Recovery 12 steps

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Contents 1- Introduction ________________________________________________________________ 1 2- Meaning of Recovery ________________________________________________________ 3 Four Dimensions of recovery ____________________________________________________________ 3 Principles of effective recovery___________________________________________________________ 4

3- 12 Step Programs ___________________________________________________________ 6 What is a 12 Step program ______________________________________________________________ 6 View of Addiction _____________________________________________________________________ 7 Spiritual Program _____________________________________________________________________ 8 Set of Suggestions ____________________________________________________________________ 9 Fellowship Meetings ___________________________________________________________________ 9 Sponsorship ________________________________________________________________________ 10 Principles of 12 Step Programs _________________________________________________________ 10 12 Steps of A.A. _____________________________________________________________________ 13

4- Plan of Recovery___________________________________________________________ 14 Foundation Steps ____________________________________________________________________ 15 Action Steps ________________________________________________________________________ 16 Maintenance & Growth Steps___________________________________________________________ 17

5- Goals of the Steps _________________________________________________________ 18 6- Spiritual Principles _________________________________________________________ 20 Principles of 12 Steps _________________________________________________________________ 20 Spiritual roots of 12 Steps _____________________________________________________________ 21

7- Recovery Promises ________________________________________________________ 22 8- Foundations of 12 Steps ____________________________________________________ 25 Step 1- the Problem __________________________________________________________________ 25 Step 2- the Solution __________________________________________________________________ 25 Carrying the Message ________________________________________________________________ 26 Birth of Alcoholics Anonymous __________________________________________________________ 26 12 Steps- plan of recovery _____________________________________________________________ 26 Formation of other Fellowships _________________________________________________________ 28

Figures & Tables _____________________________________________________________ 29


1- Introduction The Recovery 12 Steps section is primarily aimed at addicts who want to recover with 12 Step programs. The information can also be useful to professionals interested in learning about this approach towards recovery so as to support their Farsi speaking clients. Although the word drug is used in most cases, it can be replaced by any substance or behaviour that constitutes addiction because the approach towards recovery follows the same principles and pattern in all 12 Step programs. To explain the various aspects of recovery with the 12 Steps, this section is divided into the following:

2- Meaning of recovery Not many of us addicts understand what it means to recover from the disease of addiction, or we mistakenly believe it is simply about stopping our drug use. But for recovery to be successful, it should address many aspects of our lives. This page provides a brief description of what constitutes an effective and successful recovery from any kind of addiction.

3- 12 Step programs The 12 Steps have proven to be the most effective method of recovery from addiction. They provide – at no cost -- a simple and effective daily program that addresses all the aspects of this multifaceted disease. This page provides an overview of the 12 Steps so that you can decide whether you want to recover using this program.

4- Plan of recovery This page describes the general plan of recovery common to all 12 Step programs. It is designed to help you see how following the actions suggested in each Step can bring about change and lead to a serene life free from addiction.

5- Goals 12 Steps The 12 Steps have a precise goal which is to produce an effective recovery from the disease of addiction. The diagrams illustrated in this page, show how each Step provides us with the tools necessary to stay clean and in daily recovery.

6- Spiritual principles This page provides diagrams that show how the spiritual principles of each Step aim to produce a change in us that will lead not only to recovery from our addiction but also to a peaceful and serene life.

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7- Recovery promises The 12 Steps first of all provide us with a program of recovery from our addiction. But beyond that they offer tools to live a life exceeding our wildest dreams, a life in harmony with ourselves, others, and a God of our understanding. The Steps are often referred to as “a design for living that works�. Here is an overview of some of the promises that can come true for us if we work this program of action.

8- Foundations 12 Steps This page provides information on the history of the 12 Steps -- why they were created and their original aim. Knowing how the Steps came to be can help us understand the background of all 12 Step programs.

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2- Meaning of Recovery Not many of us addicts understand what it means to recover from the disease of addiction, or we mistakenly believe it is simply about stopping our drug use. But for recovery to be successful, it should address many aspects of our lives. This page provides a brief description of what constitutes an effective and successful recovery from any kind of addiction.  

Four dimensions of recovery Principles of effective recovery

The disease of addiction has many faces, and is seen in the use of various kinds of substances and in a range of destructive behaviours. Addiction, unlike other illnesses, damages not only the physical but also the mental and spiritual dimensions of our life. Finding a definition that covers all the elements for an effective recovery from addiction has been difficult. But in 2010, the Substance Abuse and Mental Health Services Administration in the United States established a definition of recovery that reflects the experience of those who have freed themselves from substance and behavioural addictions. The agreed definition of recovery was: “Recovery is a process of change through which individuals work to improve their own health and wellbeing, live a self-directed life, and strive to achieve their full potential.”

Four dimensions of recovery An effective recovery from addiction has to address four major dimensions of our life. These are:

1. Health: as addicts, we must recover our health by overcoming and managing our disease, while also living in a physically and emotionally healthy way. 2. Home: recovery from addiction means having a stable and safe place to live. 3. Purpose: recovery from addiction means having meaningful daily activities, such as a job, school, volunteerism, family caretaking, or creative endeavours, and the independence, income and resources to participate in society 4. Community: recovery from addiction means having relationships and social networks that provide support, friendship and love.

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Figure 1 : Dimensions of recovery


Principles of an effective recovery The principles that guide us towards an effective recovery are: Figure 2 : Principles of effective recovery

1. Acceptance We start our journey into recovery on the principle of hope that there is a solution and that we can recover. Many times we find this hope in a 12 Step fellowship through witnessing others who have recovered. We come to accept our condition as a disease and are willing to take actions to recover from it. This small leap of faith -- based on the experience of other addicts -- gives us the courage to work the 12 Steps. We ultimately address all the areas of our lives, and in doing so reclaim the life we were originally meant to live. Acceptance and hope are the catalysts of the recovery process.

2. Our responsibility Taking charge of our lives is the principle foundation for recovery. Once we accept we are suffering from a disease and take responsibility for our recovery, we make the choice as to which path to take to achieve our goal. We feel empowered by taking an active role in choosing and working with the services and supports that assist us in our recovery. By doing so, we gain the strength and clarity to make decisions about our recovery, and regain control over our lives.

