One of the most common conversations in my work is about the pathways of recovery that people choose. Clients in addiction treatment have often participated in a variety of programs, many of which follow a traditional, step-based model. Others have exposure to the growing range of options: culturally-specific systems, clinical approaches, methods borrowed from the mental health landscape. Many possibilities these days (see the list below). More pathways generally means better outcomes. After all, human experience is highly individualized, and healing is irreducible to simple steps or procedures.
Clients often want to talk about one aspect of this ever-evolving landscape of treatment options: how does a given program or model compare with Alcoholics Anonymous? This is both simple and deeply nuanced: AA saves lives for those it saves, and the research is clear about why. But it's not for the reasons AA itself claims.
What the Research Actually Shows
The recent evidence on AA's effectiveness is robust and undeniable. A 2020 Cochrane systematic review—the gold standard in medical research—analyzed 27 studies involving over 10,000 participants and found that AA and Twelve-Step Facilitation programs led to higher rates of continuous abstinence than other established treatments, including cognitive behavioral therapy (Kelly, Humphreys, & Ferri, 2020). The abstinence rates are approximately twice as high among those who attend AA compared to those who don't (Tonigan, Toscova, & Miller, 1996). These are significant findings that cannot be dismissed.
But here's what we must understand: the research also reveals that what makes AA work for those it works for is not the twelve steps, not the Big Book, not the surrender to a higher power. It's belonging (Kelly & Yeterian, 2011; Pettersen et al., 2019). It's the sense of community, connection, and mutual support that some people find when they walk into those rooms. The specific mechanisms of change in AA—the ones that actually predict sustained recovery—are social support, increased abstinent social networks, and finding purpose through helping others (Pagano et al., 2013).
This matters because if we understand what actually works, we can help more people find healing in ways that don't require them to fit themselves into a model that may not match their needs, beliefs, or circumstances.
The Geography of Healing: Understanding What Addiction Is Protecting
Throughout my work, I have explored addiction through what I call the geography of healing—a framework that recognizes how addiction emerges from the intersection of developmental vulnerabilities, trauma responses, and the nervous system's learned patterns of protection. Each person's addiction has a direction, a geography:
Elsewhere: The flight from unbearable presence, seeking transcendence through hallucinogens or behaviors of departure—these individuals learned before language that belonging was dangerous.
Inward: The freeze response to unmet needs, finding artificial solace in opioids or benzodiazepines—these individuals learned that reaching out is futile, that the world does not respond.
Onward: The hypervigilance that never settles, maintained by stimulants and compulsive activity—these individuals learned that stillness invites catastrophe.
Backward: The fight response to crushed power, unleashed through alcohol and defiant behaviors—these individuals learned their will would be destroyed unless fiercely defended.
Sideways: The cannabis haze that makes everything slightly more manageable while deferring what must eventually be faced.
Each of these patterns formed through embodied experience, through the nervous system's direct encounter with an environment that felt unsafe. And here is what contemporary research confirms again and again: if the pattern formed through embodied, relational experience, it can only be reorganized through embodied, relational experience (Bessel van der Kolk, 2014; Porges, 2011).
This is why belonging works. Not cognitive insight. Not surrender to a higher power. Not working through steps in order. Belonging works because isolation was often the original wound, and connection becomes the medicine (Maté, 2008; Hari, 2015).
What AA Gets Right (and What It Doesn't)
AA gets belonging right. When someone walks into a room full of people who understand—who have lived the chaos, the shame, the bewildering loss of control—and finds themselves welcomed without judgment, something essential happens. The nervous system, which organized itself around the impossibility of safe connection, encounters new evidence. Perhaps presence is survivable. Perhaps needs can be met through reaching out. Perhaps others can be trusted.
This is healing at the deepest level—not because of any particular technique or philosophy, but because humans are fundamentally relational beings, and we heal in relationship (Schore, 2019).
But AA also gets things wrong, and the research bears this out:
The Problem with Powerlessness
Step One requires admitting powerlessness over alcohol. While acknowledging loss of control can be important, the emphasis on powerlessness contradicts decades of research on personal agency and well-being. Studies consistently demonstrate that increased personal agency—the sense that one's actions matter and can influence outcomes—is essential for psychological health and sustained behavior change (Ryan & Deci, 2000; Bandura, 2001).
