Having an understanding of the 12 Step Model during early recovery from alcohol abuse/alcoholism and other drug abuse/addiction can be helpful to SOME, but not all clients. The 12 step model is based in behavioral, spiritual, and cognitive principles that form the core of 12-step fellowships such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA). It is suitable for problem drinkers and other drug users and for those who have substance use disorders.
Two of the general goals in individuals with alcohol or other drug problems: acceptance (of the need for abstinence from alcohol or other drug use) and surrender, or the willingness to participate actively in 12-step fellowships as a means of sustaining sobriety. These goals are in turn broken down into a series of cognitive, emotional, relationship, behavioral, social, and spiritual objectives.
In the 12 step model alcoholism and other drug addiction are considered illnesses that affect individuals both mentally and physically in such a way that they are unable to control their use of alcohol or other drugs. Viewed from this perspective, the concept of controlled use of alcohol or other drugs amounts to denial of the primary problem, that is, loss of control. These models assume addiction can be arrested but not cured, they ascribe to the AA/NA philosophy as described in AA/NA literature that relies heavily on a combination of spirituality and practicality, and advocate peer support as the primary means for achieving sustained sobriety.
Participation in self-help groups is central to the 12 step approach and is regarded as the primary agent of change. It is vital that the counselor is well versed in client-centered therapeutic skills, including unconditional positive regard and good active listening skills, combined with a good working knowledge of 12-step philosophy and the practicalities of getting active in 12-step fellowships. It is imperative that a collaborative relationship with the client exists and utilizes confrontation in a constructive, non-punitive manner.
The goal is to:
Assess the client’s alcohol or other drug use and advocate abstinence.
Explain basic 12-step concepts (e.g., surrender, higher power).
Advocate and actively support and facilitate initial involvement in AA/NA.
Facilitate ongoing participation (e.g., getting a sponsor).
Suggest and discuss specific readings from AA/NA literature.
Help the client learn to use AA/NA as resources in times of crisis and to support and enjoy yourself in sobriety.
Help the client develop an initial understanding of more advanced concepts such as moral inventories.
The counselor does not:
Conduct sessions with an intoxicated client.
Attend AA or NA meetings with the client.
Act as a sponsor.
Threaten punishments for noncompliance.
The counselor’s role is broadly defined as including education and advocacy, guidance and advice, and empathy and motivation. For example, guidance and support include monitoring client involvement in AA/NA, encouraging clients to volunteer for basic service work, identifying appropriate social events the client might participate in, locating appropriate meetings, and clarifying the role of a sponsor.
How Directive Is the Counselor? 12 step counseling is similar to many cognitive-behavioral therapies in that it is focused and requires the counselor to be fairly directive while still maintaining good rapport. The counselor is not regarded as the primary agent of change; rather, it is the 12-step fellowship (AA or NA) that is seen as the agent of change. Accordingly, the counselor needs to conceptualize treatment as the product of a collaborative relationship and should assume responsibility for doing the best he or she can to establish that collaborative relationship. However, it is not the counselor’s goal to break down the client’s denial, to provide all support needed to stay sober, to take the client to meetings, and so forth. Even in emergencies, the counselor’s role and responsibilities are limited. The ultimate responsibility for recovery is on the client. The counselor is a guide and a source of support, but the key to recovery is always seen as active involvement in one or more 12-step fellowships. The counselor maintains a position of unconditional positive regard and acceptance of the client’s illness, regardless of whatever resistance emerges.
Some of the meetings on this list are 12 step-based meetings and others are not. Feel free to check some of them out.