The Differences Between 12-step Meetings and Group Therapy

Before I actually went to some open 12-step meetings, I thought they would be like group therapy meetings. However, 12-step meetings have basic differences from group therapy meetings.

Twelve-step meetings are free. Most group therapy costs some amount of money.

Members don’t give advice to each other. Or at least, experienced members of Narcotics Anonymous and Alcoholics Anonymous don’t tend to give advice to each other. Instead, members share their own experiences. They tell about what worked for them, and what didn’t work.  The topic is often about how to get through situations without using drugs or alcohol, but may also be about how to live with difficult life situations, and still retain one’s serenity.

In group therapy, members are encouraged to give advice, or feedback, to other members. Some treatment centers believe that alcoholics and addicts must be confronted, so that denial can be broken through. Twelve-step meetings don’t take this stance. Instead, members offer their own experience, freely and without expectations. It’s a subtle difference, but important. Other 12-step members don’t assume they know what another person should do about life decisions; they simply offer their own experiences.

In 12-step meetings, there’s no therapist or counselor in charge of the meeting. There’s no “head addict.” Instead, there’s a chairperson, a member of the 12-step program who opens and closes the meeting. This person is in charge only in the sense that she guides, rather than controls, the meeting. Some chairpersons guide more than others. For example, some chairpersons will interrupt a member who’s sharing something that can be harmful to the group. This could mean interrupting a “drunkalog” (long pointless sharing that glamorizes drinking or using drugs). Other chairpersons let the meeting run its course, believing that a Higher Power is always in control. The chairperson is responsible for starting and ending the meeting on time.

No record of attendance is kept at 12-step meetings. A person is considered to be a member of Narcotics Anonymous when that person says they are a member. The only requirement for membership is a desire to stop using drugs.

Twelve step meetings are held in slightly different ways in different areas of the country. In some places, meetings range from fifty minutes to an hour and a half.  At “speaker” meetings, one person tells their story of addiction and recovery for the whole hour, traditionally telling “what it was like, what happened, and what it’s like now.” At other types of meetings, all persons present are offered a chance to share or pass to the next person. In some meetings, members who wish to share raise their hands and are called on by the meeting chairperson. In group therapy, all members are usually expected to say something during the session, but at NA or AA, no one is coerced to speak.

I tell my patients about these differences, because many people who really need the guidance and support that 12-step meetings don’t go, because of their mistaken opinions about meetings.

They think they will be made to speak at an NA or AA meeting, and don’t want to go for that reason. Other patients say if they hear people talking about drugs it will make them want to use drugs. Other people say they “don’t want to hear everybody else’s problems.”

Problems are shared at meetings, but the emphasis is on solutions. Most good meetings don’t allow the meeting to become a dumping ground for negative experience. The emphasis of meetings is on solutions to problems. I explain that in most meetings, sharing about specific drugs is discouraged. NA members are encouraged to share about what they are feeling, and what kind of help they need to remain abstinent from all drugs.

Overall, the mood of 12-step meetings is one of humbleness, where one recovering addict shares what worked for her with the rest of the group, without expectations and with humility. By contrast, in group therapy, feedback or advice is usually given by other group members. But an addict’s tendency with such an approach is to ask, “Who are you to be telling me what to do?” Narcotics Anonymous meetings recognize that advice and feedback often grates on addicts, and their meetings are constructed differently. Other member’s experiences are offered as learning opportunities.

Twelve step members aren’t perfect, to say the least. Many members are wrestling with serious mental and emotional problems. Sometimes members do lapse into advice-giving and preaching, but nearly always lose this tendency to try to control others as they progress in their own recovery.

There’s a reason 12-step recovery has been around for seventy-five years. Many other recovery methods have attained a brief popularity, only to fade away within ten or twenty years. Twelve step recovery has helped millions of people worldwide, continues to grow, and will be with us for a long time to come.

7 responses to this post.

  1. Posted by soBer liVing on September 30, 2011 at 3:36 pm

    Thank you so much for the explanation! I’ve always wanted to attend meetings for my opiate addiction (pain killers, never heroin or any IV drug) but in my community we only have AA with no option for NA. I was raised without church or religion so I’ve always been too intimidated and felt that I would be required to speak and would look foolish not knowing anything about religion or the bible. Being that I’m a Methadone maintenance patient, would that present an issue (IE. the whole therory of “you aren’t sober because you are still on a drug)?

    And on a totally different subject… Does donating plasma have any negative consequences being a MMT patient? Since they are filtering your blood I wasn’t sure if maybe the Methadone would be removed from the blood, etc.

    Thank you SOOO much for all the info you post! I know that I personally appreciate it more than you know. Thank you for your time and efforts!


    • Technically, AA says that only people who have a desire to stop drinking can be AA members. But about 70% of their members also used other drugs. And since you’re on methadone, you certainly shouldn’t drink, both because of the possible interaction with methadone and because you are at increased risk for developing an addiction to another drug (alcohol really IS a drug).
      So my feeling is yes, you certainly can benefit from going to meetings. I tell patients not to mention that they are on methadone (or Suboxone) when they go to either NA or AA meetings, because I fear they won’t be welcomed as a new person should be welcomed.

