12 Step Under the Microscope

The 12 Steps, under the Microscope
Twelve-Step treatment and recovery support likely will never be able to shed all criticisms directed its way. But one clinical psychologist and retired college instructor believes no one should be able to argue successfully that Alcoholics Anonymous (AA) and its principles have not undergone rigorous research.

That certainly had been true in the late 1980s when the Institute of Medicine (IOM) pointed out the lack of an evidence base for 12-Step approaches, but Joseph Nowinski, PhD, says that analysis fueled substantial research that now forms the content of his new book, If You Work It, It Works! The Science Behind 12-Step Recovery.

The Hazelden Publishing book is targeted largely to a general-interest readership, but Nowinski believes its straightforward accounting of major studies will prove useful to addiction professionals as well.

“It can help them to understand why they are sending someone to AA,” says Nowinski, who operates a private practice near Hartford, Conn. “I don’t like to go to a doctor who wants to give me a particular treatment and can’t explain why he thinks it’s going to work.”

Nowinski himself played an integral role in one of the most prominent studies comparing 12-Step and other approaches in the treatment of addiction. Yale University researchers in 1990 asked Nowinski to design an alcohol treatment program based on the 12-Step model. His “12-Step facilitation” intervention would be used in one of the three treatment arms in Project MATCH, a highly cited study in which nearly 2,000 individuals with an alcohol use disorder received either 12-Step facilitation, cognitive-behavioral therapy (CBT) or motivational enhancement therapy (MET).

The researchers found that all three treatments succeeded in promoting abstinence and reducing overall drinking at periods from three to 12 months post-treatment. In addition, 12-Step facilitation was reported to be as helpful to persons with an alcohol abuse problem as it was for those with more severe alcohol dependence.

Nowinski’s book focuses on crucial elements that enhance the success of 12-Step treatment and/or support once an individual decides to pursue that route. He considers these factors particularly critical:

• Consistent attendance at some 12-Step meetings. Research has shown that attending two to three meetings a week will yield a 70% probability of maintaining long-term sobriety five years post-treatment.

• Having a 12-Step sponsor, with particular importance on securing one in the first few months of recovery.

• One’s perception of one’s place in the 12-Step group. Research has indicated that the most actively engaged members who truly identify as being part of the group tend to have the best outcomes.

Nowinski, who also pens a blog for Psychology Today, says he becomes the target of criticism on many occasions when he writes about the 12 Steps. He sees several reasons why this remains such an incendiary topic.

“One is that AA has grown and grown—it is ubiquitous,” he says. “Anybody who feels they have a different approach sees it as competition.”

Another reason involves AA’s practice never to respond directly to criticism, based on its traditions that reinforce anonymity. “AA does not have a public relations office,” Nowinski says. “It is an easy target.”