Britain has an addiction crisis – is 12-step recovery the answer?

The tenets of Alcoholics Anonymous have been replicated across different forms of addiction treatment, while numerous studies have proven their effectiveness. So why do they remain misunderstood, asks Anna Wolfe

‘There isn’t a cure for alcoholism, but there is a solution that offers far more than abstinence’ (iStock)

Despite being the world’s most lethal substance, alcohol has become the most accessible and normalised drug of choice. What many don’t realise is that help is equally as accessible; it simply isn’t always suggested or, like addiction itself, fully understood.

Since its founding in 1935, the Alcoholics Anonymous 12-step model has been used as the basis of 30 other fellowships, including Gamblers Anonymous and Narcotics Anonymous. The realities of AA’s positive impact on the world are undeniable and immeasurable – but undiscussed. There isn’t a cure for alcoholism, but there is a solution that offers far more than abstinence. And it’s one the UK is in desperate need of.

Between them, the Priory Group’s Dr Niall Campbell and Dr Neil Brener have more than 53 years of psychiatric experience across the NHS and the private sector, with a speciality in addiction. They’ve seen it all, and seen the recent worsening of what Dr Brener calls the “violating illness”.

“I don’t know any addiction psychiatrist or therapist who would say rates aren’t on the rise,” Dr Campbell adds. “Addiction to not only drugs or alcohol, but sex, shopping, screens, gambling. It’s often combined. People start something and go onto something else.” (This is known as cross-addiction, and occurs because the substance or compulsive behaviours are merely symptoms of a bigger disorder.)

The data speaks for itself. Over the past three years, the UK has witnessed an 84 per cent increase in eating disorders, a 100 per cent rise in screen-based addictions, and an estimated 30 per cent surge in gambling addictions, with seniors being particularly affected. Recent headlines have highlighted even more troubling trends, too: drug-related deaths have risen by 80 per cent over the last decade, and deaths “wholly attributable to alcohol” hit a record high in 2022. More of us report struggling with depression, and recent news that one in four women are on antidepressants has drawn attention to a broader problem – the lure of quick fixes and a failure to treat root causes.

When untreated, addiction becomes a family affair. The NHS cites family members with poor mental health or substance misuse disorder as a critical cause of children forming addictions of their own later in life. While reports on the post-pandemic spike in drinking-related deaths are devastating, we won’t see the actual effects until children grow up. And we’re beginning to, with England topping the global chart for child alcohol use. “If you catch it early, you can have a wonderful life,” says behavioural psychologist Dr Samantha Duggan.

Most people have spiritual needs and a desire to connect with some purpose beyond ourselves. The need for community in healing or recovery processes is arguably part of this

Dr Naomi Thompson

Early intervention could save lives, but societal structures make such a thing a challenge. Shelter’s report on record child homelessness is concerning for a multitude of reasons. One, though, is that most homeless individuals have mental health disorders and/or substance abuse issues. England and Wales have the highest prison populations in Western Europe, with half of inmates battling drug addiction, fueling crimes like shoplifting and burglary. Failure to intervene leads to dire consequences, including further homelessness, imprisonment, and even fatalities.

False narratives surrounding what an addict “looks like” are also detrimental to individuals in denial, or those who would have sought help sooner. Professions with some of the highest rates of alcoholism are, in fact, law, healthcare and management. The reality is that “70 per cent of alcoholics go on functioning,” Dr Duggan says. “They get up, and they go to work. They just underperform.” People slip through the cracks.

“Most GPs and doctors have very little teaching on addiction,” says Dr Brenner. Eighty-two per cent of 600,000 dependent drinkers receive no help, and the NHS only handles acute cases. Short detox stints don’t work, and only 23 per cent of alcohol treatment referrals come from health services. Despite this, alcohol treatment costs the NHS over £3.5bn annually, with individuals with drinking problems occupying, Dr Brenner says, “20 per cent of hospital beds at any given time”.

