The Therapeutic Effects of the 12 Steps

True Self

By Allen Berger, PhD

The Twelve Steps of Alcoholics Anonymous have been heralded as the most important spiritual development of the past 100 years. It is my opinion that they should also be considered one of the most innovative psychological interventions of the past century. As evidence, consider the fact that the Twelve Steps have had more success in treating a wide variety of addiction problems than all other medical or psychological intervention or treatment programs combined.

What are the therapeutic forces that enable the Twelve Steps to help so many people who are struggling to reclaim their lives? My conclusion is that the Twelve Steps help us recover our lost true-self. They provide a framework that helps us work out a new understanding of ourselves and that teaches us a design for living that encourages authenticity and responsibility. This new design for living honors our basic nature. Working the Twelve Steps creates a powerful personal transformation that leads to a deep sense of well-being, serenity, and peace of mind.

A main source of much of our psychological distress stems from the belief that we need to be something we aren’t — that is, attempting to live by the unreasonable demands of our false-self. We have alienated ourselves from our true-self in favor of an idealized version of who we should be. We’ve lost sight of the importance of character, people-centered values, keeping our integrity, authenticity and honesty, and honoring our true-self. We’ve made things more important than people.

This is the veer in the trajectory of our personal development that the Twelve Steps correct. The Steps help us wake up from the trance that our culture has created. They help us deconstruct our reliance on a false-self and guide us on an incredible journey of self-discovery and self-actualization. They help us clean house and make amends to those people we have hurt. They help us stay centered, grounded, and humble. They help us become authentic and present in our lives. They help us restructure our self-concept into something more positive, solid, and flexible. They help us recover our true-self.

Abraham Maslow made the following observations about the importance of a basic need like self-actualization:

  • The absence of self-actualization breeds illness. (The absence of our true-self creates serious problems; it becomes a breeding ground for addictions and other forms of psychopathology.)
  • The presence of our true-self prevents illness. (This is the most important protective factor against alcoholism and other drug addictions.)
  • The restoration of the true-self cures illness. (This is the experience millions of us have had in recovery: our true-self is restored through working the Twelve Steps.)

The Organization of the Twelve Steps

The Twelve Steps are numbered for good reason. The optimal therapeutic benefit occurs when they are worked in order, because the Steps are interdependent. Each Step builds on the one that precedes it to create a powerful transformative experience. What happens in Step 1 creates an experience that readies a space in our psyche for what happens in Step 2. Step 2 leads to what happens in Step 3, and so on. This is how change unfolds across all Twelve Steps. The Twelve Steps create a momentum that motivates us to honestly face ourselves and others like we have never done before.

Grouping the Steps

We can cluster or group the Twelve Steps into four functional groups. Steps 1-3 form the first grouping. These Steps demolish the foundation of our self-destructive life, the one that didn’t work, and build a stronger and more resilient foundation for a new life that works under any condition whatsoever.

Steps 4-7 form the second grouping. These Steps help us develop a positive self-concept by encouraging authenticity and promoting self-awareness and personal accountability. They help us to become our best possible selves.

The third grouping, which consists of Steps 8 and 9, helps us become trustworthy by righting the wrongs we have done to others. They teach us the nature of healthy relationships and to aim at having the best possible attitude toward human relations.

The last three Steps, Steps 10-12, form the final cluster. These Steps help us maintain our new way of life. They continue to promote self-awareness, self-realization, and emotional maturation through serving others and an ongoing program of personal and spiritual growth.

The process of working the Steps is like constructing a building from the ground up. You’d work in intervals and wouldn’t move on until the previous job was completed. First, you’d demolish the old foundation because it was faulty, weak, and unable to support the new structure you hoped to build. Next, you’d dig a foundation and strengthen it with mortar and steel, and then you’d build the frame. In the meantime, you would constantly provide necessary maintenance to keep what you already built in good shape. In construction, it’s essential to use the best talent and materials available. You wouldn’t build something halfheartedly. And so it is with working the Steps. The Steps must be worked to the best of our abilities if we are to gain their full benefits.

The Steps facilitate a restructuring of the self. They help us find meaning in our lives and in our recovery by changing our emotional and spiritual values.

Allen Berger, PhD, is a popular public speaker and nationally recognized expert on the science of recovery, is the author of 12 Stupid Things That Mess Up Recovery and 12 Smart Things to Do When the Booze and Drugs Are Gone.