3. Fellowship support 12 Step fellowships play an invaluable role in recovery. Fellow addicts encourage and engage with each other, providing each other with the support needed to recover and, more importantly, to maintain recovery. Getting support from 12 Step fellowships has proven to be the most effective means for us to recover. We need the help of each other to overcome a disease that is much bigger than anyone of us alone. Studies have shown those of us who are involved with Fellowships often benefit from improved social functioning, material and family adjustments, and improved psychological adjustments. Working the 12 Steps with the support of the Fellowship enables us to develop an active spiritual life, a greater sense of self-reliance and self-confidence, and a decreased dependence on others. Another contributing factor in our recovery process is the involvement of people who believe in our ability to recover. In addition to fellow addicts in recovery, this group includes family members, providers, faith groups, community members, and other allies

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that form vital support networks. Through these relationships, we discover a sense of belonging, empowerment, and autonomy.

4. A process Each of us has distinct needs, strengths, preferences, goals, culture, and background – which determine our process in recovery. Unlike other diseases, addiction cannot be treated by a doctor giving us a generic pill to “cure” us. The disease of addiction affects each of us differently, damaging different aspects of our lives -- which need to be addressed for our recovery to be successful. For example, addiction drives some to crime and into legal problems, whereas others suffer marital or financial problems. Addressing and resolving these problems have to be part of our recovery process to ensure we don't go back to using drugs, which has been our usual way of coping with life’s problems. Fortunately the 12 Steps not only help us overcome our disease but also provide us with the tools to deal with all of life’s problems. Recovery from the disease of addiction is not linear, and many of us relapse during our journey into recovery. This is part of our recovery process. In fact, relapse usually teaches us things we needed to learn about our disease. It does not mean we have failed or that we cannot recover. The basis for our recovery, though, is simple: Abstinence from drugs and a fellowship of people who can support us along the way.

5. Holistic An effective recovery should encompass our whole life, which means that all aspects of our wellbeing should be taken into account. In 12 Step programs, they say that addiction to drugs is only a symptom of our problem. What happens then is that addicts in recovery can point to improvements in all facets of their lives. We finally get to work on rebuilding all the things on which our addiction wreaked havoc. This means we work on improving – or winning back --family relations, our jobs, education, health, spirituality, creativity, social networks, recreation, and community participation - all the elements that define a healthy and human life.

6. Professionals An effective recovery should address areas of our lives that may be contributing factors to causing or contributing to our primary disease of addiction. Among these factors are psychological issues like trauma and depression. The experience of trauma (such as physical or sexual abuse, domestic violence, war, and disaster) is often a precursor to, or associated with, alcohol and drug use, mental health problems, and related issues. It is important to treat each of our illnesses or conditions as separate issues and seek appropriate help for them. Some of us may need professional help for detoxification or other mental or physical ailments. It is important to recognize the limitations of a12 Step program and not treat it as a medical or a psychological form of treatment. For example, if you are suffering from diabetes, working the Steps will not cure you, although its principles will help you come to terms and cope with it. We need to go to the right professional for treatment. This is all part and parcel of our recovery – which is ultimately about taking responsibility for ourselves and taking care of ourselves. There is a saying in the fellowship that poses the question: “are you willing to go to any length to get sober and stay that way.” And “any length” often means getting help from doctors or psychotherapists for our non-drug issues.

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3- 12 Step Programs The 12 Steps have proven to be the most effective method of recovery from addiction. They provide - at no cost - a simple and effective daily program that addresses all the aspects of this multifaceted disease. This page provides an overview of the 12 Steps so that you can decide whether you want to recover with this program.        

What is a 12 Step program View of addiction Spiritual program Set of suggestions Fellowships meetings Sponsorship Principles of 12 Step programs 12 Steps of AA

What is a 12 Step program 

A 12 Step program is a set of principles outlining a course of action for recovery from addiction, compulsions, and other behavioural problems. The Steps are not a medical treatment program run by professionals, but rather are based on the experience of people suffering from the disease of addiction who found a solution towards their recovery. Originally proposed by Alcoholics Anonymous (A.A.) as a method of recovery from alcoholism, the 12 Steps were first published in 1939 in the book Alcoholics Anonymous (usually referred to as the “Big Book”). The 12 Steps have been adopted by many fellowships to address a wide range of problems, including drugs, gambling, over-eating, and sexual compulsion. Over 200 of these self-help organizations, with a worldwide membership of millions, employ 12 Step principles for recovery. Addicts who did not relate to the specifics of alcohol addiction formed Narcotics Anonymous. Some other 12 Step programs addressing drugs include Cocaine Anonymous, Crystal Meth Anonymous, and Marijuana Anonymous. Compulsive behavioural issues are addressed in fellowships such as Gamblers Anonymous, Overeaters Anonymous, Sex and Love Anonymous, Co dependence anonymous and Workaholics Anonymous. Auxiliary groups such as AlAnon and Nar-Anon, for friends and family members of alcoholics and addicts, respectively, are part of a response to treating addiction as a disease that affects families and others close to the addict. The 12 Steps offer clear-cut directions in a step-by-step approach on how to recover from addiction and maintain recovery. In addition, the Steps can act as “a design for living” in the sense that they provide a template on how to make over our lives – made painful by our addiction -- into something healthy, whole and serene. At their core, the 12 Steps are designed to change our way of thinking and behaving, because, ultimately, it is these aspects of ourselves that have led us to becoming addicts.

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As summarized by the American Psychological Association, working the 12 Steps involves the following:      

Admitting that one cannot control one's addiction or compulsion Recognizing a greater power that can give strength Examining past errors with the help of a sponsor (experienced member) Making amends for these errors Learning to live a new life with a new code of behaviour Helping others that suffer from the same addictions or compulsions

View of addiction 

In 12 Steps programs, addiction is seen as a disease. The emphasis in these programs is on what happens to a person’s mind, body and soul when he or she develops the disease of addiction, as opposed to the type of substances being abused or types of compulsive behaviours. Most probably if we are suffering from addiction we engage in various combinations of destructive habits and use of drugs. For example, we may take heroin to get us high, pills to help us sleep, alcohol to moderate us, food to numb us, and so on. In this way, each drug or behaviour serves to fix us in areas where we lack the inner resources to do so ourselves. 12 Step programs believe three dimensions of a person gets affected with the disease of addiction: physical, mental, and spiritual. The physical abnormality is described as an allergy that sets off a compulsion to continue abusing substances or act out on compulsive behaviours despite adverse consequences. The mental abnormality is seen in the phenomenon of craving and obsession. The spiritual malady is said to be based in an extreme form of self-centeredness and self-will. For example in Narcotics Anonymous, the statement in the First Step (“We admitted we were powerless over our addiction -- that our lives had become unmanageable.”) refers to how the disease of addiction has rendered our mind and body abnormal, which in return causes us to lose the power of choice or control over the substance we abuse. The mental component of the disease of addiction is described as our insanity. This insanity causes us to repeat the same behaviour despite knowing we cannot stop once we have started or believing that the result will be different this time. The “unmanageability” referred to in the First Step refers to the consequences in our life, such as loss of job, family, or problems with the law because of our addiction. The disease concept of addiction is accepted in all 12 Step programs and has been scientifically proven and medically recognized worldwide. Most treatment modalities nowadays treat addicts on this basis thanks to the emergence and success of 12 Steps programs. For further information on the disease concept of addiction, please refer to Addiction.

