Touted as the gold standard for recovery from addiction, the Alcoholics Anonymous model of 12-steps remains the go-to route for treatment. However, if substance abuse treatment should be evidence-based, where’s the evidence backing up the success of the 12-step program? That’s why the endless debate between group therapy vs. 12-step programs remains today.
Both alternatives are valid options, often incorporated in many forms of addiction treatment programs. One follows a more technical approach, while the other offers a peer-support environment that’s undoubtedly valuable for addiction recovery.
Understanding Group Therapy
Substance abuse treatment professionals use different group treatment models to help patients through the different phases of recovery. However, each group therapy model has something unique to offer patients. All forms of group gatherings can be therapeutic. However, when we talk about group therapy, specific elements distinguish therapy groups from other types of groups.
For a group therapy gathering, especially for substance abuse treatment, it must be a limited group with a trained leader and intend to result in some type of healing or recovery from substance abuse. In addiction treatment, there are five models of group therapy:
- Psychoeducational groups teach about substance abuse in general.
- Skills development groups that hone the skills needed to break free of addiction.
- Cognitive-behavioral groups help rearrange patterns of thinking and also actions that lead to addiction.
- Support groups provide a forum where members can debunk each other’s excuses and still provide supportive change.
- Interpersonal process group psychotherapy or therapy groups allow patients to recreate their pasts in the here-and-now of a group setting to rethink the relational and other problems they have fled using addictive substances.
During treatment, therapists use a combination of the first four models. Still, this form of therapy won’t discuss multifamily and multi-couple groups. They do, however, focus on family relations as they affect and are affected by someone with a substance use disorder.
Read more: 10 Group Therapy Topics to Expect in Rehab
What are 12-Step Programs?
The founders of Alcoholics Anonymous (AA) created the 12-step model to set the guidelines to treat alcohol addiction. Today, countless programs stem from the 12-step principles, including Narcotics Anonymous, Debtors Anonymous, and more. Overall, this self-help program guides members through twelve steps to help them identify their needs and start growing in their recovery journey.
The 12 steps as defined by Alcoholics Anonymous are:
- We admit that we are powerless over alcohol and that our lives have become unmanageable.
- I came to believe that a Higher Power greater than ourselves can restore us to sanity.
- We decided to turn our will and our lives over to the care of God as we understood him.
- Made a searching and fearless moral inventory of ourselves.
- We admitted to God, to ourselves, and others the exact nature of our wrongs.
- We were entirely ready to have God remove all these defects of character.
- Humbly asked Him to remove our shortcomings.
- Made a list of persons we had harmed and became willing to make amends to them all.
- We made direct amends to such people wherever possible, except when to do so would injure them or others.
- Continued to take personal inventory and, when we were wrong, promptly admitted it.
- We sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying also for knowledge of His will for us and the power to carry that out.
- Having had a spiritual awakening due to these steps, we tried to carry this message to alcoholics and practice these principles in our daily lives.
Group Therapy vs. 12-Step Programs: Which One Is Better?
When it comes to group therapy vs. 12-step programs, there’s a big disconnect, mostly due to misinformation. Since professionals do not lead 12-step programs, these end up being self-help groups that follow a specific plan. Many people have an issue with the religious or spiritual aspect of 12-step programs, so they look for other alternatives like SMART recovery, for example.
Differences Between 12-Step Programs and Group Therapy
While both programs feature a group-setting approach, they couldn’t be more different from each other. 12-step programs focus heavily on self-help and are more voluntary than group therapy. Besides that, group therapy’s leadership aspect, structured by a licensed professional, marks the most significant difference.
|12-Step Programs||Group Therapy|
|Leadership||– Peer leader or someone in recovery|
– Leadership is earned over time
|– Trained professional|
– Appointed leader
|Participation||Voluntary||Voluntary and involuntary|
|Content||– Environmental factors|
– Emphasis on similarities among members
– Focuses on the here-and-now
|– Examines intragroup behavior and looks into extra group factors|
– Emphasis on differences and similarities among members
– Focuses on historical stories and the here-and-now
|Group goals||– Positive goal setting with behavioral-oriented goals|
– Focuses on the group as a whole and the similarities among members
|– Ambitious goals with immediate and individual goals|
– Focuses on individual goals as well as the group
|Uses psychotherapy techniques||No||Yes|
|Leader activity||Educator or role model||Responsible for directing the therapeutic experience|
A Combined Group and 12-Step Program Approach
While the evidence around 12-step programs is low, and even group therapy success rates are inconclusive, there’s a place for these therapeutic gatherings in rehab. The issue with both approaches is that results are self-registered, so it can be challenging to track results adequately.