17 Responses

  1. Joe C. says:

    Hey Allen, I hope you’re checking the comments because I have a quick question. You make a stunning and compelling argument: “As evidence, consider the fact that the Twelve Steps have had more success in treating a wide variety of addiction problems than all other medical or psychological intervention or treatment programs combined.”

    This is rather compelling; where does this evidence come from? I count myself as a 12-Step fan (but not fanatic). It would be very useful to point skeptics in the direction of any studies or stats that do a running tally of 12-Step success.

    Right now, about 23 Million Americans identify with being in recovery from some substance – booze or drugs (SAMHSA). 1.3 million of those are in AA; maybe there’s another million in NA, CA, MA, PA, etc.

    Of course many AA (and other 12-step) successes have passed away, crossing the finish line clean and sober. I don’t know if there are numbers on all the people who have overcome addiction since 1939 and how many of them can be counted in the 12-Step ranks. But are there numbers, say, just from this century that add up 12-step success and all other modalities?

    This data would be really useful.

    • Thomas B. says:

      Hey Joe,

      I just read your recent comment with a query for Allan Berger’s, regarding his article that was posted this week on AA Agnostica. I don’t have specific numbers that you asked about, but you might be interested in a related article published this week in the New York Times, AA and the Challenge of Evidence-Based Medicine, that dealt with the general effectiveness of AA.

      The article concludes that AA has been shown to be effective even when controlling for a selection bias statistical effect.

      • Suzanne T. says:

        Re: New York Times article on AA and the Challenge of Evidence-Based Medicine

        AA has two programs.
        1. Attend meetings for the rest of your life.
        2. Work the 12 steps and then focus on staying spiritually fit.

        Reality: very few people in AA work the steps.

        These studies are based on the Fellowship Program of how many meetings do you attend.

        My biggest concern for the alcoholic, non-theists of the world is where do you find a sponsor who can guide you through the Big Book (written by obvious Bible Bangers) so they can benefit from the steps, recover and experience the promises coming true in their lives.

        Bill W. stayed away from the disease concept because he didn’t want to get caught up in controversy. I think it’s a good approach because there’s so much we don’t know about alcoholism and effective treatment. And I share Bill W’s hope that someone will develop a better program and maybe even a cure.

        So just like the debate about God can keep us from working the steps, so can the debate about alcoholism.

        I’m staying sober the old fashioned way, before there were meetings and a fellowship. I’m not staying sober on meetings. My “AA” service is to sponsor people through the steps. It’s a joy beyond words to watch alcoholics and addicts transform and to be a part of that process. And I learn and grow as much or more than my sponsee through the process.

        And I am part of a dying breed…

  2. John L. says:

    It’s fair to say that this article represents the “psychogenic approach”, as opposed to the “biogenic approach” as put forward by Dr. James Milam in the book, Under The Influence. To Milam (and me) alcoholism represents a physical addiction to a drug, ethyl alcohol. Our first priority in recovery is not improving our spirituality or getting rid of character defects — it is staying away from the First Drink. Once we are getting better through abstinence, we have many areas of recovery to work on: financial, social, intellectual, and physical. These areas of recovery are not addressed by the Steps.

    I think the Steps can be helpful or can be harmful. They are sufficiently vague that “working” them can be alsmost anything. My own take on them is far more negative than Allen Berger’s: A Searching and Fearless Inventory of the A.A. Steps Themselves.

  3. Suzanne T. says:

    Thank you Roger for this excellent article and for introducing me to Dr. Berger. I agree with this article because of the amazing transformation I experienced working the steps. I stopped therapy while working the steps and after amends with my family I returned to my therapist. After an hour interview/appointment she said:

    “You have made more progress working the steps than you could have made with another 20 years of therapy. I don’t think you need therapy now and my door is always open if you need me.”

    Later I met a psychiatrist at a clean and sober Christmas Party. He was not “one of us” and when he discovered I wasn’t an AA Jesus freak he asked if I would take him thru the 12 steps so he could see what they are and how you work them. So we got together and when we were done I asked:

    “Aren’t you concerned about your job security? If people discover how effective this is and it’s free, why would they pay you guys thousands of dollars a year?”

    His reply is really insightful. He laughed and said:

    “Suzanne, I’m not worried at all. My patients would never work this hard.”

