Recovery after substance abuse is a road that no one has to walk alone. There are many support groups in treatment to help people put substance abuse and addiction behind them.
This intervention is designed and intended to be used in brief individual outpatient treatment for those who qualify for it. It facilitates clients’ entry into 12-step self-help groups that promote abstinence and offer guidance and tools to achieve it.
TSF therapy clients may not have heard of or been exposed to 12-step programs, or they may have had exposure to such a program through previous treatment. These 12-step fellowships may be faith-based or spiritual in nature. Typically, however, 12-step facilitation therapy is based on the core principles of Alcoholics Anonymous (AA), so in this writing, AA will be the focus. For people whose primary substance is not alcohol, their TSF therapy may be based on the principles of a group such as Narcotics Anonymous.
There are several ways to deliver a 12-step facilitation therapy, according to the Recovery Research Institute. One way is how it was done in Project MATCH in the 1990s, which was the first TSF developed for clinical research, the institute says. It also can be used within a cognitive-behavioral problem-solving framework.
The First 12-Step Program: Alcoholics Anonymous
Alcoholics Anonymous is an international fellowship that has helped countless people who struggle with controlling their drinking. It is estimated to have millions of active members worldwide. It was founded in 1935 by Bill Wilson (also known as Bill W.), a Wall Street stockbroker whose promising career was derailed by his chronic drinking, according to AA. The organization claims that AA’s origins can be traced to the Oxford Group, a Christian organization founded by Frank Buchman. Before Wilson founded AA, he joined the Oxford Group to help him stop drinking after a schoolmate friend encouraged him. AA says Wilson was unconvinced by his friend’s story of transformation as well as the Oxford Group’s claims—until 1934.
That year, Wilson credited a powerful spiritual experience that brought him out of his depression and despair and gave him the clarity and peace to stop drinking. He later co-founded AA, whose 12-step model has served as the foundation for other 12-step programs, including secular ones designed to offer an alternative to programs with a religious or spiritual focus.
The 12 Steps
Here are the original 12 steps of Alcoholic Anonymous:
Step 1: We admitted we were powerless over alcohol—that our lives had become unmanageable.
Step 2: Came to believe that a Power greater than ourselves could restore us to sanity.
Step 3: Made a decision to turn our will and our lives over to the care of God as we understood Him.
Step 4: Made a searching and fearless moral inventory of ourselves.
Step 5: Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
Step 6: Were entirely ready to have God remove all these defects of character.
Step 7: Humbly asked Him to remove our shortcomings.
Step 8: Made a list of all persons we had harmed and became willing to make amends to them all.
Step 9: Made direct amends to such people wherever possible, except when to do so would injure them or others.
Step 10: Continued to take personal inventory and when we were wrong promptly admitted it.
Step 11: Sought through prayer and meditation to improve our conscious contact with God, as we understood Him, praying only for knowledge of His will for us and the power to carry that out.
Step 12: Having had a spiritual awakening as the result of these Steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.
3 Key Ideas in 12-Step Facilitation Therapy
According to the National Institute on Drug Abuse (NIDA), 12-step Facilitation Therapy treatment is promising to help recovering substance users sustain recovery. The therapy typically adheres to the behavioral, social, and spiritual concepts of the 12-steps of Alcoholics Anonymous (AA). The goal of the program is to make it so that people can join AA and start working the steps for sustained sobriety and personal enlightenment.
NIDA outlines three key ideas in 12-step facilitation therapy:
- Acceptance. This includes the realization that drug addiction is a chronic, progressive disease that one acknowledges they have no control over and that life has become unmanageable because of it. Acceptance also involves realizing that willpower by itself is not enough to solve or overcome the problem and that abstaining from addictive substance is the only alternative.
- Surrender. If the 12-step facilitation therapy is faith- or Christian-based, then surrender means giving oneself over to a Higher Power, accepting the support structure of others in recovery, and following activities that are the 12-step program lays out.
- Active involvement. This means clients who are in this therapy will attend 12-step meetings and related activities and participate in them.
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How 12-Step Facilitation Therapy Works
The Twelve-Step Facilitation Therapy Manual offers thorough guidance about how the program works. This therapy is structured into 12 sessions that are held within 12 consecutive weeks. Each session has a specific agenda and follows a recommended pattern.
If the client is single, then the sessions will involve just that person. If the client has a partner or spouse and appears to be in a stable relationship, then 10 sessions will be held with the client in recovery while the other two sessions will be held with the client and the loved one. A client also can receive a maximum of two individual emergency sessions if a therapist determines that they are needed.