Still, self-help programs do have a place in addiction recovery. Most drug addiction treatment programs encourage patients to participate in self-group settings during and after treatment. These groups are, without a doubt, helpful during the early stages of recovery. The added layer of community support can help people maintain abstinence from the addictive substance after rehab.
However, a combined group and 12-step approach is perhaps the most effective course of treatment. At first, group therapy provides patients with the necessary tools and strategies to manage and treat their addiction.
Also, group therapy, alongside individual therapy and other addiction treatment services, can effectively help someone overcome their addiction. Then, the addition of self-group programs offers patients a space to go when they leave formal treatment. For many recovering from addiction, finding a supportive environment to turn to can be challenging, especially if they have strained relationships with family members and friends.
Effectiveness of Treatment
Although evidence is limited and research can be skewed, studies are looking at the effectiveness of 12-step programs. The latest findings report the median length of abstinence by AA and NA members to be greater than five years. Of course, those who maintain regular meeting attendance can achieve and sustain longer-term abstinence. Of those, about 45% of AA members and 55% of NA members maintained abstinence for more than five years.
Special Populations Need Different Help
A question of concern is whether special populations can benefit as well from 12-step programs and group therapy settings as others. For example, women, youth, and people with co-occurring mental health disorders might not be apt to derive the same benefits from self-help groups as other participants.
Research states that women may not identify as strongly as men with 12-step programs. Partly because women resist the notion of powerlessness and surrender associated with the AA program. Interestingly, women only make about one-third of AA members.
Another particularity with women in self-help groups is their past experiences. Many women struggling with substance use disorders are victims of violence and sexual assault. Speaking about these experiences in a mixed-gender setting can be challenging and potentially dangerous to them. Thus, many therapists prefer women-only groups to offer a more welcoming, understanding, and supportive environment.
Less than 16% of AA and NA members are under 30, and less than 2% are under 21. Youth members don’t affiliate with 12-step programs, mostly because they don’t align with the idea of lifetime abstinence. They also lack interest in spiritual matters, don’t engage with 12-step group activities, and have difficulty relating to the program’s steps.
Instead, group therapy can offer a tailored approach to youth members that self-help groups can’t. Because group therapy occurs in small groups, therapists have the opportunity to draft and create a more targeted setting that will engage with youth members.
Individuals with Dual Diagnosis
People with co-occurring mental illness and substance use disorder have a more significant challenge in their recovery process. Because 12-step programs don’t have the guidance and support of a licensed therapist, it can be tricky to provide the right support to individuals with dual diagnoses. Of course, there’s evidence that 12-step programs can be beneficial to those with co-occurring disorders. However, the outcomes vary tremendously.
Some specialized self-help groups, like Double Trouble in Recovery (DTC) and Dual Recovery Anonymous, can offer a better environment for people with a dual diagnosis. These types of programs have higher levels of attendance than traditional self-help groups.
Still, for patients with these challenges, a combination of group therapy and personalized individual therapy is the best option. A group therapy session can be with groups that share very similar co-occurring mental illness.
For example, a therapist can gather a small group of people that struggle with addiction and schizophrenia simultaneously. This group will share relatable experiences, emotions, challenges, and thoughts that will allow the group-setting to be successful. Self-help groups are not regulated, so it’s impossible to section groups.
Finding Help for Addiction
Just like addiction affects everyone differently, there shouldn’t be a one-size-fits-all approach to addiction treatment. The discussion between group therapy vs. 12-step programs will likely never end. Both options offer a therapeutic environment with pros and cons. Some people might feel more inclined to follow the principles of 12-step programs, while others have difficulty with the spirituality aspect of it. Having options is the best course of treatment.
At Lighthouse Recovery Institute, our therapists develop personalized treatment programs for our patients. Our rehab programs also incorporate research-based treatment, including group therapy, individual therapy, and more. We also encourage our patients to attend 12-step programs to promote their recovery and offer them a safe space to attend after leaving our premises.
So, if you or someone you know is struggling with drug and alcohol addiction, please contact us for help. Our admission specialists are always available to answer any questions you may have about our treatment center. We know that you have the power to win this battle against addiction, and we’ll be here cheering you on every step of the way.
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Daley, D. C., Stuart Baker, M. A., Donovan, D. M., Hodgkins, C. G., & Perl, H. (2011). A Combined Group and Individual 12-Step Facilitative Intervention Targeting Stimulant Abuse in the NIDA Clinical Trials Network: STAGE-12. Journal of groups in addiction & recovery, 6(3), 228–244. https://doi.org/10.1080/1556035X.2011.597196
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NIDA. 2020, June 1. Where do 12-step or self-help programs fit into drug addiction treatment?. Retrieved from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/where-do-12-step-programs-fit on 2021, March 10