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Spiritual program 

The 12 Steps is a spiritual program of recovery from the disease of addiction in the sense that it suggests we find a connection to a Higher Power, a power that is outside our limited personal resources. As people who have developed a lifethreatening disease, we do not have the power to help ourselves, and therefore need a Power that is greater than ourselves to solve our problem. Fundamentally, all 12 Steps programs believe the root of any kind of addiction is our lack of self-esteem and value, which we compensate for by resorting to drugs or behaviours to make us feel good about ourselves. Our addiction fills up the emptiness we feel inside, while making us feel powerful and able to cope with life. Yet this way of living eventually leads us to misery and even death. If at our core we are lacking the inner resources that make us whole and healthy individuals, for whatever reason that may be, then we need a power greater than ourselves to help us regain our humanity as normal human beings. Addiction is a harmful relationship with a substance or behaviour that has replaced the healthy, authentic relationship we ought to have with ourselves, our God, and our fellows. For this reason, the 12 Steps are spiritually based: they address in a fundamental way this disease of self-centeredness, rather than simply the substance or behaviour being abused, which is merely a manifestation of the disease. Working the Steps is intended to replace self-centeredness with a growing moral consciousness and willingness for self-sacrifice and unselfishness, which in turn brings about the right relationship with God, others and ourselves. In 12 Step programs this moral consciousness is known as a “spiritual awakening” – when we awaken to the reality of our own brokenness and powerlessness and gain the humility to realize there is a Power greater than us that can help us. A "spiritual awakening" is believed to develop, most frequently, over a period of time. But we see its beneficial effects on us as it releases us from the suffocating self-absorption that afflicts us. We see the world in a new way. We no longer are alone in a hostile universe. We become interested in our fellows. We can love, and we can be loved. The 12 Steps are based upon spiritual principles, three of which are honesty, openmindedness, and willingness -- embodied in the first three Steps. When these principles are followed to the best of our ability, the possibility of recovery is opened to us. 12 Step programs are neither religions, nor sects, nor cults. Neither are they psychotherapy, scientific or medical forms of treatment. The program places importance on developing a working relationship with a “Higher Power” because it is only through finding and believing in a power greater than ourselves that we can start to recover. Each one of us has the freedom to choose his or her own understanding of a Higher Power. The only suggested guidelines are that this power be "loving, caring, and greater than one's self". Individuals from countless spiritual and religious backgrounds, as well as many atheists and agnostics, have developed a relationship with their own Higher Power. The 12 Steps often make use of the word "God" and some members who have difficulty with this term prefer to use “Higher Power". No one should ever let their disbelief in a God keep them from finding recovery in a 12 Step program. Ultimately, the spiritual principles of the 12 Steps is to help us grow in our relationship with a God of our understanding who will help us live a new way of life, free from our addiction and in peace and serenity.

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Set of suggestions 

12 Step programs are a course of action based on the experience of addicts in recovery, who share their experience, strength and hope with others so that they may recover too. The Steps are suggestions only. We are we not forced to do anything we do not want to do. There is, though, a saying in 12 Steps fellowships that indicates the importance of following suggestions: “we suggest you pull the parachute cord when you jump out of the plane.” Addiction is a serious affliction, and following these suggestions may be a matter of life and death for many of us. There will come a time when we have to ask ourselves how desperate we are to recover and whether we will allow our negative opinions and beliefs deter us from giving recovery in a 12 Step program a try. In fellowships there is a saying that describes a closed state of mind that will keep us from seeking recovery: “contempt prior to investigation”. Originally the 12 Steps were created to help chronic alcoholics recover - those who had developed the disease and who had lost the power to control their alcoholic consumption. Although just about everybody could benefit from the principles of the 12 Steps to have a better and more serene life, the Steps are intended for those who have become powerless over their addiction and need the help of a higher Power to remedy their problem.

Fellowship meetings 

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12 Steps Fellowship meetings are like clubs where addicts who share a common form of addiction gather together to share their experience of addiction, the Steps, and recovery with one another. These meetings are self-help or support groups with no requirements for membership and free to anyone who has a desire to stop their addiction. Fellowship meetings act as an arena where we find support and identification. A meeting is a place where we reveal the hardships of our disease and the triumphs we have found in recovery. It's a place where we can let go of shame and guilt, for no one is better or worse than us. It's a place where we can feel safe and at home, for we all know how it feels to be suffering from the disease of addiction. Attending 12 Step fellowship meetings is an effective source of support, the support that our families and communities often could no longer provide as we sank deeper into our addiction. But Fellowship meetings by themselves are not the solution; in order to recover we need to work the 12 Steps. Fellowships meetings are held together by the 12 Traditions, which act as guidelines that help the groups’ function and ensure the survival of the overall fellowship. For further information please refer to: Anonymous Fellowships.

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Sponsorship 

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Because 12 Step programs are not run by professionals nor held in treatment centers, sponsorship is used as a means to support one another towards recovery. Newcomers in 12 Step programs are encouraged to find a more experienced person in recovery with whom they can relate as soon as possible. Together they can work the Steps, with the sponsor providing his or her experience and guidance. In addition, a sponsor provides support by making suggestions to newcomers to help them in their recovery, such as attending meetings, how to avoid relapse, reading of literature, writing, or meditation. A sponsor's role is not that of a legal adviser, a banker, a parent, a marriage counselor, or a social worker. Nor is a sponsor a therapist offering professional advice. A sponsor is simply another addict in recovery who is willing to share his or her journey and experience of the 12 Steps. For further information please refer to: Sponsorship.

