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Twelve-Step Programs: Effectiveness with Christian, Atheist, and Agnostic Participants

Among the many treatment options available to treat addiction, 12-step programs often prove to be effective. Research demonstrates that participation in 12-step programs such as Alcoholics Anonymous (AA) aids in sobriety as well as improved psychosocial functioning (Emrick, Tonigan, Montgomery, & Little, 1993; Tonigan & Hiller-Sturmhofel, 1994). Despite many divergent theories regarding the causes and treatment of addiction, researchers generally conclude that addiction has a physical, social, and spiritual component (Boeving, 2010). AA recognizes that addiction has a physical component by the assertion that it is an illness, and the social dimension is addressed through meeting attendance and sponsorship (Alcoholics Anonymous World Services [AAWS], 1984). The spiritual component is covered in the 12-step modality through the completion of steps which lead to admitting powerlessness and instead rely on a “Power greater than ourselves” (AAWS, 1984, p. 15). The progression through the 12 steps of AA is viewed as the means to the participants’ necessary spiritual growth and development of a personal relationship with a Higher Power which is central to abstinence (Tonigan, 2007; Horstmann & Tonigan, 2000). Given the spiritual emphasis in 12-step recovery programs, it is important to determine if these programs are effective with atheist and agnostic participants.

While participation is not limited to God-believers, evidence shows that 12-step programs are generally quite effective among spiritual participants (Horstmann & Tonigan, 2000). One study which supported this finding investigated 47 AA members, 98% of which described themselves as spiritual or religious, who reported four years of sustained abstinence (Horstmann & Tonigan, 2000). These researchers concluded a positive relationship between collaborating with God in recovery and length of abstinence. This collaboration has also been referred to as third-order change which indicates a willingness of an individual to surrender control of their lives by trusting instead in a Higher Power (Buker, 2003). The concept of surrendering and trusting God leads to redemption and living according to the Holy Spirit and God’s Word (Buker, 2003). If we view abstinence as a surrender of self-control and a reliance on God, certainly, the success of AA appears to be more readily achieved through the adoption of this principle. Given that atheist and agnostic participants do not espouse the AA principle of surrender to a Higher Power which is believed to be essential to abstinence (Buker, 2003; Horstmann & Tonigan, 2000) the question remains regarding the effectiveness of 12-step programs for these participants.

Researchers conducted a study utilizing 587 AA participants to determine if AA participation and sobriety was the same for atheist or agnostic participants and spiritual participants (Kaskutas, Turk, Bond, & Weisner, 2003). These researchers interviewed participants upon admittance to an inpatient stay or before the third outpatient visit (T1), again at 1 year (T2), and at year 3 (T3). The longitudinal findings suggested that initial involvement in AA was similar among the secular (atheist and agnostic), the unsure, the religious, and the spiritual, however, by T3, the decline in AA attendance was two to three times higher in the secular and unsure groups versus the religious and spiritual groups (Kaskutas et al., 2003). Other research concurs that spiritual participants were more likely than atheist and agnostic participants to remain in 12-step programs (Tonigan, Miller, and Schermer, 2002).

Researchers have found that atheist and agnostic participants could experience the same level of sobriety as spiritual participants if they remained in 12-step programs (Tonigan, 2007; Tonigan et al., 2002) and that non-spiritual participants who experienced a spiritual awakening were twice as likely to report sobriety (Kaskutas et al., 2003). Utilizing 1,526 self-reported atheist, agnostic, unsure, spiritual, and religious clients, researchers conducted Pearson product correlations of AA attendance and abstinence and found that AA attendance correlated highly with sobriety, but degree of belief in God did not (Tonigan et al., 2002). It is important to understand the role, then, that spirituality does play in achieving abstinence. Spirituality could be an indirect effect of sobriety rather than a direct effect (Tonigan, 2007). It could be that spirituality simply leads to the adoption of behaviors that reduce drinking rather than the belief in God itself influencing abstinence directly (Tonigan, 2007). This is an important distinction because one could surmise that if Tonigan’s findings are valid, then perhaps other deeply rooted convictions of the individual could sustain abstinence behavior.

Twelve step programs such as AA emphasize an admittance of powerlessness and a reliance on God or a Higher Power (AAWS, 1984). Atheist and agnostic alcoholics who choose to participate in AA and disregard the spiritual aspect of the program and instead focus on the fellowship component could benefit, yet may not be able to find a replacement to “God” in the step work that is powerful enough to sustain abstinence (Magura, 2007). While research suggests that spirituality is not a predictor of abstinence, it is indicated that those who continue to participate in AA tend to increase in their spiritual beliefs and practices which can, in turn, encourage greater participation in AA thus greater odds of sobriety (Tonigan, 2007). Future research could seek to determine a means of increasing attendance among atheist and agnostic participants so that they could benefit from 12-step modality just as their spiritual counterparts. Research seems to be lacking in the determination of what, if anything, atheist and agnostic participants of AA, seem to rely on as they admit powerlessness and surrender their own will. Additional studies could seek to determine if reliance on fellow group members and the sense of connectedness and accountability is the motivating factor for these participants in maintaining sobriety.


Alcoholics Anonymous World Services, (1984). This is AA: An Introduction to the AA Recovery Program. New York, Author.

Boeving, N.G. (2010). Sneaking God (Back) Through the Back Door of Science: A Call for a Comparative Addictionology. Pastoral Psychology, 59(1), 93-107. doi: 10.1007/s11089-009-0217-7

Buker, B. (2003). Spiritual Development and the Epistemology of Systems Theory. Journal of Psychology and Theology, 31(2), 143-153.

Emrick, C.D., Tonigan, J.S., Montgomery, H., & Little, L. (1993). Alcoholics Anonymous: What is currently known? In McCrady, B.S., & Miller, W.R., eds. Research on Alcoholics Anonymous: Opportunities and Alternatives. New Brunswick, NJ: Rutgers Center of Alcohol Studies, 41-76.

Horstmann, M.J., & Tonigan, J.S. (2000). Faith Development in Alcoholics Anonymous (AA): A Study of Two AA Groups. Alcoholism Treatment Quarterly, 18(4), 75-84.

Kaskutas, L.A., Turk, N., Bond, J., & Weisner, C. (2003). The Role of Religion, Spirituality and Alcoholics Anonymous in Sustained Sobriety. Alcoholism Treatment Quarterly, 21(1), 1-16.

Magura, S. (2007). The Relationship between Substance User Treatment and 12-Step

Fellowships: Current Knowledge and Research Questions. Substance Use & Misuse, 42, 343-360. doi:10.1080/10826080601142071

Tonigan, J.S. (2007). Spirituality and Alcoholics Anonymous. Southern Medical Journal, 100(4), 437-440.

Tonigan, J.S., & Hiller-Sturmhofel, S. (1994). Alcoholics Anonymous: Who benefits? Alcohol Health & Research World, 18(4), 308-309.

Tonigan, J.S., Miller, W.R., & Schermer, C. (2002). Atheists, Agnostics and Alcoholics Anonymous. Journal of Studies on Alcohol, 63(5), 534-541.


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