Beyond 12 Steps: There Are Many Paths to Addiction and Many Roads to Treatment and Recovery

beyond twelve steps

When we think of recovery programs for substance use disorders or addictive behaviors, many of us automatically think of the Twelve Steps. No surprise, since millions of people throughout the world embrace this philosophy that sprung up in the 1930s when the first Twelve Step group, Alcoholics Anonymous (AA), was founded. Today there are Twelve Step mutual support groups for individuals and families that focus on other drugs, such as cocaine, marijuana, nicotine, or prescription pills. There are Twelve Step groups for those with co-occurring addiction and mental health disorders. There are Twelve Step groups for people addicted to gambling, sex, over eating, and other compulsive behaviors. And the list goes on.

Yet, even with all these choices, Twelve Step recovery isn’t for everyone. Just as there are many paths to addiction, there are many roads to treatment and recovery beyond the Twelve Steps.

Although they overlap, there is a distinction between treatment and recovery. Depending on the individual need or situation, treatment often begins with detoxification, medical and psychological care, followed by a period of more intense therapy. Recovery may include peer support groups or other types of ongoing support. Some treatment centers may incorporate elements and tools of recovery.

A closer look at treatment

As the National Institute on Drug Abuse (NIDA) reminds us in their “Principles of Drug Addiction” guide , addiction is a brain disease with far-reaching health and social consequences. It can increase our risk for a number of mental and physical illnesses, and the dysfunctional behaviors that go hand-in-glove with addiction can negatively affect a person’s ability to function in the family, workplace, or community.

“Because drug abuse and addiction have so many dimensions and disrupt so many aspects of an individual’s life, treatment is not simple. Effective treatment programs typically incorporate many components, each directed to a particular aspect of the illness and its consequences,” NIDA experts state.

According to NIDA, more than 14,500 specialized drug treatment facilities in the United States provide counseling, behavioral therapy, medication, case management, and other types of services to persons with substance use disorders. Such treatment can be delivered in outpatient, inpatient, and residential settings by a variety of providers, including counselors, physicians, psychiatrists, psychologists, nurses, and social workers.

What constitutes effective addiction treatment

Drugs vary, just as the behaviors of the individuals who take them vary. So it makes sense that treatment needs also differ. “Matching treatment settings, interventions, and services to an individual’s particular problems and needs is critical to his or her ultimate success in returning to productive functioning in the family, workplace, and society,” says NIDA.

The most effective treatment is one that addresses associated medical, psychological, social, vocational, and legal problems, in addition to an individual’s substance use and abuse problems. NIDA also stresses that, ideally, treatment should be appropriate to a person’s age, gender, ethnicity, and culture.

Here are some other elements of effective treatment adapted from NIDA’s guide:

  • Length of treatment and relapse provisions should be taken into account. Many people leave treatment too soon, so it is important that strategies are put in place to engage them for the appropriate time period. Experts suggest at least three months, with longer durations as necessary.
  • The most effective behavioral therapies motivate change, encourage abstinence, build resistance skills, introduce healthy and positive activities that replace an addictive lifestyle, and improve interpersonal communication and relationships. Such therapies can include family counseling and participation in peer support groups during and after treatment.
  • Appropriate medications—especially when combined with counseling and other behavioral therapies—are often necessary for some people, especially those with co-occurring disorders.
  • Treatment plans should be continually monitored and altered as necessary when an individual’s needs change. Some plans might be adapted to include parenting instruction, vocational rehab, or special social or legal services.
  • Drug use during treatment should be monitored and addressed.
  • Drug related behaviors often put people at risk for infectious diseases like HIV/AIDS or hepatitis, so treatment plans may need to include testing and referral services

A closer look at recovery

In 2011, the Substance Abuse and Mental Health Services Administration (SAMHSA) developed this working definition for recovery from mental and/or substance use disorders : “A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.”

In addition, SAMHSA identified these four dimensions that support a life in recovery:

  • Health—overcoming or managing one’s disease and making informed, healthy choices that support physical and emotional wellbeing;
  • Home—having a stable and safe place to live;
  • Purpose—having meaningful daily activities (a job, school, volunteerism, family, etc.) and the independence, resources, and income to participate in society;
  • Community—having relationships and social networks that provide support, friendship, love, and hope.

Guiding principles of recovery

Here are other important elements of recovery that SAMHSA identified:

  • Hope, fostered by peers, family, providers, allies, and others is the catalyst for recovery.
  • Self-determination and self-direction are the foundations of recovery and empowerment.
  • Recovery pathways are varied, highly personalized, and “non-linear” (characterized by continual growth and possible setbacks).
  • Recovery is holistic, encompassing body, mind, spirit, and community.
  • Peer, family, community, and/or professional support are invaluable in recovery.
  • Healthy relationships and social networks support recovery.
  • Culture—including values, traditions, and beliefs—can ground a person in recovery.
  • Physical and emotional trauma should be addressed and the traumatized individual supported in recovery.
  • Respect is a basic ingredient of recovery, and people affected by mental health and substance use problems are deserving of it.

Alternatives to Twelve-Step recovery

An Internet search will reveal that the list of addiction and mental health mutual-help recovery groups and programs is vast and varied, depending on your need, interest, or preference. Here are some to consider that will give you and idea of what’s out there:

beyond 12 steps

A culture of recovery

Many who struggle with substance use and/or mental health problems find that a recovery community offers them safety and structure that was missing when their lives were in chaos.

No matter your sexual orientation, your ethnicity, your religious or secular beliefs, your age, or your gender, there are individuals and organizations to turn to for support. There are also a number of on-line support groups and resources available. If you’re having difficulty finding one, try SAMHSA’s “National Helpline,” 1-800-662-HELP (4357). This is a confidential, free, 24-hour-a-day, 365-day-a-year, information service, in English and Spanish, for individuals and family members facing mental and/or substance use disorders. This service provides referrals to local treatment facilities, support groups, and community-based organizations. They also have an online treatment locator at www.findtreatment.samhsa.gov.


Cynthia Orange is an award-winning writer, editor, writing consultant, and author. Her most recent books are Take Good Care: Finding Your Joy in Compassionate Caregiving and Shock Waves: A Practical Guide to Living With a Loved One’s PTSD. She has written extensively about prevention, addiction, recovery, caregiving, and trauma, and is also a published essayist and poet.

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