Principles of 12 Step programs There are certain guiding principles common in 12 Step programs that if adhered to will make our journey into recovery more successful. They are: Figure 3 : Principles of 12 Step programs

1. Never cured   

12 Step programs believe we are never cured of the disease of addiction. Once the disease has developed, like any other chronic illness, it will always remain with us. The Steps provide a plan of recovery to keep this disease in remission on a daily basis. That is why working the Steps is a daily affair in maintaining recovery. As drug addicts, we need to accept we are suffering from a life-long illness and that it is never again safe to use any kind of mind-altering substances. We have lost this luxury. As difficult as this may seem to many of us, this fact about our condition has to be accepted if we hope to make a start in our journey towards recovery.

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2. Total abstinence 

12 Step programs for drug addicts advocate total abstinence from all mind-altering substances. This is because the program addresses the actual disease of addiction, as opposed to focusing on any one type of substance being abused. As they say in Narcotics Anonymous and other 12 Step fellowships, changing from one substance to another to beat addiction is like changing deck chairs on the Titanic. Experience has established beyond any doubt that once we have developed the disease, taking any mind-altering substance will set it in motion again. The only defence we have against this disease is to stay away from it for the rest of our lives - one day at a time. To take any drug, even after a period of abstinence, sets off that craving, that compulsion. The disease is always waiting, they say in 12 Step programs. But the program is there too, and many, many people enjoy years and decades of being drug free. Behavioural addictions are different, though, since one cannot abstain totally, for instance, from food. For such addictions, the 12 Steps suggest a plan of recovery based on guidelines of moderation. Behavioural addictions are not as black and white as substance addictions in that behaviour will vary according to each individual. For example, one food addict may eat too much when he or she wants to avoid uncomfortable feelings, whereas another food addict will starve him or herself for the same reason. With behaviour addictions it is important to understand root causes of the disease. Working an honest and thorough Step 1 will help us understand why a behaviour has become problematic and provide us with the tools to keep our addictive behaviour in remission. Admitting that the behaviour has, in a sense, got us beaten, opens the door to recovery. For addicts, surrender is a victory.

3. Our responsibility 

12 Step programs emphasize that we must take responsibility for our own recovery. Unlike other illnesses where you give responsibility to a doctor to cure you, with addiction it is up to each of us to take the actions necessary to become clean and stay in recovery. The program promotes self-responsibility and self-care – a concept that may be foreign to many of us, even more so if raised in a culture where self-care is foreign. But with addiction, we have to understand that we are suffering from a life-threatening illness, and it is up to us to work the program of recovery. It is a choice each one of us has to take – either to continue giving power to our addiction or take responsibility for it and do what is necessary to get well. Our responsibility to recover takes many forms, from practical things such as attending meetings, working the Steps, and getting a sponsor, to emotional aspects of being gentle and patient with our condition. Although we are not responsible for our disease of addiction, this program says we are responsible for the consequences of our behaviour and actions. For example, if your drug addiction has led you to steal, then you are responsible for the consequences regardless of suffering from this disease. But the Steps make provision for this, and part of working this program is about righting the wrongs we have done. When working the 12 Steps we need to ask ourselves whether we are willing to go to any length to get better, whether we are going to take responsibility for our disease, and whether are going to make recovery our number one priority. Unfortunately many of us have to reach rock bottom before we can admit to our disease and accept the plan of recovery as suggested by the 12 Steps. This is

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because that so long as we believe we have power and can exercise self-will, there is little likelihood of having the humility to admit to powerlessness.

4. Daily program 

Based on the chronic nature of addiction, 12 Step programs advocate a daily program of recovery. “Staying in the day” and working the program “a day at a time” are phrases heard again and again in 12 Step meetings, and for good reason. It is beyond the capability of any addict to imagine a life without drugs or their compulsive behaviours. In fact, to do so is to set ourselves up for relapse. The program therefore encourages us to stay clean “just for today” and not to worry about how we will manage tomorrow. This principle also helps us “stay in the here and now” and to keep our recovery as a first priority in our lives. This principle also makes everyone in the program equal in that no one is “more” recovered than another. It also eliminates Dutch courage and grandiosity, and it keeps us humble in our recovery. All of us in recovery have no more than a “daily reprieve” -- that is, we are clean for only 24 hours at a time.

5. No monopoly 

The 12 Steps do not claim to be the only approach toward recovery from addiction. Rather, it simply offers a solution towards recovery from addiction, to those who have found no other way.

6. 4 criteria to work the program There are 4 fundamental criteria that if practised will help us work the 12 Steps more effectively to achieve recovery. They are: 1) Belief in a Power greater than ourselves: as chronic addicts we need to stop relying on ourselves for a solution to our problem, but instead rely on a Higher Power to help us. Our Higher Power can be a power of our own choosing, just so long as it is not ourselves. Some members of 12 Step fellowships make the meetings they attend regularly their Higher Power. Some think of God as standing for “good orderly direction.” The point is that as addicts we have played god and have failed in our attempts to stop our addiction. Relying on a Power greater than ourselves will help us look for a solution outside ourselves while relieving us of the burden of trying to find a solution on our own for this disease. 2) Honesty: Honesty in the context of the 12 Steps means having the courage to see the truth about our condition. It is the honest admission that we have a disease over which we have lost control and power. This criterion helps us become humble enough to look for a solution outside ourselves. 3) Open-mindedness: In the context of the 12 Steps, to be open-minded means to avoid as much as possible the kind of thinking that shuts us off from solutions, the kind of thinking that leads us to believe we know better – and to dismiss the suggestions of the program, while clinging to the belief that nothing works for us. In describing the stubborn, self-defeating attitudes of the chronic addict, members of 12 Step fellowships like to point out that “my best thinking got me here.” Open-mindedness helps overcome our sense of grandiosity and pessimism.

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4) Willingness: In the context of the 12 Steps, willingness means to have a desire and an eagerness to take action. It is a willing attitude that helps us put aside old ideas and try solutions we may not at first like or agree with. Practise of these criteria demonstrates our humility and desperation to go to any length to recover.

