2024’s Top Posts – #1 – 12-Step Facilitation is the eighth most frequently used therapeutic approach in treatment facilities

~ Jason Schwartz

There are a lot of problems in addiction treatment, but 12-step hegemony is not the problem that advocates and media coverage would lead one to believe.

There’s a widely held belief that 12-step culture exerts a smothering pro-abstinence stranglehold on public health and policy responses to substance use. It’s a strange phenomenon when one considers that AA explicitly endorses moderation for people who are able to do so, cannabis is being legalized and commercialized, alcohol consumption is up in recent years, experiments with decriminalization, the spread of public health campaigns that depart from the tobacco abstinence messages with new messages about safe fentanyl use, and that the most visible public health responses to the opioid crisis are efforts to flood the zone with naloxone and low threshold buprenorphine.

Further, 12 step isn’t even a hegemonic force in the treatment space. The 2020 National Survey of Substance Abuse Treatment Services found 12-step facilitation to rank 8th out of 14 therapeutic approaches. (Keep in mind that 12-step facilitation is an evidence-based treatment.)

It’s worth asking why this is so frequently misrepresented.

National Survey of Substance Abuse Treatment Services (N-SSATS): 2020

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Published by Jason Schwartz

I have been an addiction professional and social worker since 1994. I started blogging in 2005 as the Clinical Director at Dawn Farm. I currently serve as the Director of Social Work and Spiritual Care for a healthcare system. I've also served as the Director of Behavioral Health at another hospital. I'm also a lecturer at Eastern Michigan University’s School of Social Work. Views expressed here are my own. Keep in mind that the field, the contexts in which the field operates, and my views have changed over time.