    I must say years later I’ve come to realize it was only out of the deep muck and mire of my hitting bottom that I was so totally humbled I was desperately looking outside myself for answers. So I worked the steps as thoroughly as I could. The steps are a journey within, a place I was terrified to go, but I had to do the work for fear I would drink again if I didn’t.

    One big thing I discovered and experienced, not mentioned in the article above, is I also got my freedom. In the 4th column of the 4th step I had a big Blinding Flash of the Obvious that the more I can identify my part in a problem, crisis etc. the more power I gain because I can change my behavior and reactions in the future. That insight and discovery melted my victim hood to the floor.

    I haven’t experienced self pity for decades.

    I don’t think many people in AA actually work the steps… as in do their major amends. Many people manage to stay sober on AA meetings and their lives get better.

    I remain so grateful to the 12 steps because I couldn’t stand living with myself the way I was before I did the work.

  4. Tommy H says:

    Well put.

  5. Laurie A says:

    “According to our founders alcoholism is a disease.” Really?

    Bill W., gave a talk to the National Clergy Conference on Alcoholism in 1960. Father X: “I notice you do not use the word disease. Do you intend to make any distinction between disease and illness?” Bill W: “We AA’s have never called alcoholism a disease because strictly speaking it is not a disease entity… we do not wish to get in wrong with the medical profession by pronouncing alcoholism as a disease entity. Hence we have always called it an illness or malady, far safer terms to use.”

    The Big Book, chapter five, likens alcoholism to “other forms of spiritual disease” – which is the only mention of disease in the first 164 pages. If I were diagnosed with e.g. tuberculosis and the physician said, “Your only hope of recovery is a spiritual awakening”, I’d demand a second opinion. As an agnostic I’ve always understood my alcoholism in psychological terms and am happy to call it a spiritual malady. Certainly it is not healthy to drink oneself into an early grave. For AA, whether or not alcoholism is a clinical disease is a Tradition Ten outside issue.

    John Crossan has explained the differences between disease and illness/sickness (I can be ill or sick but not necessarily be suffering from a disease). In Jesus: A Revolutionary Biography, he wrote: “Medical anthropology or comparative ethno-medicine has proposed a basic distinction between curing a disease and healing an illness.” He quotes Leon Eisenberg:

    Patients suffer illnesses; physicians treat diseases. Illnesses are experiences of disvalued changes in states of being and in social functions; diseases in the scientific paradigm or modern medicine are abnormalities in the structure and function of bodily organs and systems… Our success in dealing with certain disease problems breeds then ideological error that a technical fix is the potential solution to all… it is essential to enquire how we can expand our horizons to incorporate an understanding of illness as a psychological event. Indeed, our worship of restricted and incomplete disease models can be viewed as a kind of ritual or magical practice in itself.

    Crossan also refers to Arthur Kleinman, viz: “The key axiom in medical anthropology is the dichotomy between two aspects of sickness: disease and illness. Disease refers to a malfunctioning of biological and/or psychological processes, while the term illness refers to the psychosocial experience and meaning of perceived disease.” Crossan adds,

    A disease is, to put it bluntly, between me and my doctor, and a bug… Disease sees a problem, unrealistically, on a minimal level; illness realistically on a wider level… A cure for a disease is absolutely desirable, but in its absence we can still heal the illness by refusing to ostracise those who have it, by empathising with their anguish and by enveloping their sufferings with both our respect and love.

    Which is what we do in AA.

    • Jack G. says:

      Thank you for that! I have never been comfortable with the disease theory of Alcoholism. I know that some people find it comforting in some way; “I have a disease”… I know it’s not a disease. It’s a behavior. The 12 steps are a suggested path to Live sober. They can be modified, personalized, edited, etc. They have existed in some form for many thousands of years. The contribution of Bill Wilson is merely a codifying of sorts.

    • Joe says:

      Thanks Laurie. One of the reasons I sought out non-God AA was specifically related to the disease theory of alcoholism expounded by Joe and Charlie in their 10-hour Big Book Study recording. I was given it, along with all the work sheets, by a Back To Basics fellow member at a F2F meeting. She wanted me to sit down with pen and paper and take careful notes on everything they said. I should not listen to the recording as I drove or ate or did any distracting activity. I should treat their words with reverence.

      I did this up to the part when Joe and Charlie started talking about the process whereby ethanol is converted to acetone and the alcoholic’s addictive nature being linked to his/her inability to process acetone effectively.