12 Steps of A.A. These are the original 12 Steps of Alcoholics Anonymous. All other 12 Step programs use the same Steps with the exception of Step 1, in which the word alcohol is replaced with a problematic substance or behaviour. In the case with Narcotics Anonymous the word alcohol has been replaced with addiction to reiterate the disease concept regardless of the type of substances being abused. The reason for this is in Step 1 the addict needs to identify and accept his or her primary problem, be it to drugs, alcohol, sex, food, gambling, etc. The other 11 Steps follow the same spiritual program of action suggested for recovery from the disease of addiction, whatever shape it has shown itself or taken form in us. 1. We admitted we were powerless over alcohol - that our lives had become unmanageable. 2. Came to believe that a Power greater than ourselves could restore us to sanity. 3. Made a decision to turn our will and our lives over to the care of God as we understood Him. 4. Made a searching and fearless moral inventory of ourselves. 5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs. 6. Were entirely ready to have God remove all these defects of character. 7. Humbly asked Him to remove our shortcomings. 8. Made a list of all persons we had harmed, and became willing to make amends to them all. 9. Made direct amends to such people wherever possible, except when to do so would injure them or others. 10. Continued to take personal inventory and when we were wrong promptly admitted it. 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. 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.

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4- Plan of Recovery This page describes the general plan of recovery common to all 12 Step programs. It is designed to help you see how following the actions suggested in each Step can bring about change and lead to a serene life free from addiction.   

Foundation Steps Action Steps Maintenance & Growth Steps

Fundamentally, the plan of recovery for all 12 Step programs follows the same pattern, whether you are addicted to a substance or a behaviour. This is because the Steps focus on individuals and how they think and why they turn to drugs or compulsive behaviours. As far as 12 Step programs are concerned, the problematic substance or behaviour is merely a symptom of the disease of addiction. It is important to work the Steps in the order that they are presented. In this way we lay down the vital building blocks on which recovery is based. We need the working knowledge of one Step to realize its purpose and gain the required incentive to work the following Step. Look at the 12 Steps as the tools you are using to build a new home, a new life where you shall live free of addiction and in peace and serenity with yourself, others, and your God. All 12 Step programs follow the same plan of recovery: first the problem is described, then the solution is offered, followed by a course of action necessary to produce recovery and – most importantly -- to maintain daily recovery. Table 1 : Design of 12 Steps

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Foundation Steps: (1 & 2) The first two Steps are the foundations on which our new life in recovery is built and are essential as we proceed on to the other Steps. Without a firm grounding in Steps 1 and 2, we would be lost as to why we should do what the program suggests. Steps 1 and 2 do not require any action on our part, but they do require a change in our belief system, which is essential if we hope to recover through this spiritual program. We first have to accept that we are suffering from a disease, and second, that there is a Power greater than ourselves who can help us recover.

Step 1: Identifies the Problem 

Step 1 provides the facts about the nature of our problem. By working Step 1, we can come out of denial and accept we are suffering from a disease that has affected us mentally and physically and over which we have lost control. This is the fundamental aim of Step 1 and a fact we have come to grips with. It is a choice each one of us has to make, for no one can convince another that they have a problem. Your choice is whether you want to stay in denial, while also continuing to believe you are a bad person, a weak person. Or you can face facts and accept you are suffering from a disease. The experience of those of us in recovery is that once we surrender to the truth that we have a disease over which we are powerless, then the burden of trying to solve – all by ourselves -- our problem is lifted. We don't need to hide in shame and guilt anymore. We see our condition for what it is, and realize there is a Power greater than us who can lift this burden and help us recover. In Step 1 of any 12 Step program, it is imperative to gain an understanding of your particular addiction, be it drugs, alcohol, food, sex, etc. For example, drug addicts must finally acknowledge they have lost power over their drug use and how their lives have become unmanageable. The same principles apply to behaviour addictions, although it is not as straightforward as with substances. With behaviour addictions the nature and extent of the problem depends on how it has impacted one’s life. For example, the problem for food addicts may be overeating or starving themselves. That person has to identify and accept how their eating habits have become a major problem, and how as a result their lives are in havoc. The same principle applies to sex, work, gambling, co-dependency, etc., in which the person first needs to acknowledge and accept the nature of their particular problem and understand why their life has been made unmanageable as the result. What is important in any Step 1 is the understanding that we are suffering from a disease regardless of how that disease is manifesting itself in our life. It is the acknowledgement and acceptance of this truth that will help to motivate us to look for a solution outside ourselves. There are many of us who suffer from multiple forms of addictions. This is not surprising when we know the root of this disease is within ourselves and that it can show itself in various self-destructive ways. If that is the case, we need to work Step 1 on each of our addictions for the necessary knowledge and acceptance to work the rest of the Steps.

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Step 2: Offers the Solution  Step 2 offers the solution to our disease of addiction. Whereas Step 1 may be hard 

to swallow because we have to admit we have a disease over which we are powerless, Step 2 offers hope. There is a way out, and we can recover. Step 2 presents the solution in the form of a Power greater than ourselves. It follows logically that if we don't have the power to help ourselves, then we must look elsewhere for that power. All we need to make a start is the courage and humility to accept we are not god, that our ways have not worked, and that we now need a Power greater than ourselves to help us. This is the essence of Step 2. The agnostic or atheist among us need not worry about being left out, for the solution to our problem is spiritual, not religious. Our God can be whatever we may choose him or her or it to be. We need only open our heart to the possibility of a God and sincerely ask for help. Our God always shows himself through one medium or another -- be it the power of a fellowship group, the comradeship and support we find from others in recovery, in nature, etc. Neither does our understanding of our God have to come all at once. Like our recovery from addiction, which is a process, our understanding of our God is also a journey. As we progress in recovery and are able to put more faith and trust in Him, we grow in our understanding of our Higher Power. What is pivotal as we embark on our new way of life in recovery is our willingness to change our belief system. We need to realize self-reliance failed when it came to stopping our addiction. In other words, we need to quit playing god and gain the humility to accept we need a Power outside ourselves for help. This will happen more easily than we might think, if we have worked an honest Step 1 and have faced the truth about our disease. It is this new belief in a God of our understanding -- and reliance on Him -- that will lift our obsession with our addiction, for ultimately it has been our obsession that has been at the root of our problem. It is also the belief and reliance on a God of our understanding that will give us the power to work the rest of the Steps. And we will surely need it, for from here on a course of vigorous action starts.

