Many people are familiar with 12 step programs such as AA. They help people with alcohol or other substance use disorders (SUD) remain sober by meeting regularly, identifying themselves as an addict, and sharing stories of triumph and failure. The meetings are led by members, not trained therapists.

Those who attend these meetings may remain in a 12-step group all their lives to reinforce their sobriety and to serve as mentors (“sponsors”) to newer members. They also may “work the steps”: perform the actions in the 12 steps, in order and without skipping.

These steps begin with admitting they have a problem with alcohol or drugs and include making an honest inventory of their faults and bad actions, apologizing and trying to make restitution to those they have wronged, and then helping others.

What Causes Addiction?

AA was an early proponent of addiction as a disease model, rather than moral weakness, but it still says that people with addictions are addicts, that they are helpless against addiction and only a higher power (and AA) can help them.

Most addiction specialists, however, now believe that addiction is only partly due to behavior. Genetic predisposition is an important factor. Environmental factors also play a role- people who have experienced trauma, physical or mental abuse, or have a pre-existing mental health issue are more likely to abuse substances.

Non-12-step addiction treatment makes individuals full partners in their recovery, assisted by science or evidence-based treatments. They need to accept responsibility for their actions but they are not helpless.

What do Non 12 Step Programs Consist of?

While a non-12-step program could be any program that has fewer, more, or different steps than a 12-step program—or even none—it usually refers to a secular program that is based on evidence, not faith.

These include:

Which Groups are Considered Non 12 Step Programs?

Secular fellowships, mutual aid societies, and self-help group alternatives to the better-known 12-step programs include:

• SMART (Self-Management and Recovery Training) Recovery. A four-point secular, science-based, abstinence-based plan to cope with problems and cravings without using drugs or alcohol.
• Moderation Management (MM). A nonprofit that teaches moderation as well as abstinence from alcohol.  They have a tool available to track your drinking in moderation, contented abstinence, uncomfortable abstinence, etc. This ledger can be kept private or made public to gain and lend support.
• Secular Organizations for Sobriety (SOS). A cognitive approach to recovery and abstinence with sobriety as the highest priority.
• Women for Sobriety (WFS). A non-profit only for women with substance use disorders that stresses personal responsibility and emotional and spiritual growth.
• LifeRing Secular Recovery. A permanent workshop for abstinence and personal recovery based on its “3-S” principles: Sobriety, Secularity, and Self-Help.
• Matrix Model. An intensive and inclusive therapist-driven treatment method intended primarily for those with SUDs involving stimulants such as cocaine and methamphetamine (meth).

Behavioral therapies

Scientific and evidence-based programs that include medically monitored detox and talk therapies, including:

• Cognitive-behavioral therapy (CBT). Psychotherapy teaches how to recognize and change negative or inaccurate thinking. Also useful for mental health issues such as obsessive-compulsive disorder (OCD), depression, and post-traumatic stress disorders.
• Dialectical behavior therapy (DBT). is a variation of CBT that is used especially for women with alcohol use disorder, especially when co-occurring with borderline personality disorder (BPD).
• Motivational enhancement therapy (MET). A method that is especially useful for alcohol use disorders but can also help people with other SUDs to overcome their resistance to seeking treatment.
• Group therapy. Similar to a peer support group but with a trained therapist guiding the meeting. Many authorities find group therapy is better than individual therapy for SUDs because the presence of peers offers challenges and support.

Medication-assisted treatments (MAT)

Drugs that are used to stop or manage the cravings for or the effects (including withdrawal pains and overdoses) of opioids to keep clients in the program until they can be weaned off them, such as:

• Methadone. A low-dose opioid that prevents withdrawal but doesn’t cause euphoria.
• Buprenorphine (Suboxone). Similar to methadone but available in many different forms, including a tamper-resistant compound that includes the opioid overdose reversal drug naloxone (Narcan) and an implant.
• Naltrexone (Vivitrol). A drug, usually in an injectable form, that blocks the effects of opioids for up to a month at a time. Someone on Vivitrol will not get high if they continue to use opioids.
• Disulfiram (Antabuse): A drug that produces severe hangover-like symptoms when alcohol is consumed while on this drug. It acts as a form of negative reinforcement.

Other

• Contingency management (CM)/Community reinforcement approach (CRA) plus vouchers. The two similar programs use a reward system—from cash and prizes to an affirmation—for staying drug- and alcohol-free. They more than double the rate of retention and sobriety.
• Holistic treatment. This type of non-12-step program focuses on improving the clients’ overall well-being with physical exercise, a healthy diet, and alternative therapies such as yoga, meditation, massage, art therapy, and equine therapy.
• Dual diagnosis treatment. This type of treatment program offers treatment for the effects of substance abuse and also for other co-occurring conditions, such as mental illnesses. If clients are diagnosed with co-occurring mental conditions, their treatment programs will be geared at simultaneously treating their mental illnesses and their addictions.

Why Others Still Choose 12-Step Treatment

Twelve-step programs are a safe entry point for some people who want to overcome addiction because:

• Free. There are no membership fees, no admission fees, though a hat is passed to pay for the room rental and coffee.
• Widely available. In larger communities there are meetings every day, sometimes several times a day in different spaces.
• Replaces hanging out at the bar. If you did all your socializing at a place dedicated to alcoholic beverages, you shouldn’t go there any longer. Even if you don’t plan to drink, just being there could trigger a craving.
• Make new friends. You shouldn’t hang around people with whom you used to drink, either. Even if they’re not drinking, their presence can be a trigger.
• Famous. Everyone has heard of AA. It’s been heavily promoted by the media, doctors, judges, and politicians.
• Anonymous. People with substance use disorders often feel ashamed or persecuted for their problems. Anonymity helps them admit their problem.
• Judgment-free. Everyone has the same problem; some are just controlling it better.
• Religious. Although some people may be turned off by the references to God and faith, others take comfort from them.