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Adapting 12-Step Programs For Teenagers

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Twelve-step programs can be extremely helpful for teens who are struggling with addiction or who are on the road to becoming addicted, but they are more useful if they are adapted to the particular needs of adolescents, according to an expert on teenage addiction.

“These programs were developed for adults, and teenagers are not little adults—they are in a totally different developmental stage,” says Steven Jaffe, MD, Professor Emeritus of Psychiatry at Emory University, and Clinical Professor of Psychiatry at Morehouse School of Medicine, in Atlanta.

Dr. Jaffe, who has spent the past 25 years working to modify 12-step programs to make them developmentally meaningful for teenagers, spoke about his work at the recent American Society of Addiction Medicine conference. “These programs are free, they’re everywhere, they provide big brothers and sisters as sponsors, and they offer recovering friends,” he notes. “That’s really important, because if teens go back to their friends who use drugs or alcohol, they will start using again, too.”

Often, teens who are treated for substance use disorders are simply told to go to 12-step meetings. “You can’t just tell them to go, and leave it at that,” Dr. Jaffe says. “They have tremendous anxiety about going, so you need to link them with a sponsor who will take them to a meeting, or else they won’t go.”

Just getting them to the meetings may not be enough, however. Some of the basic concepts of 12-step programs may be troublesome for teenagers, according to Dr. Jaffe. The first step talks about being powerless over drugs and alcohol, but the word “powerless” can be a big turn-off for teens, he observes. “The goal of a teen is to have power, and they think, ‘Who wants to be part of a group that’s powerless?’”

Instead, Dr. Jaffe encourages them to think about getting clean and sober in order to enhance their power. “It’s the same step, but it’s rephrased and reemphasized to make it developmentally appropriate,” he says. “I tell them, flunking out of school, being thrown out of the house and being arrested as a result of drugs or alcohol is not powerful.”

Another concept in 12-step programs that teens can have trouble with is surrender. “Many teens, especially girls, have found themselves in very vulnerable situations when they are drunk or high, and the last thing they want to do is surrender. I tell them if they get clean and sober, they’ll be strong, and never have to put themselves in a position where bad things like that can happen.”

Dr. Jaffe developed two workbooks he uses with teenagers to make 12-step programs more meaningful to them. “So often, teens will tell me the negative consequences of using drugs and alcohol one day, and the next day they’ll deny it. So I have them write down the consequences in the workbook, so they can’t deny it the next day.” It takes one hour to complete the Adolescent Substance Abuse Intervention Workbook, which is then presented to a counselor individually or at a group. The Step Workbook for Adolescent Chemical Dependency structures the working of the first five steps.

Dr. Jaffe can be contacted about his work with teens and 12-step programs at srjaffe@bellsouth.net.

11 Responses to this article

  1. Avatar of Eric
    Eric / April 15, 2013 at 12:49 pm

    I developed my addiction during my teen years and carried it into my young adult life. Looking back at it I dont think there would have been anyway I would have gotten sober in my teen years. I was simply to naive and arrogant. It took years of suffering to finally commit myself to 12 step recovery. Once I decided to I went to a san diego sober living called Normal Heights. The place changed my life. I would highly recommend visiting their site.

  2. Avatar of larry
    larry / July 5, 2012 at 1:51 pm

    Its interesting that the govt. should state 12 step programs are a religious organizations. When the twelve steps are the basis for any type of recovery, except 4 those sufferng from politicalism. I have been involed in recovery for twenty plus years and have seen various types of recovery groups. BUT they all seemed to have the 12 steps as basis, no matter type of groups that are out there.

  3. Doug / June 20, 2012 at 9:05 pm

    Why not introduce kids to other programs such as SMART Recovery? Given the well-documented sexual predation at 12-Step meetings (ever hear of the 13th step?) I would rather my kids get help from trained facilitators with professional oversight.

  4. Avatar of Sonny Boy
    Sonny Boy / June 6, 2012 at 9:26 pm

    I contend this 12 step for kids is a dire mistake. Why tell kids they gotta attend meetings for the rest of life, or else die. Moreover, they will remain alcoholics and dope addicts for life, and will never fully recover. This is just a means of treacherous brainwashing for the young. A real sad state of affairs.

  5. Peter Wolczuk / June 2, 2012 at 12:55 pm

    Perhaps Dr. Jaffe could find further inspiration by looking into some of the young peoples’ groups of Alcoholics Anonymous, Narcotics Anonymous and others who have allowances for special interest groups. These groups consist mostly of members in their teen years (or younger) up to twenty five or thirty or where ever the home group members have placed a cap. These people include those who have worked through the early stages up to several years and have found ways of helping teens, and sometimes, those who are even younger. It’s not like a professional has discovered a new area that has been neglected and is in need of patronage.
    Most of us who have become members of AA and other Twelve Step groups are people who escaped into an addiction and thereby arrested our development at an age well before adulthood so that way the Steps are designed makes them very adaptable to young people.
    I should also point out that the young people groups in Twelve Step fellowships are like all special interest groups in that they do not restrict attendance to those who have the special needs; just that the members who take on the work of providing the service are members of the special interest group and are held to the Twelve Traditions – just like all home groups.
    Also, bravo to Denny A for pointing out one of the several (or many) things discussed at AA meetings which are not part of the original program, nor in the literature, but are discussed as if they were part of the original program.
    As for “powerless” it is a difficult thing to grasp; even for adult alcoholics with an accumulation of life experiences. Just last night, at an AA meeting which I attended, it came up as a topic and one member shared that he had often worked outdoors in many weather conditions where he had to learn how to get the job done in rainy weather but, he was powerless over a hurricane as well as alcohol. Sort of a parable to help understand, since alcohol has that sort of destructive power over me.