Action Steps: (3 to 9 - Actions to recover)  

Steps 3 to 9 are called action Steps because, unlike Steps 1 and 2 that are simply principles that we need to abide by, these are the actual actions we need to take in order to recover. Having learned about the nature of our problem in Step 1 and belief in our God in Step 2 for a solution, we are prepared for the actions called for in Steps 3 to 9. The foundation of these action Steps is based on the fact that as addicts we are suffering from the disease of self. Our lack of inner resources of value and esteem has led us to rely on substances or behaviours to feel good about ourselves. But as a result of these destructive mechanisms, we have ultimately harmed others and ourselves. In 12 Step programs our addictive nature is identified as self-will run riot -- this is the root of our problem. For this reason, Steps 3 to 9 provide us with the tools to rectify the damage of our past so that we can start anew as whole human beings. These Steps are like mortar and bricks for building a new life. You want your new life to be free of resentment, fear, guilt, and shame -- all the things that kept us acting out on our addiction. These Steps show us how to clean up the debris of the past, so our new home can become clean free from addiction.

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Maintenance & Growth Steps: (10 to 12 - Actions to maintain & grow in recovery) 

Steps 10 to 12 are the actions we need to take on a daily basis to maintain our recovery and to grow in our conscious contact with our God.  We have recovered from a diseased state of mind and body (Steps 1 & 2); and we have repaired our past and are living free of shame (Steps 3 to 9). But how do we ensure that we do not lose ground? How do we hold on to what we have so far achieved? These are the aims of Steps 10 to 12, to provide us with the tools to maintain our recovery, while also living in harmony with others, our God and ourselves.  Since we are never cured of our disease of addiction, Steps 10 to 12 spell out what to do on a daily basis to keep our new home – our new way of life clean. Step 10 sums up in a simple way – a way that we can practice daily -- the lessons of Steps 3 to 9. It is the Step we practice to maintain the life we have built in recovery – the new home we have built for our self -- and keep it from falling apart. Step 11 is about making our new life peaceful and serene. By practicing this Step we deepen our conscious contact with our God through prayer and meditation. We discover the true relationship he wants with us and realize the beautiful plans he has in store. Step 12 is about inviting others into our new life – into our new home -- those still suffering this deadly disease, those who are lost and hopeless. We show them how they too can be free of the pain of addiction by working the 12 Steps. We carry the message of recovery. As they say in 12 Step fellowships, we keep our sobriety by giving it away.

We entered the program as hopeless addicts, most of us at death’s door, with no wish but to stop our addiction. The miracle of this program is that it offers us not only the means to recover, but also a way of life beyond our wildest dreams. Many of us in recovery often express gratitude for our disease of addiction because ultimately, it led us to12 Step programs, which showed us how to live a life in true peace and harmony.

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5- Goals of the Steps The 12 Steps have a precise goal which is to produce an effective recovery from the disease of addiction. The diagrams illustrated in this page, show how each Step provides us with the tools necessary to stay clean and in daily recovery. The table below illustrates how the Steps are structured and the goals each aims to achieve. Table 2 : Goals of 12 Steps

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Each of the Steps has a specific purpose. When we work a Step, two things occur: we benefit from the wisdom and change embodied in that Step, and we are made ready to work the Step that follows. There is a proven logic behind their structure. It is therefore important to work the Steps in order and not jump around or choose to work only those that at first appeal to us. After working Step 1, we feel so relieved, so elated that we feel we should right away share this great discovery. We want to carry the message of recovery to others – in other words, start working Step 12. Although this is admirable – and also signifies our readiness for change in our attitude towards life, – at this early stage it is better to focus on working our own Steps. We need to learn what is in those Steps to process our recovery and to heal first. Experience has shown that if we work the Steps in order we are less likely to relapse. Working the Steps one after the other will also help us avoid the other pitfalls of early recovery, such as becoming egocentric or controlling, or falling prey to another addiction such as codependency or compulsive helping. It is also more beneficial for those we might help, because it is only by working the Steps that we will understand what the message of recovery is and be able to carry it to others. Remember that Step 12 Steps states, “ … as the result of these steps, we tried to carry this message….” There is also a difference between helping others, such as supporting other members of our group -- which is great for preventing our own relapse -- and carrying the message, which is sharing with another our working experience of the 12 Steps.

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6- Spiritual Principles The diagrams below show how the spiritual principles of each Step aim to produce a change in us that will lead not only to recovery from our addiction but also to a peaceful and serene life.  

Principles of 12 Steps Spiritual roots of 12 Steps

Principles of 12 Steps There is a set of principles underlying each Step that, when practised, will help us work that step more effectively to achieve its desired goal. Table 3 : Principles of 12 Steps

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Spiritual roots of 12 Steps The diagram below illustrates how the spiritual roots of each Step lead to a healthier connection with ourselves, with others, and with our God. Knowledge of these spiritual roots will help us understand why working the 12 Steps will ultimately lead us to a life of peace and serenity. Table 4 : Spiritual roots of 12 Steps

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7- Recovery Promises The 12 Steps first of all provide us with a program of recovery from our addiction. But beyond that they offer tools to live a life exceeding our wildest dreams, a life in harmony with ourselves, others, and a God of our understanding. The Steps are often referred to as “a design for living that works”. Here is an overview of some of the promises that can come true for us if we work this program of action.

We will accept our disease 

We will not regret that we fell prey to the disease of addiction, but accept it for it led us to recovery through the 12 Steps – and a new and spiritual way of life. As our journey in recovery continues, we will see our relationship with our Higher Power grow richer and more rewarding. We will see that he has a plan for us that exceed all our expectations. Neither will we want to forget that we suffered from addiction, for it will serve as a reminder of the miserable life we had -- and be grateful for how much we have achieved through the grace of this program.

Our obsessions will be lifted 

If we work the Steps to the best of our ability and are thorough and diligent about them, the results will amaze us. The compulsion to use drugs – even the desire to use them – will be lifted forever, a day at a time. Working Steps 1 and 2 makes this possible. In Step 1 we surrender and admit we have no power over our addiction, that we cannot think our way out of our problem – that we need a Power greater than ourselves to show us the way. In Step 2 we come to believe in our God who helps remove our obsession with drugs.

We will find recovery  

Our disease will stay in remission on a daily basis and will recover from a diseased state of mind and body. As a result we will experience a new life free from our addiction. We will no longer be slaves to drugs, doing things we never thought we’d ever do or becoming people we never thought we’d be. Nor do we need ever again find ourselves at the mercy of drugs, having them dictate how we live -- and degrading ourselves to get them. We will be free from the shackles of our addiction and be able to enjoy mental, emotional, physical, and spiritual wellbeing. We can finally become the people we were meant to be.

