What’s Missing in a 12-Step Program for Addiction Treatment?

12-Step Program

If you or a loved one is struggling with addiction to alcohol, drugs, gambling, or food, you may seek help from a 12-step program. Alcoholics Anonymous (AA) and other 12-step programs can be very beneficial for people struggling with addictions. However, there is one key element that’s missing from these addiction recovery programs—the brain.


When AA was started in 1935, the founders did not have access to sophisticated neuroimaging techniques. Because of this, they never considered the brain as an integral part of addiction treatment. Today, with advanced brain-imaging tools, we know now that brain health is a critical component of recovery from a substance use disorder or behavioral addiction.

AA, along with Narcotics Anonymous (NA), Cocaine Anonymous (CA), Gamblers Anonymous (GA), Overeaters Anonymous (OA), and similar programs are powerful, time-tested, and have worked for millions of people around the world. Yet they clearly do not work for everyone. For example, a study conducted by the Department of Veterans Affairs showed 43% of AA attendees were sober at 18 months. This means over half relapsed.

One of the reasons for the lower efficacy is that this program and many other addiction recovery programs include no steps to address the physical functioning of the brain, which is the missing link to breaking any addiction.

With this in mind, it’s time for a new 12-step program that is based on neuroscience. This advanced approach builds on the strengths of earlier methods to create a more powerful addiction recovery program.

This updated program uses a more balanced model that includes biological, psychological, social, and spiritual factors. As you will see, each of these aspects of life play an important role in a person’s ability to overcome alcohol abuse, drug abuse, and other addictions.

Alcoholics Anonymous (AA) and other 12-step programs can be very beneficial for people struggling with addictions. However, there is one key element missing from these addiction recovery programs—the brain. Click To Tweet


Here are the 12 steps to recovery using an updated brain-based addiction treatment model:

Step 1: Know what you want.

Most addiction-recovery programs start with acknowledging trouble, by knowing when you are powerless over a substance or behavior. In fact, it’s better to start one step earlier by knowing exactly what you want in life. To break free from the chains of addiction, you must know your life goals.

What do you want in your relationships, career, and physical and spiritual health? Write it down on a sheet of paper, then ask yourself every day, Is my behavior getting me what I want?

Step 2: Know when your addiction has taken you hostage.

This step is similar to Step 1 in the AA model. Know when you’re powerless and your life has become unmanageable. What are the signs of addiction?

In general, if your behavior (drinking, drugs, eating, shopping, gambling, sex, etc.) gets you into trouble with your relationships, health, work, money, or the law—and you do it again, you have a problem.

Step 3: Make a decision to care for, balance, and repair your brain.

The missing link in nearly all addiction treatment programs is that they don’t look at and assess brain function on a routine basis. If your brain isn’t working at an optimal level (and most addicted brains aren’t), you will have a much harder time getting and staying sober, despite your best efforts.

Step 4: Reach for forgiveness for yourself and others.

To overcome any addiction, you need self-love, self-care, and forgiveness of yourself and others. If you do not love yourself, you won’t take proper care of your brain, and you will likely continue to hurt it.

Forgiveness is the gift that keeps on giving. It is powerful medicine. Research shows a connection between forgiveness and reduced anxiety, depression, and psychiatric disorders. Improving mental health symptoms may lower the tendency to self-medicate.

Step 5: Know your addiction brain type.

All brains are not the same. The brain-imaging work at Amen Clinics shows that there are different brain types related to personality. Understanding your own brain type is critical to getting the right help for addictions. Here is a quick summary of the 5 basic brain types:

  • Brain Type 1: Balanced—People with this type tend to have healthy brains overall, which makes them less likely to have addictions.
  • Brain Type 2: Spontaneous—The brain SPECT scans of this type typically have lower activity in the front of the brain in the prefrontal cortex (PFC), which is associated with impulsivity and risk-taking.
  • Brain Type 3: Persistent— People with this brain type often have increased activity in the front part of the brain, in the anterior cingulate gyrus (ACG). Too much activity here means people can get locked into compulsive worries and behaviors that don’t serve them.
  • Brain Type 4: Sensitive—The SPECT scans of this type generally show increased activity in the limbic or emotional centers of the brain. This can make people prone to negativity, which may lead to self-medicating with alcohol, drugs, or food.
  • Brain Type 5: Cautious—On SPECT, this brain type is associated with heightened activity in the anxiety centers of the brain, such as the basal ganglia, insular cortex, or amygdala. These individuals may use alcohol and other substances to calm anxiousness.

