Does the 12-step therapy work to quit alcohol?

BarcelonaWe've seen it in countless movies: "Hello, my name is So-and-so and I'm an alcoholic." We know the acronym for Alcoholics Anonymous (AA) and what it stands for. But what we might not know is that behind these initials – and this recurring phrase – lies a twelve-step therapeutic method that two men from Ohio created in 1935 and which, since then, has helped millions of people worldwide. This method is applied today in 68 countries, including Spain, where there are up to 586 active groups of Alcoholics Anonymous (AA). A study by Harvard Medical School and Massachusetts General Hospital concluded in 2020 that this twelve-step AA therapy "is more effective than other established treatments for increasing abstinence" and improves outcomes particularly "in the long term," helping people stay sober for longer. The survival and constant global expansion of this system for nearly a century also attest to its effectiveness.

However, when reviewing the twelve specific steps proposed by the method, some of them grate from a scientific point of view. The first point is clear: "admitting we were powerless over alcohol," a necessary step for any therapy (admitting there is a problem). But the second is no longer so clear: "believing that a Power greater than ourselves could restore us to sanity." And other points – not all of them – also exude a religious air inherited from their origin: the more rural United States of the early last century. "The program was created by two men who were religious, but it's not about making you believe in God or going to mass, in the end it's about adopting an idea of a higher power as you conceive it, be it God, Allah, or anything else," explains by phone the general secretary of the AA service board in Spain, who assures that one does not need to be religious or spiritual to follow this therapy, which "serves everyone." And he insists on a basic premise of the program: "No one is forced to do anything here."

In fact, one of the factors that explain the success of the method, according to psychologists, is not the steps themselves, but the fact of sharing the process with people who have gone through or are going through the same thing. There are no professionals or psychologists, it is the alcoholics themselves who organize themselves. "It is the paradigm of self-help," explains Josep Maria Suelves, psychologist at the Public Health Agency of Catalonia and member of the Working Group on Addictive Behaviors of the Official College of Psychology of Catalonia. "You cannot judge AA without taking its origin into account: it was born in the 1930s in the United States in a very religious society and at a time when the moralistic perspective was dominant. Alcoholics were not seen as ill but as people who did not know how to control themselves, they were socially rejected and the medical system offered them no solution," explains Suelves, and highlights group therapy as "the great contribution" made by the creators of AA in the last century: "At least in the treatment of alcohol, they were the first to use group therapy".

In an AA meeting, there are figures such as the coordinator, the secretary, or the treasurer, all volunteers, but "anyone can lead the session" and there are no strict rules, simply "there is a round of words in which each person's turn is respected and no debate or discussion takes place," explains the general secretary of the group in Spain. It also usually includes the reading of one of the so-called twelve traditions, which are the reflections that accompany each of the twelve steps, in order to guide the reflections towards this topic. However, the spokesperson assures that following these steps is not a strict formula that requires a specific order or time for each one. "The most important thing is the first point, because you have to be honest with yourself, and then you take the other steps almost without realizing you are taking them," he explains.

Helping others

Another element of the AA program is the figure of the "godfather" or "sponsor," someone who has already managed to overcome alcoholism and who helps or accompanies the person starting the process. "It's all suggested, nothing is mandatory, but it's a person who understands you because they've been through the same thing and gives you advice to stay sober," explains the AA spokesperson, adding: "The most important thing is that you realize that no one here will criticize you or scold you for anything." In fact, one of the main objectives of the program is that any of the members can become a sponsor, and herein lies another psychological benefit of the therapy: helping others is comforting and also helps to stay sober.

"Many times, quitting alcohol means leaving your social network and many people are left alone. AA also fulfills the function of a group or community that makes this person feel more supported," also highlights Óscar Pino, coordinator of an adult mental health center and spokesperson for the Official College of Psychology of Catalonia. He also points to a possible explanation for the success of a method that has this spiritual or religious component: "There are mental health studies that show that religious people better overcome psychological problems because they pass control to divine will, and this relieves them of potential guilt."

"There are people who have tried many other methods and have not succeeded, who have reached very problematic situations due to alcohol consumption, and who finally, with AA's support, make a click and truly find the path to recovery," says Suelves. However, he makes it clear that participation in AA groups should not exclude professional medical intervention. "Alcohol withdrawal syndrome can be lethal, can produce phases of delirium tremens, and requires professional medical treatment," he recalls.

Fortunately, current society is very different from that of a century ago and is now aware that alcoholism is a disease and not a weakness of character or moral failure, as was thought a century ago. "Alcohol consumption causes changes at a cerebral level that, at a certain point, lead to a real addiction and the disease is considered chronic," points out Pino. The general secretary of the AA board assures that the link between the association and public health services, at least in Spain, is total. "We are very connected, we need each other," he states, and also explains that members of the group go to institutes to give prevention talks for adolescents: "Our main objective is to bring the message to any alcoholic who is suffering to tell them that recovery is possible".