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We will experience a new freedom 

We will experience a new sense of security and freedom as old habits die away. We will not be obsessed with finding money to feed our drug habit, and we will not be running away from life or people. We have made amends to those we have harmed, made restitution to them, and can now hold our head up high. We become secure in the knowledge that no matter what life throws at us, we have the tools of the 12 Steps to help deal with it. All we need to do is apply their principles. Our thinking is improved and we once again can trust our instincts in deciding how to proceed, in any situation. Life is easier and we walk with a lighter step, knowing that we will never be given more than we can handle. We will not feel less than or fear being labeled as addicts. We have a program today that helps us accept our reality and to value ourselves. Where once we spent whole days in isolation using drugs, now we suddenly find ourselves yearning for life – working towards that degree we wanted, working the job we liked, being the parent or the son we were meant to be. There's money to pay for the bills because we haven’t spent it on drugs. People around us are happier because they don't need to worry about where we are or whether we have stolen from them. We start to mature. We take responsibility and become confident. We are able to accept others and ourselves.

We will live a purpose driven life 

Though work on the 12 Steps starts with an admission of powerlessness, we then gain an incredible power over our lives. We discover inner resources made possible through our conscious contact with our God, which help us deal with life calmly. Miracles start happening. We find ourselves capable of doing things others shy away from. We become determined. Having come close to throwing away our lives, we now live life with purpose and confidence. We find ourselves willing to carry the message of recovery to other addicts, wherever they may be – in prisons, in hospitals, and in other facilities. We no longer are afraid of going out in the world. In place of fear is a willingness to be of use to others. We will no longer sit in self-pity, dreaming of how life could have been and bemoaning how unfairly fate has treated us. Instead, we will become useful members of our community. Each day our esteem for ourselves will grow as we reflect on the great changes in our life made possible by this program. We will be able to give ourselves credit for having the willingness and courage to break away from this disease, for facing reality, and for having the humility and diligence to work this rigorous spiritual program. As we work the Steps and lose our obsession with drugs, we find ourselves interested in life again, interested in becoming part of humanity and re-joining the community of our fellows. We leave behind that destructive selfishness that made us do anything and forsake everyone to feed our addiction. This freedom enables us to experience life in its fullest and realize what it has to offer. To our amazement, we find ourselves willing to join with others as equals – neither better than nor less than. We realize the world is not all about us. We are no longer greedy or selfish people, blind to the needs of others. We realize we are far from perfect, but instead are a work in progress, trying our best to move in the right direction – a day at a time.

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We will forgive others and ourselves 

We will learn how to forgive ourselves by accepting that our shameful behaviour was the result of a disease over which we had no power. But now that we have taken responsibility and worked the Steps to right the wrongs we did, we are relieved of the guilt and shame that afflicted us. We will no longer be running away from others or ourselves.

We will be useful to others 

Ironically, we will see how our horrific experience with this disease can benefit others. Seldom do normal people, or even professionals, understand why addicts behave the way they do. But in recovery, our experience of having been lost and then finding the way out can be a great help and inspiration to others suffering from addiction. The surest way to help a suffering addict is through our story of victory over our disease.

We will be in conscious contact with our God 

Slowly, as we work this program, our trust in our Higher Power grows. We become secure in the knowledge that he is present and looking after us. We come to see that our God has always loved us and helped us, even more so during the days we were incapable of loving or caring for ourselves. We feel serene and at peace in the knowledge that there is no problem too difficult to tackle, that our God will never give us more than we can handle. We will experience miracles as we journey in our recovery. The God of our understanding remains a real and active presence in our lives.

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8- Foundations of 12 Steps This page provides information on the history of the 12 Steps -- why they were created and their original aim. Knowing how the Steps came to be can help us understand the background of all 12 Step programs.      

Step 1- the Problem Step 2- the Solution Carrying the Message Birth of Alcoholics Anonymous 12 Steps- plan of recovery Formation of other anonymous Fellowships

Step 1- the Problem  Bill Wilson, who co-founded Alcoholics Anonymous in 1935, had ruined a promising career on Wall Street by his drinking. Also, in the couple of years before getting sober, his out-of-control drinking and inability to hold a job put a considerable strain on his marriage. During that time, in 1933 and 1934, he was hospitalized for alcoholism at Towns Hospital in New York City on four separate occasions. While there he was put under the care of Dr. William Silkworth, who was known for his innovative methods in treating alcoholics. During Bill’s first stay at Towns Hospital, Dr. Silkworth explained to him his theory that alcoholism is a disease rather than a moral failure or a matter of willpower.

Dr. Silkworth believed that alcoholics were suffering from a mental obsession, which combined with an allergy, made compulsive drinking inevitable once the alcoholic picked up that first drink. To break the cycle, one had to abstain completely from alcohol use. This information was a revelation to Bill, who was greatly relieved to see for the first time why he could not stop drinking despite his best efforts. After being released from Towns Hospital, Bill managed to stay off alcohol for a month before he started drinking again. He had learned about the nature of his problem, but that in itself was not enough to keep him sober. He did not yet know the solution to his problem. The discovery of the nature of our problem – our addiction -- is what Bill later incorporated as the essence of what is now Step One in all 12 Step programs.

Step 2- the Solution 

Ebby Thatcher, a chronic alcoholic and an old friend of Bill, visited him in his home in late 1934. To Bill’s amazement, Ebby was sober. When asked how he had managed to do this, Ebby said that he "had got religion." Though Bill was sceptical regarding how a God in his life could help him stop drinking, he later wrote of that meeting with Ebby, who is considered the first sponsor since he carried the message of recovery to Bill: "My friend suggested what then seemed a novel idea. He said, 'Why don't you choose your own conception of God?' That statement hit me hard. It melted the icy intellectual mountain in whose shadow I had lived and shivered many years. I stood in the sunlight at last.” This concept of choosing one’s own Higher Power was later incorporated into Step 2, and it underscores that 12 Step programs are about spirituality, rather than religion.