Step 6: Lock up cravings.

All of us are vulnerable to cravings. When you have addictions, seeing something that reminds you of the substance you use can spark the emotional memory centers in the brain and trigger cravings to indulge in your old behavior. Even after decades of sobriety or steering clear of gambling, bulimia, video games, or porn, your brain is still vulnerable to cravings and those old patterns of behavior.

To conquer your cravings, keep your blood sugar levels balanced, manage stress, and get adequate sleep. In addition, take nutritional supplements that help control cravings, such as N-acetyl L-cysteine (NAC), alpha lipoic acid, and chromium.

Step 7: Drip dopamine; stop dumping it to keep the brain’s pleasure centers healthy.

Dopamine is a feel-good chemical. When people take drugs, the amount of dopamine released can be 2-10 times higher than what their brain produces for natural rewards. High-fat, high-sugar food combinations can also light up the brain’s dopamine pathway similar to the way drugs and alcohol do. Dumping dopamine wears out your brain’s pleasure centers.

Find ways to drip dopamine, rather than dumping it. High-value activities that drip dopamine include exercise, meditation, yoga, massage therapy, pleasurable music, hugs, and hand-holding.

Step 8: Eliminate the Pushers and Users who make you vulnerable.

Cultivating bad habits—and good ones—is a team sport. You become like the people you spend time with. Pushers and Users are people who encourage or are complicit in your negative behaviors. Addictions need lots of accomplices to start and sustain them. Avoid them as much as possible.

Step 9: Tame your Dragons from the Past and Kill the ANTs.

Dragons from the Past are the internal beasts that breathe fire on the emotional centers of the brain and keep us stuck in the past. ANTs are automatic negative thoughts that also prevent us from making the changes necessary to achieve an addiction-free life.

Take time to understand how past experiences are driving your addictions. In addition, learn to challenge the ANTs by asking yourself if your negative thoughts are true.

Step 10: Get help from those who have tamed their own addictions.

Success leaves clues. Addiction mentors and support groups are often critical pieces to the healing process. The people you meet at support groups have walked your path and may have strategies that can help you.

You can create your own support group. Simply write down the names of 10 people who will encourage you in your addiction recovery efforts and spend as much time as possible with them.

Step 11: List the people your addictions have hurt, share it with a mentor or sponsor, and make amends if you can.

This is a combination of AA steps that is essential to improve your relationships and to have a better sense of yourself. Now, you can do this step with a better-balanced brain.

None of us exists in a vacuum. Admitting your wrongs to others, asking for forgiveness, and making amends if you’re able can make you less likely to continue the behavior that is hurtful to others.

Step 12: Carry the message of brain health to others and continue to practice these 12 steps.

This last step is similar to the 12th Step of AA and other anonymous programs. If you want to keep your sobriety, you need to share the principles with others. It completely works for brain health, too. Your brain is always listening to what you do, but it is also listening to the actions of others. Make sure you are sharing brain health, not illness, with those you love.

When you follow these brain-based steps, you will be more likely to achieve and maintain freedom from your addictions and bad habits.

Addictions and other mental health issues can’t wait. At Amen Clinics, we’re here for you. We offer in-clinic brain scanning and appointments, as well as mental telehealth, clinical evaluations, and therapy for adults, teens, children, and couples. Find out more by speaking to a specialist today at 888-288-9834 or visit our contact page here.


  1. I have been clean and sober for 10 years. I went through a treatment program that had the 12 steps and psycho Nuro plasticity center within it. I definitely needed the brain healing for the steps to work for me. I have worked in treatment for 7years now and would totally be interested in working at a treatment center that works with both aspects again.

    Comment by Cynthia Goodwin — September 15, 2023 @ 4:31 AM

  2. Where are the meetings held for this program? Genius

    Comment by Johnny B — September 15, 2023 @ 6:03 AM

  3. I agree that the brain’s condition must be addressed, the credibility factor with this post regarding addiction recovery is that most addicts and alcoholics in early sobriety cannot afford the type of brain therapy performed by the amen clinics. Those who come in with substantial income would benefit highly from this. I suggest an article in which supplements would be suggested for someone who is within the first year of sobriety. They might not be able to afford the supplements, but it might give them a pathway to better brain health out of the gate. Something is better than nothing. Your 12 steps arent a comparison to the actual 12-steps, its almost insulting the attempt made to profit off a program that helps millions. I dont believe any true stats exist as AA doesnt affiliate with such studies. As someone who has walked a couple hundred women through the steps, I can say, brain health is a needed education, especially when women attempt to get sober in later years, and are battling declining hormones.