The powerlessness framework can inadvertently diminish the very sense of self-efficacy that research shows is crucial for recovery (Shavidze, Ronel, & Gueta, 2024). Some people find paradoxical empowerment through accepting powerlessness, but for others—particularly women and marginalized individuals whose power has already been systematically stolen—this requirement can reinforce patterns of disempowerment that contributed to their addiction in the first place (Herndon, 2001).
Contemporary recovery research emphasizes building agency, not surrendering it. The most effective interventions help people discover their capacity to make meaningful choices, to influence their environment, to recover their will (Miller & Rollnick, 2013).
The Higher Power Dilemma
Six of AA's twelve steps mention God or a higher power. For those with spiritual or religious beliefs, this can provide meaningful framework for healing. But for secular individuals, agnostics, atheists, or those whose spiritual beliefs don't align with AA's Christian origins, this requirement creates an insurmountable barrier (Horvath, 2000).
Research on what actually predicts recovery consistently shows that meaning and purpose matter—but that meaning can come from countless sources beyond spiritual belief: connection to nature, creative expression, service to community, philosophical inquiry, human relationships (White, 2007). The requirement to surrender to a higher power excludes many who might otherwise benefit from community support.
The Relapse Conceptualization Problem
Perhaps AA's most problematic practice is the sobriety date system. When someone relapses in AA, they're often told they've "lost" their sobriety and must start counting from day zero. Research unequivocally contradicts this approach.
Relapse doesn't erase the learning, growth, and neural reorganization that occurred during periods of abstinence (NIDA, 2024). The brain changes that happen during recovery don't disappear when someone uses again. The skills developed, the insights gained, the relationships built—none of these are erased. Recovery is not an on-off switch but a long-term process of change involving improvements in health, wellness, self-direction, and purpose (SAMHSA, 2012).
Contemporary harm reduction approaches recognize that any reduction in substance use or substance-related harm represents meaningful progress (Marlatt & Witkiewitz, 2010). The all-or-nothing abstinence model doesn't reflect the complexity of how nervous systems actually reorganize and how humans actually change.
What Actually Works: The Evidence Base
If we step back from both AA orthodoxy and our cultural fixation on pharmaceutical solutions, the research reveals something both simpler and more challenging: healing happens through connection, embodied experience, meaning, and purpose.
Belonging and Social Support
The research is unequivocal: social support and recovery-oriented social networks are among the strongest predictors of sustained recovery (Pettersen et al., 2019; Best et al., 2016). But it's not just any social connection—it's the quality of relationships and whether they support recovery rather than continued use that matters (McCrady, 2004).
The 2023 U.S. Surgeon General's Advisory on the healing effects of social connection confirms what addiction researchers have long known: social connection influences overall well-being directly, while social isolation increases the risk of premature death as much as smoking 15 cigarettes a day (Murthy, 2023). Belonging matters because humans are fundamentally relational creatures, and we heal in relationship.
This is why AA works for those it works for—not because of the steps, but because of the belonging. And this is also why countless other forms of community connection can serve the same healing function.
Embodied Practice and Movement
Research consistently demonstrates that physical activity—particularly movement practices that integrate challenge, presence, and agency—produces effects comparable to or exceeding those of both medication and psychotherapy for depression, anxiety, and substance use disorders (Schuch et al., 2016; Stubbs et al., 2017; Wang et al., 2014).
I have watched hundreds of people—many caught in patterns of dissociation, freezing, hypervigilance, or defensive anger—encounter climbing walls or running trails and discover something their nervous systems had not previously known: they could meet a challenge and not collapse, could face fear and not flee, could be fully present in their bodies and survive.
Each climbing route is a problem to be solved—not intellectually but somatically. Your body must find solutions that your mind cannot predict. For someone organized around the flight response, someone whose earliest learning was that safety requires departure, climbing offers a paradox: you cannot leave, but you are not trapped. The wall holds you, demands your presence, will not permit dissociation. You must arrive fully in your body to continue upward.
For someone caught in freeze, someone whose system learned that passivity is the only option when needs cannot be met, climbing insists on agency. Nothing happens unless you initiate it. No one can climb the wall for you. Your will, your choice, your action—or no progress.
Running offers similar opportunities for nervous system reorganization. After fifteen minutes, after thirty minutes, after the initial adrenaline fades and the body settles into its work, something shifts: not escape but engagement, not away-from but toward. The runner discovers, somewhere along the trail, that they have arrived in their body. They are here, fully present, and nothing catastrophic has occurred.