      From my limited understanding, this is not the explanation adopted by modern medical professionals.

      At this point, I put down my pen and stopped listening to Joe and Charlie. My quest then started for AA without the need to believe AA ‘scripture’ without question. I knew I was not going to be able to discuss my concerns about the scientific accuracy of J&C’s disease model of alcoholism with the person who gave me the recording. She would take my questionning as an indication that I had not spent enough time on my knees!

      Thus, having found aaagnostica and online agnostic groups, I am changing in my attitude. ‘Illness’ or ‘malady’ are the words I use when talking about alcoholism to newcomers. I avoid the term ‘disease’ because, as you rightly say, Laurie, it is precluded by Tradition 10 and, not being a medical professional, I cannot personally comment with any authority on medical matters.

      Thank you for taking the time to share your thoughts.

      • Laurie A says:

        Best we stay out of this controversy, none of our business and side-tracks us from Tradition Five. AA’s critics – Stanton Peele (The Diseasing of America), Ken Ragge (The Real AA), Jeffrey Schaler (Addicition is Choice) et al – scorn the disease theory of addiction. One school of psychologists asserts that problem drinking is learned behaviour and as such can be unlearned.

  6. Russ H says:

    After many years of exposure to the 12 Steps in AA I continue to believe what I believed when I first saw them. They are not about sobriety. They are about character building. The principles of self-examination, restituion, compassion, kindness, accountability and turning outward toward others seem to be universal. I am utterly unconvinced that working the steps in order is important. Nor do subscribe to the notion of any “higher” power other than our own higher selves. The assertion that the 12 Steps are a “treatment” for addiction or anything else is specious. In AA we don’t treat our alcoholism – we simply abstain from a substance that we finally understand is dangerous to our mental and physical health. Many of us do undertake character building (12 Steps or otherwise) and experience wonderful consequences. But addiction is not a “disease of character” and hence cannot be “treated” by character building.

  7. Rob says:

    Where is the statistical analysis to substantiate the claim of success of 12 step programs beating all other treatment options combined?

  8. Illona says:

    Fascinating question: “…is alcoholism maybe a moral disease?” When the ways we behaved outside of a higher sense of consciousness, during our inebriation, were often morally corrupt, it does make one stop to consider this question. It is a question I would have fought tooth and nail prior to taking on the 12 Steps, but which question I look at in a contemplative way now. Thank you for this observation, life-j. And a bow to you, Roger, for sharing this reprint. It’s good to be reminded of the egg-within-the-egg aspect of shedding layers of the false self in order to come to what is authentic and of depth in ourselves and then taking the learning of it outward.

  9. Ann M. says:

    I worked the steps out of order because I absolutely could not believe I could be “restored” to sanity, since I had never been sane in the first place. I was planning suicide at the age of 8 or 9. And I had no belief in any kind of a Higher Power. It was not until I started doing the rest of the steps and slowly began to feel better, that I was able to look at the 12 step program itself and make that my Higher Power.

  10. Thomas B. says:

    Excellent article – thanks so much Roger and Allen for this preceptive article, which demonstrates the generic effectiveness of the 12-step process that draws on universal humanist, ethical and moral principles relevant to all of humanity. It effectively transcends and translates the doctrinaire god-language of early 20th century, predominantly Christian America into a rational and universal application that is relevant to all seeking recovery from addiction, whether of different beliefs or no belief. This article essentially broadens and deepens the effectiveness and truth of the prevalent saying heard around AA rooms, “It works if you work it !~!~!”

  11. life-j says:

    Essentially I would say this is a correct point of view of the 12 steps. Only I would of course have liked to see a more critical approach to the god parts. There are even further questions as this relates to alcoholism: If alcoholism is not a moral failure – according to our founders it is a disease – then what is it going to help to do a moral inventory? Well it does help, as we know. This article sort of provides a clue – is alcoholism maybe a moral disease?
    There are passages in the big book that are brilliant. Descriptions of alcoholism don’t get any better than the beginning of chapter 3, even its style is hard to beat, but so much else is such a mess logically.
    But for starters this is still a pretty good description of how the steps work.

    • Jeb B. says:

      Step four is not an inventory of morals or morality; it is a moral inventory, an honest inventory, as opposed to a dishonest inventory. Bill’s choice of words was frequently misleading. Another example is “We will not regret the past…” The only definition that fits the context is “mourn the loss of; poignantly miss…”

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