Editing Twelve-step program (section)

==Criticism==
{{See also|Alcoholics Anonymous#Criticism|Gamblers Anonymous#Criticism|Narcotics Anonymous#Controversies|Overeaters Anonymous#Criticism|Self-help groups for mental health#Criticism|Sexaholics Anonymous#Criticism}}

Some medical professionals have criticized twelve-step programs as "a cult that relies on God as the mechanism of action" and as lacking any experimental evidence in favor of its efficacy.<ref name="Kaskutas2009">{{cite journal | last1 = Kaskutas | first1 = Lee Ann | title = Alcoholics Anonymous Effectiveness: Faith Meets Science | journal = Journal of Addictive Diseases | date = 2 April 2009 | volume = 28 | issue = 2 | pages = 145–157 | issn = 1055-0887 | eissn = 1545-0848 | doi = 10.1080/10550880902772464 | pmid = 19340677 | pmc = 2746426 | url = }}</ref><ref name="Lilienfeld2015">{{cite book |last1=Lilienfeld |first1=Scott O. |last2=Lynn |first2=Steven Jay |last3=Lohr |first3=Jeffrey |last4=Tavris |first4=Carol |title=Science and pseudoscience in clinical psychology |date=2015 |publisher=The Guilford Press |location=New York |isbn=9781462505814 |edition=Second |url=https://scottlilienfeld.com/wp-content/uploads/2021/01/Science-and-Pseudoscience-in-Clinical-Psychology-Second-Edition-by-Scott-O.-Lilienfeld-PhD-Steven-Jay-Lynn-PhD-Jeffrey-M.-Lohr-Phd-Carol-Tavris-PhD-z-lib.org_.pdf |access-date=27 January 2023}}</ref><ref name="White2008">{{cite book | title = Recent Developments in Alcoholism | last1 = White | first1 = William L. | last2 = Kurtz | first2 = Ernest | chapter = Twelve Defining Moments in the History of Alcoholics Anonymous | date = 2008 | volume = 18 | pages = 37–57 | publisher = Springer New York | issn = 0738-422X | doi = 10.1007/978-0-387-77725-2_3 | pmid = 19115762 | isbn = 978-0-387-77724-5 | url = }}</ref> Ethical and operational issues had prevented robust [[randomized controlled trials]] from being conducted comparing twelve-step programs directly to other approaches.<ref name="Lilienfeld2015"/> More recent studies employing non-randomized and [[Quasi-experiment|quasi-experimental]] studies have shown twelve-step programs provide similar benefit compared to motivational enhancement therapy (MET) and cognitive behavioral therapy (CBT), and were more effective in producing continuous abstinence and remission compared to these approaches.<ref name="Kelly2020">{{cite journal | last1 = Kelly | first1 = John F | last2 = Abry | first2 = Alexandra | last3 = Ferri | first3 = Marica | last4 = Humphreys | first4 = Keith | title = Alcoholics Anonymous and 12-Step Facilitation Treatments for Alcohol Use Disorder: A Distillation of a 2020 Cochrane Review for Clinicians and Policy Makers | journal = Alcohol and Alcoholism | date = 6 July 2020 | volume = 55 | issue = 6 | pages = 641–651 | issn = 0735-0414 | eissn = 1464-3502 | doi = 10.1093/alcalc/agaa050 | pmid = 32628263 | pmc = 8060988 | url = }}</ref><ref name="pmid33316028">{{cite journal |vauthors=Heather N |title=Let's not turn back the clock: Comments on Kelly et al., "Alcoholics Anonymous and 12-step facilitation treatments for alcohol use disorder: A distillation of a 2020 Cochrane review for clinicians and policy makers" |journal=Alcohol and Alcoholism (Oxford, Oxfordshire) |volume=56 |issue=4 |pages=377–379 |date=June 2021 |pmid=33316028 |doi=10.1093/alcalc/agaa137 |url=https://www.researchgate.net/publication/347836811}}</ref><ref name="Cochrane2020"/>