According to the manual, the first session can last 1.5 hours to complete and has several objectives. Among them are:
- Introducing clients to Alcoholics Anonymous’ perspective of alcoholism
- Helping clients review their level of alcohol involvement, including whether they are dependent
- Explaining how the 12-step facilitation therapy program works
- Attempting to engage clients in actively participating in this program. This is also known as “Give AA a chance.”
Sessions two to 11 follow a common format, and all core topics must be covered in these meetings. Each session also includes specific, recovery-related tasks and suggested reading materials that can be read and acted upon between sessions. The reading material will come from Alcoholics Anonymous-approved texts. Program participants are asked to keep a journal that is reviewed by the therapist at the beginning of each session.
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Therapist, Client’s 12-Step Facilitation Therapy Roles
Before you or a loved one starts 12-step facilitation therapy, it’s important to know the roles of the therapist and client in this setting. According to the manual, therapists working with this intervention are there only to educate, advise, and support the client. The individual therapist is not seen as the agent of change; the AA fellowship is.
The therapist also acts as a coach and resource to facilitate the client’s understanding of alcoholism (or substance abuse), the fellowship of AA (or the 12-step group being used), and its 12 steps. The person is also there to help clients to stay sober one day at a time with AA’s help.
Clients are expected to attend all sessions, come to every session sober, and keep a journal. They are also expected to make an honest effort in all recovery tasks the therapist suggests they do and be honest, even when they make a slip. They are also encouraged to focus on sobriety one day at a time.
Is 12-Step Facilitation Therapy Effective?
According to the Research Recovery Institute, evidence in favor of the 12-step facilitation therapy in alcohol use disorder treatment is strong. It writes, “Twelve-Step Facilitations (TSFs) produce outcome benefits as good or possibly better than other active treatments. It is particularly helpful and has clearer advantages when it comes to increasing rates of continuous abstinence and full, sustained substance use disorder remission (i.e., an absence of symptoms for 12 months).”
“Whether one type of TSF is advantageous over another is uncertain. While there is sound reason to assume Twelve-Step Facilitation (TSF) approaches also work for individuals with other drug use disorders, evidence for drug use disorder populations (other than alcohol) is more limited.”
The American Society of Addiction Medication (ASAM) also supports 12-step facilitation therapy as a tried-and-true approach.
“It is far more than advising a patient to ‘go to AA’ and providing them a list of meeting locations and times,” ASAM writes. “In Twelve-Step Facilitation, the therapist actively probes and nudges, encouraging not only attendance, but participation, in meetings; it explains the potential benefits of working with a sponsor and promotes the individual developing a relationship with a sponsor; it explores problems or psychological resistances to attendance, participation, actual ‘working the steps,’ and the development of a sponsor-sponsee relationship; and it opens the door to ‘AA-related activities’ such as volunteer service to one’s AA ‘home group’ or AA ‘clubhouse’ and involvement with AA-related social events, retreats, and local and state conventions.”
For people who are recovering from substance addiction who want to join AA (or the TSF therapy that may be offered at the treatment center of their choosing) and need motivation or structure to ensure they met their goals, 12-step facilitation therapy could be just what you are looking for.
Just one more thing…
If you are considering joining a 12-step group, it is important to know before going in that no one is expected to perform each step perfectly. Wilson writes, “No one among us has been able to maintain anything like perfect adherence to these principles.” The steps; however, are there to guide clients and encourage them to grow spiritually. TSF therapy clients will be expected to try each one so they can continue to move toward sobriety and abstinence.
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If you or someone you know is struggling with addiction and/or a mental health disorder, Pathway to Hope is ready to help. Call us at 844-557-8575 or contact us online today so we can guide you in finding the right treatment program. We can walk you through the process to help determine if you need addiction treatment services or another arrangement that better fits your needs. Don’t delay. If you need addiction treatment, get it now.
Nowinski, J, (January, 1999).Twelve Step Facilitation Therapy Manual. Project Match. Retrieved March, 2018 from https://pubs.niaaa.nih.gov/
Alcoholics Anonymous, (January, 2018).AA Timeline. Alcoholics Anonymous. Retrieved March, 2017
National Institute on Drug Abuse, (January, 2018).12-Step Facilitation Therapy (Alcohol, Stimulants, Opiates). National Institute on Drug Abuse. Retrieved March, 2018 from https://www.drugabuse.gov/
Miller, M, (February, 2015).The Relevance of Twelve-Step Recovery in 21st Century Addiction Medicine. American Society of Addiction Medicine. Retrieved March, 2017 from https://www.asam.org