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After Ebby’s visit, Bill continued to drink and landed again at Towns hospital. But this was to be the last time. While lying there in bed and full of despair at his nightmarish predicament, Bill cried out: "I'll do anything! Anything at all! If there be a God, let Him show Himself!" He then had what is nowadays called a spiritual experience, in which he all of a sudden felt the unmistakeable presence of God in his life. Bill had hit rock bottom, he admitted he was powerless over his disease and needed a power greater than himself for help. This honest admission, together with his humility to ask his God for help, was to be his salvation. That was in December 1934, and Bill never drank again. He died in 1971.

Carrying the Message 

Experiencing this miracle in his life, Bill decided to help other suffering alcoholics – the seed of the Alcoholics Anonymous fellowship. For months after that, though, he had no luck getting anyone sober. As he finally had to admit, he was going about it the wrong way by preaching to alcoholics that they must find God in order to sober up. At this point, Dr. Silkworth advised him to give these alcoholics the medical facts first, and to give it to them hard: tell them of the obsession that condemns them to drink to the point where they go mad or die. Dr. Silkworth knew that an alcoholic was more likely to accept this stark truth from another alcoholic. Bill’s experience set in motion the way millions in recovery today maintain their sobriety -- by carrying the message of recovery to others.

Birth of Alcoholics Anonymous 

A few months later, Bill was on a business trip in Akron Ohio. When the venture turned sour, Bill was tempted to drink but realized that if he was to stay sober he must talk to another alcoholic. Bill phoned local ministers to ask if they knew any alcoholics and was referred to Dr. Bob Smith. They met soon afterward, though Dr. Bob was initially reluctant to hear Bill out. But Dr. Bob was so impressed with Bill’s knowledge of alcoholism and willingness to share his own experience that he became the first alcoholic Bill helped into sobriety. Dr. Bob’s sobriety date of June 10, 1935 is considered the founding date of Alcoholics Anonymous.

12 Steps- plan of recovery Figure 4 : Bill & Dr. Bob talking to a prospect

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Bill and Dr. Bob then sought to develop a simple program to help chronic alcoholics, a program that would help drinkers realize that willpower is useless in overcoming their problem. Their position was that alcoholics were in a state of insanity, rather than a state of sin. Alcoholics needed to realize that they couldn't conquer alcoholism by themselves - that surrendering to a higher power and working with other alcoholics were required to get sober. So the two of them set off visiting hospitals for prospects, and would start off by giving these prospects the medical facts about their disease. They then would ask the alcoholic if he was ready to surrender and admit to powerlessness over his drinking. The alcoholic would then be invited to pray to a higher power that he be restored to sanity. With this, the alcoholic’s admission of complete defeat was complete - and now he was ready for recovery. Two realizations grew out of Bill’s work in Akron. The first was that to remain sober, an alcoholic needed another alcoholic to work with. The second was the 24 hours concept: that if the alcoholic could resist the urge to drink by postponing it for one day, one hour, or even one minute, he could remain sober. Both these concepts are part of all 12 Steps programs and advocated to this day. At the time they got sober, Bill and Dr. Bob were attending meetings of the Oxford Group, a Christian movement popular in the 1930s and a place where many turned to for their problem with alcohol. Though Bill soon broke away from the Oxford Group, its teachings and structure influenced the formation of Alcoholics Anonymous and the 12 Steps. By 1939, Bill, with the help of the first 100 recovering alcoholics, wrote the Big Book of Alcoholics Anonymous. In it they set down what they had learned about recovery from alcoholism. The main objective of this book is to help suffering alcoholics find a power greater than themselves. In this book Bill outlined the 12 Steps, which are a suggested program of action to achieve recovery. Bill has credited the Oxford Group as the inspiration for the 12 Steps, saying in 1955: "The early AA got its ideas of self-examination, acknowledgment of character defects, restitution for harm done, and working with others straight from the Oxford Group and directly from Sam Shoemaker, their former leader in America, and from nowhere else." Bill also gave credit to the Oxford Group for saving his life. Figure 5 : Cover of the original Big Book of AA

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Formation of other Fellowships 

Following the success of Alcoholics Anonymous, other 12 Step programs developed, with the second one being Al-Anon. Pioneered by Bill’s wife, Lois, it aimed to help family members of alcoholics. About 20 years after the start of A.A., as drug abuse became a major problem, the fellowship of Narcotics Anonymous was founded. All 12 Step fellowships are based on and adapted from the 12 Steps of Alcoholics Anonymous. The only important difference among these fellowships is Step One and Step Twelve. In these two Steps members identify with their primary problem, and fellowships have adapted them to correspond to a specific substance or behaviour that has become a major problem. (“We admitted that we were powerless over… (problematic substance or behaviour) - that our lives had become unmanageable”) and (“Having had a spiritual awakening as a result of these steps, we tried to carry this message to ___ and to practice these principles in all of our affairs”). The Step 1 of Narcotics anonymous does not specify a particular type of substance, but rather uses the word addiction to emphasize powerlessness over the disease of addiction as opposed to a specific substance. But as far as the actions required for recovery are concerned, all 12 Step programs follow the same principles. In addition, all 12 Step fellowships adhere to the same general guidelines known as the 12 Traditions, meeting formats, and organizational structure as Alcoholics Anonymous.

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Figures & Tables Figures Dimensions of recovery _________________________________________________________ 3 Principles of effective recovery ____________________________________________________ 4 Principles of 12 Step programs ___________________________________________________ 10 Bill & Dr. Bob talking to a prospect ________________________________________________ 26 Cover of the original Big Book of AA _______________________________________________ 27

Tables Design of 12 Steps ____________________________________________________________ Goals of 12 Steps _____________________________________________________________ Principles of 12 Steps __________________________________________________________ Spiritual roots of 12 Steps _______________________________________________________

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About Hamrah Given that addiction is scientifically proven to be a disease, and the effectiveness of 12 Step programs towards recovery from it, Hamrah has been established to provide information on the disease of addiction, its various manifestations and its effects on family members. Our hope is to empower you with information about 12 Step programs and Fellowships so that you may find the means and the support to recover and live a new way of life free from addiction. The information provided, aims to empower: 1- People suffering from addiction, be it to substances or behaviours. 2- Addicts in recovery wishing to enhance their knowledge of 12 Step programs and Fellowships. 3- Family members and or friends seeking to recover from the effects of a loved one’s addiction on their lives. 4- Community members interested to learn about the disease of addiction and recovery with 12 Step programs. 5- Professionals interested in enhancing their knowledge of 12 Step programs and Fellowships so as to support their addicted clients towards recovery.

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