===Confidentiality===
The [[Twelve Traditions]] encourage members to practice the [[Spirituality|spiritual]] principle of [[anonymity]] in the public media and members are also asked to respect each other's [[confidentiality]].<ref name="LEVINE2000">{{cite book |title=I shop, therefore I am: compulsive buying and search for shelf |editor1=Benson, April Lane |chapter=Chapter 18: Debtors Anonymous and Psychotherapy |pages=431–454 |year=2000 |isbn=0765702428 |oclc=301650820 |author=Levine, Betsy; Kellen, Bonnie|publisher=Jason Aronson }}</ref> This is a group [[Norm (sociology)|norm]],<ref name="LEVINE2000"/> however, and not legally mandated; there are no legal consequences to discourage those attending [[List of twelve-step groups|twelve-step groups]] from revealing information disclosed during meetings.<ref name="COLEMAN2005"/> [[Statute]]s on [[group therapy]] do not encompass those associations that lack a professional [[therapist]] or [[clergyman]] to whom confidentiality and privilege might apply. Professionals and [[paraprofessional]]s who refer patients to these groups, to avoid both [[civil liability]] and [[licensure]] problems, have been advised that they should alert their patients that, at any time, their statements made in meetings may be disclosed.<ref name="COLEMAN2005">{{cite journal |author=Coleman P |title=Privilege and confidentiality in 12-step self-help programs. Believing the promises could be hazardous to an addict's freedom |journal=The Journal of Legal Medicine |volume=26 |issue=4 |pages=435–74 |date=2005-12-01 |pmid=16303734 |doi=10.1080/01947640500364713|s2cid=31742544 }}</ref>

===Cultural identity===
One review warned of detrimental [[iatrogenesis|iatrogenic]] effects of twelve-step philosophy and labeled the organizations as [[cult]]s,<ref name="ALEXANDER1984">{{cite journal |last=Alexander |first=F. |author2=Rollins, M. |year=1985 |title=Alcoholics Anonymous: the unseen cult |journal=California Sociologist |volume=17 |issue=1 |pages=33–48 |issn=0162-8712 |oclc=4025459 |location=Los Angeles |publisher=California State University}}</ref> while another review asserts that these programs bore little semblance to religious cults and that the techniques used appeared beneficial to some.<ref name="WRIGHT1997">{{cite journal |last=Wright |first=Kevin B. |title=Shared ideology in Alcoholics Anonymous: a grounded theory approach |journal=Journal of Health Communication |volume=2 |issue=2 |pages=83–99 |year=1997 |pmid=10977242 |doi=10.1080/108107397127806}}</ref> Another study found that a twelve-step program's focus on self-admission of having a problem increases deviant [[Stigma (sociological theory)|stigma]] and strips members of their previous [[cultural identity]], replacing it with the deviant identity.<ref name="LEVINSON1983">{{cite book |last=Levinson |first=David |chapter=Current Status of the Field: An Anthropological Perspective on the Behavior Modification Treatment of Alcoholism |title=Genetics Behavioral Treatment Social Mediators and Prevention Current Concepts in Diagnosis |volume=1 |pages=255–61 |year=1983 |pmid=6680227 |doi=10.1007/978-1-4613-3617-4_14 |series=Recent Developments in Alcoholism |isbn=978-1-4613-3619-8}}</ref> Another study asserts that the prior cultural identity may not be replaced entirely, but rather members found adapted a [[Biculturalism|bicultural]] identity.<ref name="WILCOX1998">{{cite book |last=Wilcox |first=D.M. |title=Alcoholic thinking: Language, culture, and belief in Alcoholics Anonymous |year=1998 |location=[[Westport, CT]] |publisher=Greenwood Publishing Group |isbn=0-275-96049-8 |pages=[https://archive.org/details/alcoholicthinkin00wilc/page/109 109–124] |chapter=Chapter 7: Language, Culture, and Belief |chapter-url=https://archive.org/details/alcoholicthinkin00wilc/page/109 }}</ref>