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Twelve Step Facilitation Therapy is a lost art in addiction treatment. As the nation faces what is easily the worst substance abuse crisis it has ever encountered, the front lines of the war on substance abuse becomes inundated with a plethora of therapeutic approaches that all claim to be most effective. This sets the stage for confusion for the families that are desperately trying to keep their loved one from falling into the overdose statistics that have been crippling an entire generation. The numbers have been staggering, reaching over 72,000 deaths as of the end of 2017(NIH, SAMHSA, 2018). These numbers look to be continually climbing for the coming years. With the fear of potential loss taking over, families are willing to turn to anything that could potentially be hopeful in the challenge to save their loved one. In the process, many of these loved ones are treated in a manner that requires continual and perpetual therapy, which is costly. The objective should be to aim for independence and providing addicts/alcoholics in addiction treatment with long term sustainable resources.

Given the debatable perspective on which approach is most effective, several studies have been conducted concerning the efficacy and stability of the various clinical approaches utilized in the treatment of substance use disorder. There have been many studies to compare and contrast between the overall effects of the different clinical perspectives. However, there is one approach that has gained notice and support from the majority of the clinical world due to its inherent strength of more effectively aligning the individual suffering from addiction with a trajectory for independent and sustainable sobriety. That approach is twelve step facilitation therapy. After having conducted a study comparing twelve step facilitation therapy with other approaches, surprising results were concluded. According to Kelly, Kaminer, Kahler, Hoeppner, Yeterian, Cristello and Timko (2017), “the novel iTSF treatment is able to stimulate greater 12-Step community mutual-help organization participation among out-patients and produce lower substance-related consequences during and following intervention” (p.2164). With this insight, the question becomes, what exactly is meant by twelve step facilitation therapy? We are glad you asked!

Although some believe it to be outdated, the twelve steps have undoubtedly become one of the most effective long-term methods for dealing with substance abuse. According to Alcoholics Anonymous World Services (2019), “Today, more than one million copies of the Big Book are distributed every year in the English language alone (it is translated into 64 languages), and A.A. membership has grown to approximately two million with a presence in more than 180 countries.” The efficacy of the twelve steps is beyond contestation, which is not to say that it is the only way; just that the numbers speak for themselves; there is also evidence that supports prayer. With this in mind, the number of clinically trained individuals, who have also experienced and actively remain involved in the twelve steps, has been steadily increasing. These individuals are uniquely equipped with both a professional training and an experiential wisdom, that when matured, results in a passionate and knowledgeable portrayal of the principles of the steps. This, in conjunction with a therapeutic approach, is a recipe for success. Twelve Step facilitated therapy provides the power of the clinical training and the essence of the twelve step principles. This approach, when properly executed, not only enables the individual to develop proper coping skills and insight, but also prepares and educates for the transition into the twelve-step community; or if you prefer, “independent sobriety” (free from institutions or facility assistance.

This is not to say that twelve step facilitation therapy stands alone in the approach to treat those suffering from addiction. It also works significantly well with several other clinically based approaches such as Cognitive Behavioral therapy (CBT) and Motivational Interviewing (MI). Twelve step facilitation therapy begins to develop and guide the individual into a manner of thinking and living that changes the individual from the internal perspective. The twelve steps are fundamentally based in a spiritual way of living that works on the individual’s self-esteem, denial, defense mechanisms, and overall spirituality. It enables the individual to develop maturity, integrity and honor through a practical manner of living one day at a time. When properly implemented, the results are dramatic and obvious. The ideal goal is to assist the client in the process of learning to live a healthy sober lifestyle. Although this is the initial goal, often times, the result if much more meaningful. The twelve steps change lives. Twelve step facilitation therapy is the focused entry ramp into this life change.

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Alcoholics Anonymous World Services, (2019). A.A.’s Big Book, Alcoholics Anonymous, and Twelve Steps and Twelve Traditions Now Available in eBook Format. Retrieved from

Kelly, J. F., Kaminer, Y., Kahler, C. W., Hoeppner, B., Yeterian, J., Cristello, J. V., & Timko, C. (2017). A pilot randomized clinical trial testing integrated 12-Step facilitation (iTSF) treatment for adolescent substance use disorder. Addiction, 112(12), 2155–2166.

National Institute of Health, Substance Abuse Mental Health Services Administration, (2018). Overdose Death Rates.Retrieved from