12-Step vs. Non-12-Step Recovery: Which Is Best for You?

Rehab is designed to provide structure as you begin the process of recovery. There are countless ways to heal, and it’s important to choose a framework that meets your specific needs. While many people benefit from 12-Step rehab programs, others prefer a more holistic approach to addiction treatment.

Recent research shows that 12-Step programs have a hugely positive impact,¹ and may even be “the most effective path to abstinence.” However, there is some question as to why this is true. For example, 12-Step programs offer social support,² which is essential during recovery, but is not unique to this philosophy. At most inpatient rehab programs, you’ll be able to build community with or without following the 12 Steps.

It’s also important to note that spirituality is a component of every 12-Step program. If you’re not interested in faith-based recovery, these groups may not be right for you. Various rehab facilities offer different 12-Step groups, such as A.A. and N.A., as well as non-12-Step programs. Before choosing which residential rehab you’ll attend, it’s best to learn as much as you can about the available options.

What Is 12-Step Recovery?

Alcoholics Anonymous is the best-known 12-Step program.³ A.A. is “an international fellowship of men and women who have had a drinking problem. It is nonprofessional, self-supporting, multiracial, apolitical, and available almost everywhere. There are no age or education requirements. Membership is open to anyone who wants to do something about his or her drinking problem.”

Members of A.A. attend group meetings,⁴ most of which have a similar format: initial announcements are followed by a reading of the 12 Steps⁵ and the 12 Traditions.⁶ Then a member will share their story. This may be followed by a group conversation, or more structured time for other members to describe their experiences. This structure is simple but effective. As one member writes, “I always feel a little better after it’s over.”

Many 12-Step groups follow similar formats, such as Narcotics Anonymous, Cocaine Anonymous, Marijuana Anonymous, and Al-Anon, which is intended for people who love someone who struggles with substance misuse. These groups define the 12 Steps slightly differently, but all share a similar philosophy.

The 12 Steps

The 12 Steps are a list of actions that group members undertake during the process of recovery. In this process, members normally begin by admitting they have a problem. Then, you’ll connect to a higher power, sometimes called “God as we understand him.”⁷ Although 12-Step groups are historically rooted in Christianity, they welcome people of all faiths, including people who don’t ascribe to a specific religion. Nevertheless, the spiritual aspect of this philosophy isn’t right for everyone.

In the process of connecting with a higher power, members then make “a searching and fearless moral inventory”⁸ of themselves and their lives. This ruthless honesty lays the groundwork for the great changes that come with recovery. By admitting your struggles to yourself, to another person, and to your version of a spiritual source, you may come to a new understanding of your emotional experience.

In Step 9, participants seek to make amends⁹ to any people they may have hurt, “except when to do so would injure them or others.” Through this process, members begin to consider the effects their actions have on their communities. There is a difference between intent and impact. As you learn more about yourself, you’ll also learn how to meet your needs in a healthy way, while participating in a supportive community.

One goal of the 12 Steps is to achieve a spiritual awakening. Step 12 refers to this directly: “Having had a spiritual awakening as the result of these steps,¹⁰ we tried to carry this message to alcoholics, and to practice these principles in all our affairs.” Members are encouraged to meditate, pray, and cultivate an ongoing spiritual practice.

In these groups, you’ll be encouraged to “work the steps” throughout the process of recovery. As you encounter new challenges, you may return to the steps again and again, not always in numerical order. In stressful times, these strategies can help you focus on your goals, avoid relapse, and make the healthiest choices available. The 12 Steps are more than a checklist; they can become a way of life. However, the steps themselves are just one component of recovery. The social aspect of 12-Step groups is also an essential part of the process.

Social Support in 12-Step Programs

Experts agree that social support—or a lack thereof—has an extremely significant impact on people with substance use disorders.¹¹ Some researchers have even postulated that “opioid addiction serves as a substitute for social attachment.” In one study, a subgroup of substance users exhibited “severe negative affect and intense craving” when exposed to perceived social rejection.

This evidence suggests that without community, people in recovery may be especially vulnerable to cravings. Whether or not those cravings lead to relapse, one thing is clear: strong interpersonal relationships are an important part of healing. Because 12-Step groups include a built-in community of people on a similar journey, they may help members get the support they need. Programs like A.A. even encourage members to become sponsors,¹² actively supporting people at earlier points in the healing process.

In most residential rehabs, you’ll be in a cohort of people who share some of your life experiences. If your program is based on the 12 Steps, you’ll have even more structured opportunities to give and receive peer-to-peer support. For example, the program at Genesis House is firmly rooted in this philosophy. They treat substance misuse as “a three-fold disease: spiritual, physical, and emotional.” Residents are introduced to the 12 Steps as soon as they arrive. They continue to engage with the steps in individual therapy, and in the evenings they “are transported to local AA/NA meetings…where they will network with others in recovery and learn more about how to stay sober.”

What Is Non-12-Step Recovery?

Although 12-Step groups are extremely valuable for some, they’re not the only way to get community support. One study found that “social networks that support recovery lead to enhanced treatment outcomes and sobriety¹³ regardless if this support stems from family, peer groups, or 12-Step programs.”

Non-12-Step programs are ideal for people who don’t ascribe to a spiritual practice, or those who simply want a different kind of structure. There are countless approaches to recovery from substance misuse, such as evidence-based treatment, individualized treatment, and experiential therapy. And even without faith in a higher power, it’s possible to heal in a holistic way.

For example, The Holistic Sanctuary in Baja California is a rehab facility with a “natural holistic healing program.” Clients do yoga, receive daily massages, and eat an organic diet. This approach “involves healing the patient’s spiritual health through meditation, catering to their physical health through exercise, and improving their psychological wellbeing through counseling.”

There are as many ways to heal as there are people with substance use disorders. Many clients benefit from a combination approach, attending 12-Step groups while also participating in different therapeutic modalities.

“In the same way that medicines and psychotherapy can go together, AA and 12-Step can go together with in-depth psychotherapy and medications when indicated.”

– Dr. Thomas Gazda, Medical Doctor, Soberman’s Estate