      NA says the only requirement to become a member is the desire to stop using drugs, and it sounds like you have that desire. By the way, NA regards alcohol as just another drug, so if your only drug was alcohol, you still “qualify” to be an NA member.

      No, donating plasma doesn’t decrease your methadone level. Methadone isn’t removed by dialysis, either.

      thanks for writing


      • Posted by Ric LaShever on September 4, 2012 at 7:17 am

        jana, thanks for your summation of the the differences between group therapy and recovery meetings; for the most part i agree with you. i would simply state that meetings are (should be?) a place where anyone looking to learn how to live without getting loaded can go and benefit from the hope, strength and experiences of others on that path. hopefully we only mention our own using just enough to give the newcomer a glimpse of someone he can relate to, certainly not to glamorize or romanticize it.

        some subtle but important distinctions: nowhere in the steps or traditions of NA are drugs mentioned. the 1st step addresses addiction and the third tradition states that the only requirement for membership is the desire to stop using. using what? the answer to that is left up to the recovering addict. that NA’s steps address addiction and not any specific intoxicant is inclusive and seems a bit more contemporary and to the point for most of us since there are so few ‘pure’ alcoholics as there were in the 30’s, 40’s and 50’s. drug addicts most certainly can find recovery in AA, however when they share it’s probably a good idea to show respect for that fellowship and identify as an alcoholic, which by the way, is precisely why bill wilson – AA’s co-founder – freely gave use of AA’s steps to the founders of NA in the 50’s to use and alter as they would, so addicts could have a place to share and identify – to which he wrote a pamphlet titled “problems other than alcohol”. it still can be found and it lays it out much better than i can. i believe, however, that the spiritual principles that come out of practicing any 12 step programs’ steps are identical so long as the steps haven’t been severely mangled.

        most of us in NA are not doctors and are not qualified to make judgements for another regarding prescription drugs. “in times of illness” is one piece of NA literature that addresses that issue. many groups ask that you not share if you have taken any ‘mind or mood altering’ substances within the last 24 hours and many feel that includes those on methadone maintenance. if that’s you then it is ultimately your decision.

        if you are seeking recovery then you have a seat in NA or AA. let no one drive you out! small minded or big shot or anyone! if you are not disruptive then you are welcome and most folks with any substantial time clean know this.

        be well and good luck,
        ric L clean date: 10/27/87

  2. I can attest to the negative attitude towards suboxone/methadone etc. @ 12 step meetings. In my first month of recovery, I went to many meetings and, being the open book that I am, mentioned that I was taking suboxone. I literally had a guy tell me, “Let’s just put it this way. When you have this lady and that lady claiming 20 years, 25 years of clean time, they’re not taking suboxone”.

    I didn’t go back to that meeting :).

    I brought this up with my sub dr., and he reminded me that he’d advised me not to bring it up in meetings. Hmm. I kinda figured that being transparent through this process would only serve to increase my chances for long-term success.

    If there’s one thing I’d change about NA/AA, it is this close-minded stance toward medication (always combined with therapy) to help the addict stay stopped. During my actual detox, I read a book by an author whose stance is this: behavioral therapy combined with medication increases the addict’s chance for success a hundredfold.

    I can attest to this from personal experience. I snorted my last “happy pill” on 6/22/11…the day I went in to be evaluated for an intensive outpatient program, actually. Oh, the irony. Point is: I began taking the suboxone film a few days later, and have not taken anything illegally since then. I completed my 6 week outpatient program – which was a God-send, by the way, and try to attend NA or AA meetings when I can. Tough with 3 little kids. Everytime this argument pops into my head, however, I’m immediately reminded of a counter-argument I heard in rehab that sums it all up rather well. If you could spend all of that time and energy, money and angst into feeding your addiction, surely you can spend a fraction of that time and energy, money and angst on keeping yourself clean. Because clean means life, health, a FUTURE. Not jails, institutions or death.

    I’ve found 12 step meetings incredibly useful and rewarding. I’m glad to see this post touting the benefits of the program. I’ve never met a more humble, down-to-earth group of people. Talk about transparent! I brought my dad to one of the first meetings I’d ever been to. As each addict spoke, the obscenities flowed rashly and freely. I think my dad was a little shell-shocked after the meeting. While every other word in my daily conversation is not “F—“, I felt right at home. My people! These people spoke of messing up, and of grace coming from a higher power, grace that was freely adminstered to us all, equally, notwithstanding jail sentences or the like. This was something I could get behind.

    So again, thanks for the post. 🙂


    • Thank you!! Well said.


    • Posted by Dayna on April 4, 2017 at 7:20 pm

      He is right. You aren’t clean, you are getting clean. It is unsafe to stop opiates abruptly. It could kill you. You should take the suboxone, go to the meetings, explain that you are not yet sober but being titrated down off the drugs. When you are done with the suboxone therapy, that is when you can tell them, hey, I am sober and _____ was my first day….and go from there. There is no room for judgement in pharmacological titrations. It is in your best interest. Theres nothing to judge, it is a medical necessity. It is up to you to educate those that don’t understand and to not take others knowledge deficit as a personal attack.


  3. i do not agree with this article i have been to 12 steps meeting and every tool used for group therapy is used in all self help groups like aa,na,big book,12 steps, ect. my name is jeffrey small and i am at student at university of maine at Augusta. my two degrees are behavior health with focus on child development and political science.


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