For many people, the first thing that comes to mind when they think about addiction recovery is Alcoholics Anonymous (AA), Narcotics Anonymous (NA) or Cocaine Anonymous (CA). These programs have helped many people over the years. But what happens when someone recognizes they need to make a change but doesn’t feel comfortable with the 12-step approach? Are there other ways to recover?
I think these are important questions, and ones worth exploring without dismissing the value of 12-step programs.
When someone expresses concerns about attending a 12-step group, I’m interested in understanding where those concerns come from. Have they attended meetings themselves, had an experience that didn’t sit well with them, or formed their impressions through friends, family or the media? I think it’s important to acknowledge those concerns rather than simply encourage someone to give the program a try. At the same time, experiencing a few meetings firsthand can be a useful way to decide whether a particular group is right for you.
There is no denying that 12-step programs have helped many people. However, they are not the only available path to recovery.
What does the research tell us?
A 2018 study by Zemore and colleagues examined four mutual-help approaches for people experiencing alcohol use disorder: 12-step groups, Women for Sobriety, LifeRing and SMART Recovery.
The researchers followed 647 participants over 12 months. Greater involvement in a person’s chosen mutual-help group was associated with better outcomes, and the researchers found no significant evidence that the benefits differed between the four groups.
This doesn’t establish that all recovery approaches are equally effective, or that every approach will work for every individual. It does, however, provide evidence that people can find meaningful support outside traditional 12-step programs.
For someone who has assumed AA is their only option, I think that’s an important finding.
What do different recovery approaches have in common?
Something else I find interesting is that many of the things people value about recovery communities aren’t unique to any particular program.
In 2011, Leamy and colleagues published a systematic review examining personal recovery in mental health. Their research identified five processes commonly associated with recovery, summarized by the acronym CHIME:
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Connectedness: Relationships, supportive communities and opportunities to connect with others who have experienced similar challenges. This might come through recovery meetings, friendships, family or community involvement.
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Hope and optimism: Believing recovery is possible. Seeing examples of people who have found recovery can be particularly meaningful. That example might come from a recovery group, a friend, a therapist, a podcast or even a character in a book or film.
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Identity: Rediscovering who you are outside of the substance or behaviour that has become problematic. What do you enjoy? What’s important to you? What might your life look like without the behaviour taking up so much of your attention?
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Meaning: Reconnecting with the things that give life purpose, whether that’s relationships, work, hobbies, spirituality or other meaningful activities.
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Empowerment: Having a sense of ownership and responsibility for your recovery, including the ability to define what recovery means to you and how you want to pursue it.
It’s important to recognize that CHIME was developed from research into mental health recovery, not addiction specifically. It isn’t a proven formula for addiction recovery, but I think it offers a useful way to consider some of the experiences and resources that can support meaningful change.
When I look at what 12-step groups offer, I can see many of these elements. But I don’t think they belong exclusively to those programs. Connection, hope, identity, meaning and empowerment can also be found in other recovery communities, therapy and everyday relationships.
Finding an approach that fits
There are several reasons someone might find one recovery approach more suitable than another.
Consider someone’s recovery goals. Traditional 12-step programs generally have abstinence as their primary goal. Someone interested in moderation or harm reduction may find that the philosophy and expectations of these groups don’t align with what they’re trying to achieve. SMART Recovery, on the other hand, recognizes different recovery goals, including abstinence and other forms of meaningful change. Therapy can also provide an opportunity to explore personal goals without requiring someone to adopt a particular recovery philosophy.
Spirituality and personal beliefs can also influence someone’s experience. Although AA describes itself as a spiritual rather than religious program, its language and traditions have historical roots in Christian spirituality. Some people find ways to incorporate their own understanding of spirituality and a higher power into the program. Others don’t connect with those concepts, and that’s okay.
There are alternatives for people who prefer a secular approach, including SMART Recovery and LifeRing. Secular and agnostic 12-step meetings also exist. Other options include Women for Sobriety, Refuge Recovery, individual therapy and various forms of community and peer support.
There isn’t necessarily a reason to choose just one. Many people find that a combination of professional therapy and peer support works well for them.
Ultimately, I think the important question is whether an approach is one you feel comfortable meaningfully engaging with. There is a difference between simply attending meetings and becoming involved in a recovery community, building relationships and putting the tools and ideas you encounter into practice in your everyday life.
The Zemore study is interesting in this regard: greater involvement in a person’s chosen group was associated with better outcomes.
My perspective on finding your own path
I’ve had considerable personal experience with different recovery communities, including extensive involvement in AA and other 12-step fellowships, groups supporting families affected by addiction, and Refuge Recovery. I’m also a certified SMART Recovery facilitator.
I’ve been fortunate to encounter people who have found recovery in many different ways: through 12-step programs, therapy, alternative recovery communities or independently. I’ve also listened to many people share their experiences of recovery outside the traditional 12-step world.
That curiosity has influenced how I work as a therapist. Over time, I’ve become increasingly convinced that recovery is rarely linear and that there isn’t a single approach that works for everyone.
I believe in working collaboratively with people to define what recovery means to them and identify the resources that might support the kind of life they want to live. Therapy can be one of those resources. It doesn’t necessarily need to replace a recovery group or community. It can be a place to explore what someone is looking for and how they might find connection, hope, identity, meaning and empowerment in their own lives.
I also think it’s important to recognize that choosing an approach doesn’t mean we stop evaluating whether it’s working.
Regardless of what you choose, you need to be honest with yourself about whether it’s helping you achieve your goals. Is meaningful change happening? Are you moving toward the things that matter to you? Is the approach you’re using actually helping?
As a therapist, part of my role is to help people have those conversations honestly. That doesn’t mean imposing my own definition of recovery or telling someone which program to attend. It means helping them examine their experiences, recognize when their behaviours aren’t aligned with their goals, and consider what changes might be helpful.
If you’re unsure where to start, consider exploring different approaches. Attend a meeting, ask questions or speak with someone who has experience with a particular program. You don’t need to assume that one approach is the only option available to you. Whatever path you choose, give yourself the opportunity to find out whether it’s helping you build the life you want.
About Dave Edwards
Dave Edwards is a Registered Psychotherapist (Qualifying) in Ontario with a Master of Arts in Counselling Psychology and more than 10 years of experience supporting individuals affected by addiction and recovery. He is also a certified SMART Recovery facilitator.
Dave works with adults experiencing challenges related to alcohol and substance use, anxiety, depression, relationships and life transitions. He offers virtual psychotherapy across Ontario and in-person sessions in downtown Toronto.
If you’re considering therapy and would like to explore whether working together might be a good fit, Dave offers a free 20-minute consultation.
More information and booking details are available at www.edwardspsychotherapy.ca.
References
Leamy, M., Bird, V., Le Boutillier, C., Williams, J., & Slade, M. (2011). Conceptual framework for personal recovery in mental health: Systematic review and narrative synthesis. The British Journal of Psychiatry, 199(6), 445–452. https://doi.org/10.1192/bjp.bp.110.083733
Zemore, S. E., Kaskutas, L. A., Mericle, A., & Hemberg, J. (2018). A longitudinal study of the comparative efficacy of Women for Sobriety, LifeRing, SMART Recovery, and 12-step groups for those with AUD. Journal of Substance Abuse Treatment, 88, 18–26.