Connecticut State Department of Mental Health and Addiction Services

Twelve-Step Facilitation

Contact:  Harry Gerowe, MS, LADC, CCDP, SCPG.  Email: harry.gerowe@ct.gov

Twelve-step facilitation is an active engagement strategy designed to increase the likelihood of an individual becoming affiliated with, and actively involved in, 12-step self-help groups. The efficacy of 12-step programs (and 12-step facilitation) in supporting persons struggling with alcohol dependence has been established. DMHAS recognizes 12-step facilitation as an evidence based practice (EBP) and this practice is embedded throughout the Department of Mental Health and Addiction Service’s continuum of care.

Background Information:

History of the 12 Steps

Alcoholics Anonymous and the 12-steps began in June of 1935, during the great depression. Bill Wilson founded the organization after discovering his Higher Power while detoxing in a Manhattan drug rehab center, which resulted in the 12 steps and traditions, which are at the heart of AA. Wilson had no formal medical or psychology training; instead, the 12 Steps were created by combining ideas from philosophy and religion.  He condensed these ideas into a concise list with a structure inspired by the Bible.

The Alcoholics Anonymous book, also known as “The Big Book”, has since become the foundation of addiction treatment. Today, an A.A. presence can be found in approximately 180 nations worldwide, with membership estimated at over two million. There are more than 123,000 A.A. groups around the world and A.A.’s literature has been translated into over 100 languages.  Anyone who is recovering will undoubtedly encounter Wilson’s system as they work their way to recovery.

Alcoholics Anonymous is the largest of the different twelve-step programs.  The next largest group is Narcotics Anonymous (NA). The largest numbers of twelve-step members are in recovery for addiction to drugs or alcohol; however, the majority of twelve-step programs deal with other issues. An example of this is Al-Anon, the third largest twelve-step program which assists family members of individuals with an addiction.  Roughly twenty percent of twelve-step programs help those struggling with addiction. The other eighty percent deal with a variety of issues from mental health to debt.

These are the Twelve Steps as published by Alcoholics Anonymous (AA):

1. We admitted our powerlessness over our illness, or drugs and alcohol—that our lives had become unmanageable.
2. Came to believe that a Power greater than ourselves could restore us to sanity.
3. Made a decision to turn our will and our lives over to the care of our Higher Power.
4. Made a searching and fearless moral inventory of ourselves.
5. Admitted to our Higher Power, to ourselves, and to another human being the exact nature of our wrongs.
6. Were entirely ready to have our Higher Power remove all these defects of character.
7. Humbly asked our Higher Power to remove our shortcomings.
8. Made a list of all persons we had harmed, and became willing to make to them all.
9. Made direct amends to such people wherever possible, except when to do so would injure them or others.
10. Continued to take personal inventory and when we were wrong promptly admitted it.
11. Sought through prayer and meditation to improve our conscious contact with our Higher Power, praying only for knowledge of His will for us and the power to carry that out.
12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to drug and alcohol addicts, and to practice these principles in all our affairs.

Power of the Group

Individual therapy is effective, but according to psychologists, one of the best ways to change human behavior is to treat individuals with similar problems in groups.  In 1905 Joseph Pratt, a physician in Boston, was one of the first to note this occurrence. He began organizing tuberculosis patients into weekly groups meetings. Even though he initially thought the groups would teach members better hygiene, Pratt quickly realized group therapy provided members a beneficial emotional lift. He noted that by giving patients the chance to share their hardships with one another, “in a common disease, they have a bond”. More recently, a pair of Stanford University researchers identified why this group approach is so effective. After reviewing approximately 200 articles on group therapy their conclusion was that: “members find the group to be a compelling emotional experience, they develop close bonds with the other members and are deeply influenced by their acceptance and feedback.”

12-Step Effectiveness

According to Project Match, a multisite clinical trial of alcohol treatment at the University of Connecticut Health Center, “no single treatment is effective for all persons with alcohol (drug) problems. A more promising strategy involves assigning patients to alternative treatments based on specific needs and characteristics of patients”.

Project Match was conducted between 1989 and 1997 wherein more than 1,700 individuals suffering from alcohol dependence were assigned to one of the three successful drug treatment therapies used by professional drug rehab programs. The therapy used was called 12-step facilitation, wherein a licensed therapist assists clients through Bill Wilson’s 12-step method. The second was cognitive behavioral therapy (CBT) which teaches individuals with a substance use issue to recognize the triggers and situations that have led to relapse. By specifically identifying people, places and situations that have led to relapse, individuals can learn to avoid these compromising situations in the future. Finally, motivational enhancement therapy (MET) was incorporated. MET, currently referred to as Motivational Interviewing (MI), is an individual-therapy-interview process that strengthens a person’s reasons for maintaining recovery.

The final conclusion of Project Match was that all three of these therapies were about equally successful at reducing alcohol (drug) intake among participants.   12 step facilitation was substantially more effective at achieving total abstinence as compared to just limiting alcohol (drug) consumption.

* adapted from 12-step program, Cold Creek Wellness Center

12 Step Groups:

Linked below is a representative list of twelve-step groups based on the set of guiding principles for recovery that was originally developed by Alcoholics Anonymous (AA). The twelve-step method has been adapted widely by fellowships of people recovering from various addictions, compulsive behaviors, and mental health issues. Additionally, some programs have adapted the twelve-step approach in part.

12-Step Facilitation Resources

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