women may resist the notion of powerlessness, the requirement of asking for help from a higher power, and admitting to past wrongs because they have experienced historical or social oppression and discrimination. Also, women may feel uncomfortable in mixed-gender groups, making open meetings feel less welcoming and decreasing the likelihood that they will attend regularly and get the support they need.

To better accommodate this, many 12-Step programs and other peer-led groups offer women’s-only groups that may be seen by women as more welcoming and supportive. Also, Smart Recovery and Women for Sobriety are programs that provide mutual-support approaches that differ from 12-step programs in structure, format, and philosophy and do not require admitting powerlessness, or the need to believe in a higher power.

Youth may struggle with regular attendance in 12-step and peer-led groups for many reasons. Some reasons include the fact that attendance in these groups by people under the age of 30 tends to be less than 2% nation-wide. That means that youth may feel they cannot relate to group members as well as peers their age. Another issue that is hard for youth is accepting the concept of never using again. Part of that difficulty is related to adolescent brain development and difficulty thinking far into the future. Other issues include logistical barriers (e.g., transportation), lack of interest in spiritual matters, and difficulty relating to some of the accumulated consequences of use that older members may discuss as reasons to seek and maintain abstinence from substances.

To accommodate this, some chapters of AA, NA, Smart Recovery, and other faith-based groups may have a separate youth program to better meet the needs of adolescents and provide greater relatability for members.

Ethnic Minorities, like women, may bristle at the notion of powerlessness inherent in 12-Step programs because of past societal oppression, or they may have trouble accepting the notion of addiction as a disease. Also similar to what was described above, ethnic minorities may view group meetings comprising primarily of White members as less welcoming and supportive to their experiences and needs.

Despite these concerns, research suggests that ethnic minorities who choose to participate in 12-step or other peer-led groups may experience benefits comparable to those of White members.

Individuals with dual diagnoses (psychiatric conditions) often have more and greater challenges in their recovery process and poorer outcomes than individuals with a substance use issue alone. This means that people with other psychiatric issues, such as depression, anxiety, PTSD, schizophrenia, and others may need a specialized or more comprehensive treatment program to achieve and maintain recovery. Medication assisted treatments, psychiatric, and individual therapies are recommended to help people with a substance use and a psychiatric condition treat both issues at the same time. Also, people with dual diagnoses may have trouble relating to others in the group who do not have a psychiatric condition, or they may perceive stigma because of their symptoms and/or diagnosis. This does not mean that dually diagnosed individuals can not benefit from membership in 12-step and peer-led groups, but they may choose to participate in these groups as an additional or adjunctive treatment and not as a stand-alone program.

To accommodate this, some communities may offer specialized 12-step or peer-led groups for dually diagnosed, such as Double Trouble in Recovery (DTR) or Dual Recovery Anonymous. These types of groups may help individuals with dual disorders feel more comfortable and safe discussing their dual recovery needs and their use of psychotropic medications as part of their ongoing treatment.

To find a peer-led support group near you, use the Network of Care Search.