header image
HomeRecovery SupportFacilitator Tips

Twelve Steps Programs and the Dually Diagnosed

Traditional Twelve Step programs provide benefits
for people with co-occurring disorders

By Joseph Nowinski

It appears that dually diagnosed individuals do make use of traditional Twelve Step fellowships such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA). One study of 351 dually diagnosed men and women treated in a hospital setting found that, even ten months after completing treatment, the percentage who attended AA and NA meetings was similar to that of individuals who had been diagnosed with only a substance use disorder. The exceptions were people diagnosed with schizophrenia or schizoaffective disorder (Jordan et al. 2002).

An analysis of Project MATCH data found that patients who functioned poorly in social situations actually did best when treated using Twelve Step Facilitation. Contrary to expectations, patients whose level of social functioning was relatively low had the poorest outcomes when treated using cognitive-behavioral therapy (Longabaugh et al. 2001). One explanation offered for this finding was that CBT may not have been implemented adequately. An alternative explanation would be that all MATCH treatments were adequately administered, but that the involvement in a fellowship such as AA, which TSF actively promotes, was helpful to lower-functioning patients. Though not empirically tested as yet, this hypothesis does have anecdotal support. For example, psychologist Cardwell Nuckols, writing about his own recovery from the dual problems of addiction and post-traumatic stress disorder (PTSD), states:

I believe two things to be true: The Twelve Step program saved my life, and psychotherapy and prescribed medication cannot replace the need for a group, which can become a haven or a home. But together, medicine, medical research, therapy, and self-help offer great hope to those of us who have tried and failed on the separate paths of self-help or treatment (Nuckols 1993, p. xiii).

There is also evidence that treatment via TSF can have a positive effect not only on substance abuse but also on symptoms of mental illness. One study compared TSF to a cognitive-behavioral treatment for men and women concurrently diagnosed with a substance use disorder and PTSD (Triffleman 2000). There is a high incidence of substance use among individuals diagnosed with PTSD. Other prominent symptoms include anxiety and depression. This study reported that men and women responded equally to treatment, that is, there were no significant gender differences. This was true for both treatments. In addition, those who received TSF showed improvement in all three domains assessed: PTSD severity, PTSD symptoms, and number of days abstinent.

Another study compared TSF to a cognitive-behavioral treatment for individuals concurrently diagnosed with a substance use disorder and major depression (Glassner-Edwards et al. 2007). This study found that patients who received TSF showed greater declines in substance use and greater reductions in symptoms of depression than those who were treated with CBT.

Again, a reasonable explanation for the above findings is that the support found in Twelve Step fellowships, which is the primary goal of TSF, has positive effects not only on substance use but also on symptoms of mental illness, in particular those illnesses whose dominant symptoms include anxiety and/or depression.

Excerpted from Twelve Step Facilitation for the Dually Diagnosed Client by Joseph Nowinski , Hazelden, 2011.


Double Trouble in Recovery is an evidence-based, Twelve-Step peer support model for people with co-occurring disorders. Materials include a Basic Guide, a Guide for Professionals, and a DVD. Learn more

Professional Development

continuing_ed_iconOur online courses will help you expand your knowledge about alcohol and drug addiction and mental health disorders.

© 2016 Hazelden Foundation
Privacy Policy Terms and Conditions Contact Us Affiliates