We can’t measure the real impact of addiction, but the available information tells a story. “It’s a fatal illness that destroys the lives of patients and all around them,” says Dr Brener. It affects all corners of society: families, friends, workplaces, and health services, to name a few.

Many treatment options are available for individuals affected. Still, unlike 12-step fellowships, none are instantly accessible, free and can offer life-long support without relying on overwhelmed infrastructures. AA appears on the NHS support page, but it is misunderstood enough as a programme for Dr Brener to insist on his medical students’ exposure to groups during their training.

‘Research suggests most people have spiritual needs and desire to connect with some purpose beyond ourselves’ (iStock)

Likely because of the confusion that surrounds AA, many continue to advocate for its worth. In 2020, the Cochrane Collaboration – internationally recognised as the gold standard for evaluating the effects of any medicine or intervention in any area of healthcare – published a review on the effectiveness of AA. It gathered data from 150 scientists from 67 institutions, and found that “AA was as good as, and most often better than, other addiction treatments”. The review also found that AA is as effective as cognitive behavioural therapy, a finding supported by Dr Campbell, who emphasises AA’s additional benefits in emotional management and spirituality. “The power of group therapy, which has a very clear direction, is enormous, and AA exemplifies this,” he says.

Anonymity is integral to keeping members of AA safe, so we can’t quantify its positive impact. However, we know that without it, millions worldwide wouldn’t be sober today – not just sober but, as Dr Campbell says, “living a better life”. He adds: “Any addiction programme I respect would incorporate the fellowship.”

While most UK rehabs use the 12-step model, securing a spot in NHS-funded residential care can be challenging, with waiting times extending to several months depending on funding distribution and local authorities. Run entirely by alcoholics, AA is grassroots, self-governed, non-professional and self-supporting. There’s no hierarchy; people come and go as they please and choose their sponsor, and everything in the programme is a “suggestion” rather than a necessity. Anybody can set up a meeting, and it’s run entirely on voluntary donations. There’s even a limit to the amount an individual can give. It isn’t affiliated with sects, denominations, politics, organisations or institutions. The focus remains solely on the individual.

The steps help individuals accept what they can’t control and take action where they can. They write a moral inventory, acknowledge the possible harm they’ve caused, and make amends. It’s a constant opportunity for growth and exercising compassion for themselves and all around them.

‘Seventy per cent of alcoholics go on functioning. They get up, and they go to work. They just underperform’

Dr Samantha Duggan

A cornerstone of the program is spirituality. “Professionals often misunderstand 12-step programmes as religious,” says Dr Duggan. While “God” is featured in the literature, it can refer to anything from nature to the support group itself. Members of all beliefs, including agnostics, participate. According to Dr Brener, while spirituality isn’t “totally necessary”, it is “helpful” in the process. Others, such as Dr Naomi Thompson, sociology lecturer at Goldsmiths University, tells me that many of us crave a feeling of belonging, whether religious in nature or not. “Researchers in the sociology of religion have found people who identify as non-religious rarely see themselves as non-spiritual,” she says. “My own research suggests most people have spiritual needs and desire to connect with some purpose beyond ourselves. The need for community in healing or recovery processes is arguably part of this.”

The second cornerstone to AA is giving back. The group’s primary aim is “to help other alcoholics to achieve sobriety”. It fosters unconditional support where individuals feel understood and cared for. People get help and then go on to help others, something that’s proven to make us all happier.

AA won’t be for everybody, and sobriety isn’t a certainty. Addiction is a complex condition, and relapse is part of many individuals’ journeys. What remains certain is the door to AA never gets shut, and there’s a simple programme available that’s helped millions of people live better lives for almost 90 years. It offers more than abstinence: friends who become family, a roadmap for navigating life’s inevitable challenges, and a profound sense of reassurance that everything – whether or not you first believe it – will eventually fall into place.

You can contact AA at www.alcoholics-anonymous.org.uk