    Comment by Susan Denee — September 15, 2023 @ 6:11 AM

  4. This is such a valuable addition to integrate into the traditional AA formula. It’s so well thought out and we know that our brain types play a huge role in everything we do. And the types are informative and easy to understand without being judgmental- which makes a big difference Dr Amen is always light years ahead and always courageous enough lovingly to buck a system -to benefit the people.

    Comment by Laura Temin — September 15, 2023 @ 6:13 AM

  5. Do you have outpatient addiction therapy?

    Comment by Alice — September 15, 2023 @ 6:46 AM

  6. These are excellent, but it's a little disappointing to me that it leaves out the most important step of all – realizing and accepting that God is available to help us through life – if we seek Him. He made us and He knows what works.

    Comment by Jan — September 15, 2023 @ 7:34 AM

  7. I agree that treating the brain is an important component of treating addiction. And I love your work.

    I believe the Twelve Step programs are a lifeline for people dealing with addiction. Creating a “12 Step” alternative is a misguided proposition. Have your own program – that’s fine, especially for that 57%. But it’s not a complete alternative to 12 Step recovery for everyone, only for some. An adjunct, yes.

    You are alienating a very strong community that could be very supportive of your work when you propose such an alternative “Teelve Step” program. Keep your steps, but I would reframe it a little bit. You will serve a lot more people that way.

    Comment by Lanie — September 15, 2023 @ 7:55 AM

  8. Hilarious that step 12 would be to promote your agenda, that is so far from what we practice in 12 step programs.

    Comment by Van — September 15, 2023 @ 9:23 AM

  9. I appreciate this post. I have struggled with food and alcohol addiction most of my life. I have been to more than 200 AA meetings, mostly with the same experience — that I leave triggered and hopeless. Neurolinguistically, how can you recover from alcohol addiction when all you do is talk about drinking or not drinking? The brain doesn't record the "not." There are few recovery words spoken. It's disheartening because I desire a community, but these "rooms" make me feel a lot sicker.

    Comment by Allison — September 15, 2023 @ 9:42 AM

  10. After failing back to drinking after going to a rehab center I went to a hypnotist in 2012.

    It worked

    Comment by Judith Panos — September 15, 2023 @ 11:53 AM

  11. I’ve been sober for over 30 years. AA and ACOA were integral in getting me to an organized path. While I can appreciate your efforts to add to the many treatment paths already established, I agree with the comment about why not work with, add to, be a part of what is working already. There are many open minds in the field of addictions. I’ll admit that my first thought while reading your assertions went something like “wow, you’ve obviously never been an alcoholic. Or actively engaged with one. “ Big questions like what do you want out of life is way too big a place to start when you can barely find your ass with both hands.

    Comment by Jacquie — September 15, 2023 @ 4:50 PM

  12. I strongly agreed about the brain healing it is so important, I am also strongly agreed about the science facts.
    As a Psychologist and therapist I understand plenty the neurophysiology of the brain, I applaud also the role of Dr. Amen in understanding addiction since the point of view of neuroplasticity and neurophysiology of the brain those are an strong scientific information that professionals needs to take in consideration in order to create an accurate treatment plan for theirs patients/clients .
    One thing is create a separate steps for recovery from addiction and other is remodeling the 12 steps from AA That was created since 1935 that already proof that millions people all over the world are in sustaining recovery just following the 12 steps program. This article mentioned that veterans from war have difficulty to recovery compared with other type of population. Well how the person or people wrote this article forgot that the founder of AA by himself was a veteran from the First War World.
    Bill W. Said that the 12 steps program it is not the only way to achieve sobriety. I agreed it is not the only way.
    I think what science said is one thing and very valid. But the 12 steps program Created by Bill W. And Dr. Bob Smith is an Spiritual Program designed for everyone.
    They already new that most of people suffering from addiction are not rich . Addicts in US today most of them can’t afford the treatment in Amen clinic . Most of them are in public assistance and having Medicaid , but also the 12 step program it is not only the steps it is also the practice of the steps with the 12 traditions too that make the sobriety very possible and reachable.
    If Amen Clinic want to create an steps for recovery from addiction based in scientific data and treatment great another treatment to fight against the addiction. The question here is how many people can have access to that type of treatment?

    Comment by Jorge — September 15, 2023 @ 5:37 PM

  13. I have Dementia in the early stages. I'm 70 years old. I found out 4 weeks ago.

    Comment by Jack B Rucker, Jr — September 18, 2023 @ 4:15 PM

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