The twelve steps. A pathway to recovery

Alcoholics Anonymous and its 12 Steps and 12 Traditions have arisen out of the experiences of recovery of alcoholics. It offers an important treatment option to the clinician who sees destructive compulsive disease in his or her practice. Despite their nonscientific, nonrational approach, AA and other 12-step programs have evolved to offer a set of attitudes, beliefs, and behaviors that can facilitate change in this group of patients. AA is the forerunner of the others and offers as its most important characteristics an unconditional acceptance of the patient's alcoholism, an unshaken belief in the concept of alcoholism as a disease, and support to foster a healthy dependence in the alcoholic. The recovery of an alcoholic involves a fairly long initial stage in which denial about alcoholism is broken down with slow and halting identity change. This characteristic underscores the primitive level of ego development in the alcoholic and the need for much continuing support, nurturance, and tolerance. Clinicians can be an important part of this support network by working with AA and other 12-step groups to help break down denial in the patient and direct individuals to the appropriate program. By allying themselves with this method and groups, clinicians will be making powerful statements about their beliefs and attitudes toward these destructive illnesses.