The nervous system needs new information, delivered in the language it understands: movement, sensation, the direct experience of meeting challenge and discovering capacity. The array of choices is vast: climbing, running, dancing, yoga, strength training, cycling, walking—any activity that provides sufficient opportunities for the body to learn.
The Developmental Work
What moves the inner line—that boundary between what has been and what might become? Recovery requires not just stopping substance use but building a life worth living. This involves what I call the four dimensions of purposeful engagement:
Developmental Completion: Finishing the integration that was interrupted. Moving through the adolescent dynamics of early recovery into genuine adult functioning. Building capacities for emotion regulation, relationship, autonomy, and will that were foreclosed during the years of active addiction.
Narrative Integration: Transforming the wound story into a wisdom story. Finding ways to make meaning from suffering, to understand the addiction not as wasted years but as a dark passage that led somewhere important. This doesn't romanticize addiction or minimize its costs—it simply refuses to let the addiction remain the only story.
Social Contribution: Finding ways to give back, to help others, to be useful in the world. This might be through peer support, mentoring, creative expression, activism, or countless other forms of contribution. The specific form matters less than the fundamental shift from being a burden to being a contributor.
Spiritual Connection: Discovering relationship to something larger than the individual self that provides ground when personal resources feel insufficient. This doesn't necessarily mean religious practice—it might be nature, creativity, community, service, meditation, philosophical inquiry, or any doorway to transcendence that respects the person's existing beliefs and values.
These four dimensions create the territory beyond the inner line—what makes crossing the threshold worth the risk. And they can be discovered and developed in countless contexts, with or without twelve-step involvement.
If Not AA, Then What?
For those who find AA meaningful, who discover genuine belonging in those rooms, who experience the paradoxical empowerment of acknowledging powerlessness—stay. The research supports that AA helps many people achieve sustained recovery, and if it's working for you, that matters more than any theoretical critique.
But if AA doesn't fit—if the spiritual requirements feel alien, if the powerlessness framework undermines your hard-won agency, if the relapse conceptualization demoralizes you—then know this: belonging can be found elsewhere. Connection can be cultivated through countless pathways. Your nervous system can reorganize through embodied practices that don't require any particular belief system.
Consider:
Movement communities: Climbing gyms, running groups, cycling clubs, yoga studios, martial arts dojos. These provide both the embodied practice that reorganizes the nervous system and the social connection that heals isolation.
Creative communities: Art studios, writing groups, music ensembles, theater companies. Creative expression provides meaning-making, embodied engagement, and social connection without requiring spiritual beliefs or surrender.
Service communities: Volunteer organizations, mutual aid networks, community gardens, advocacy groups. Contributing to something larger than yourself builds purpose and provides the sense of usefulness that sustains recovery.
Nature immersion: Hiking groups, conservation organizations, outdoor recreation communities. The natural world offers its own form of transcendence and belonging, its own opportunities for presence and embodied engagement.
Secular recovery communities: SMART Recovery, LifeRing, Refuge Recovery, and countless local peer support groups offer community without the spiritual requirements. While research shows these groups may have slightly lower engagement than AA for some populations, they work well for those whose needs they match (Kelly et al., 2024).
Recovery residences and community centers: Recovery cafés and community recovery centers provide peer-driven support and belonging without requiring adherence to any particular model.
The key is finding communities that offer what the research shows actually works: genuine connection, opportunities for contribution, embodied engagement with challenge, meaning and purpose. The twelve steps are optional. Belonging is essential.
The Geography of Your Own Healing
Your addiction emerged from somewhere—from disruptions in early development, from trauma responses that organized to protect you, from a nervous system that learned patterns of flight, freeze, vigilance, or fight. Your healing will require finding the territory beyond your inner line: the place where presence becomes survivable, where needs can be met through connection, where stillness doesn't invite catastrophe, where power doesn't require defiance.
That territory exists. Many have found it through AA. Many others have found it through climbing, through running, through creative expression, through service, through communities organized around shared purpose rather than shared pathology. The path matters less than the arrival. The method matters less than the belonging.
Upon an infinite line of potential suffering there reside an infinite number of places for healing. AA is one such place. But only one. The research gives us permission to acknowledge this truth with both compassion and clarity: what heals is not any particular system or set of steps, but the fundamental human experiences of being seen, being welcomed, being useful, being connected. Of discovering that you belong—here, in this body, in this community, in this life worth living.
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