  6. elaine b. / June 1, 2012 at 8:58 pm

    12 step programs are very effective. However, as of May 23, 2012, the Substance Abuse and Mental Health Service Administration has created provisions that will not allow treatment providers to encourage anyone to attend 12 step meetings based on the “religious nature” of A.A. These regulations are listed under “Charitable Choice Provisions” and prevent any organization that receives SAMHSA funding from referring clients to 12 step programs.

  7. Concerned Citizen / June 1, 2012 at 7:07 pm

    Interesting. This matches what I learned teaching anger management to teens. If the teens view managing anger as giving up power, they dismiss everything that follows. If the topic is presented as a strategy to maximize their options and this increase their power, the results are better.

  8. Avatar of Denny A
    Denny A / June 1, 2012 at 2:45 pm

    Perhaps also reading some of the books Alcoholics Anonymous, and Twelve Steps and Twelve Traditions may help. The entire purpose of the Steps is to gain power, such as “… and the power to carry it out” (Alcoholics Anonymous, page 59), and “… for victory over alcohol.” (Alcoholics Anonymous, page 76) And, while often heard in meetings, it is interesting to note that “surrender” is not mentioned in the first 326 pages on Alcoholics Anonymous, is only mentioned in 6 of 43 Personal Stories of recovery, and is not in the book Twelve Steps and Twelve Traditions at all, not one time. It is one of those word-of-mouth concepts, possibly from religious distortions of the AA Program, known only to those who do not study AA literature.

  9. Lisa Frederiksen - BreakingTheCycles.com / June 1, 2012 at 1:56 pm

    This is marvelous and a much needed resource for teens in recovery. Thank you Dr. Jaffe!

  10. Patti Herndon / June 19, 2012 at 8:06 pm

    My son, who is in long term recovery benifitted, early on in the journey, by learning related to 12 step philosophies. He is, as well as our collective family is, grateful the 12 step program/resource was available at a critical point in the addiction journey -15 years ago when we were very scared and had no where else to turn for guidance/support.
    However, it’s important to share that as much as the 12 step philosophy helped us in those initial miles of the addiction journey; the ‘most’ momentum in the recovery journey,related to developing increased hope, coping and healthy change for both my son and us, as parent advocates, has occurred as a result of the learning we’ve engaged related to cognitive behavioral-based strategies, like those utilized in Motivational Interviewing, and those in CRAFT (Community Reinforcement and Family Training), SMART Recovery (Self Managament and Recovery Training Friends and Family) peer support groups. Yes. Of course we all understand there is no panacea in terms of resources that facilitate sustainable recovery. That’s exactly why it’s so good that we are living in a time when there is an increasing menu of options for support/treatment inthe addictin journey.

    I often share with other parents that are traveling the beyond difficult, challenging road of addiction with a son or daughter, that my son/my family was served ‘best’ by applying an amalgum of strategies we learned and tried…all along the way.
    The best wisdom I could share with any other parent in the addiction journey, that regards engaging helpful resources for ‘your’ circumstances, is to be mindful/cautious of those programs that would suggest (directly or subtly/ indirectly) something along the lines of: ‘our program’ is the only one that will ulimately save the alcoholic/drug addict from themselves, and that ‘our program’ is effective for all -unless inthe case the person ‘fails to follow the suggestions’.

    Implications that your addicted family member, challenged by an alcohol/drug addiction, is ‘flawed’ in some way, i.e. spiritually, morally etc.. is a red flag. If the therapy/program use cliches or espouses theories that imply that your addicted family member is incapable of ever telling the truth. Example: “If her lips are moving she’s lying” -These are red flags that you need to pay attention to….because these kinds of beliefs about addiction perpetuate stigma and that stigma decreases self efficacy and increases coping with substances like alcohol and other drugs.
    Choose resources that aim to engage your innate strengths for coping and problem solving and hope. Research them all…Then, try something else in the case the resource you engage doesnt facilitate the momentum you are hoping for in recovery -yours and your addicted childs. And keep doing that “trying something else” until it does.

  11. Patti Herndon / July 21, 2012 at 3:18 pm

    Larry, you say you find it interesting that the government frames 12 step programs as ‘religious’ and that “the twelve steps are the basis for ‘any’ type of recovery -no matter the type of groups out there”.

    As to your notion that ‘all’ recovery programs have a base (or basis) in 12 step philosophy; you are incorrect. The basis for Cognitive Behavioral methodologies for support/peer support- which would be those in the category known as ‘non 12 step’ approaches- do not resemble 12 step approach. There fore, 12 step is not a basis for ‘all groups out there’. And to your comment “…except those suffering from “politicalism”. Definition of ‘politicalism’ is “zeal or party spirit in politics” -source: Dictionary .com
    Hmmm…I’m tryin’ here…but really have no clue what your point was there with that random term. But, no matter, I suppose -free speech and all. LOL…At least ‘the govt.’ got that right, eh? ;0)

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