The History of the 12 Steps – And Why Fellowship Hall Still Uses Them Today

Key Takeaways:

• The 12 Steps began in the 1930s with Alcoholics Anonymous and were shaped by people who understood addiction firsthand.
• Their principles focus on honesty, connection, community, and spiritual growth.
• Modern research, including a major Cochrane Review, shows that 12-Step–based approaches can support long-term recovery.
• Fellowship Hall continues to use the 12 Steps because they offer structure, connection, and hope alongside evidence-based treatment

How the 12 Steps Were Born

When you’re trying to understand treatment options, you might feel flooded by terms, programs, and approaches. The 12 Steps stand out because they’ve been around for so long, and it’s natural to wonder whether something created nearly ninety years ago can still help people today.

To make sense of that, it helps to look at where the Steps came from.

The 12 Steps started in 1935 at Alcoholics Anonymous (AA). Two individuals, Bill Wilson and Dr. Bob Smith, met at a time when they were both fighting for their own sobriety and found that talking openly about their struggles helped them stay grounded. That shared experience later grew into a community. According to the official history from Alcoholics Anonymous, the Steps were developed to capture the practices early members leaned on: honesty, humility, accountability, and a spiritual connection defined in whatever way made sense to each person.

By 1939, AA published Alcoholics Anonymous (often called “The Big Book”), giving the world its first look at this new program. These weren’t written to sound impressive or academic; they were written by people who were trying to stay alive, sober, and connected. That raw, human foundation is part of the reason so many people still find comfort and strength in them today.

What the 12 Steps Are Designed To Do

Sometimes the Steps get reduced to a checklist, but they were never meant to be a strict formula — they were meant to guide healing. Each one encourages you to look at your life in a new way, open yourself to help, repair what feels broken, and build a recovery that lasts.

A few principles sit at their core:

• Honesty about your relationship with substances
• Openness to change and support
• A sense of connection to something larger than yourself
• Willingness to repair relationships
• Daily practices that help you stay grounded

None of this requires a specific religion. The Steps speak about a “higher power,” but people interpret that in whatever way feels true to them: spiritual faith, the support of a group, nature, or even a sense of purpose they’re rebuilding.

The Steps work because they help you move from isolation toward connection. For many people, that shift becomes the turning point.

What Modern Research Tells Us About the 12 Steps

You may be wondering how something created in 1935 holds up against today’s clinical standards. That’s an important question, especially when you’re looking for safe and effective treatment.

A 2020 analysis published in the Cochrane Database of Systematic Reviews found that 12-Step Facilitation therapy can be as effective — and in some cases more effective — than other clinical interventions for maintaining long-term abstinence. The researchers noted that people who engage in AA or other 12-Step groups often build stronger social networks that support recovery, which plays a big role in long-term outcomes.

The National Institute on Drug Abuse (NIDA) also highlights mutual support groups as a meaningful part of a person’s recovery network. According to NIDA, these groups complement evidence-based treatment by helping people reduce the risk of relapse and find a reliable support system. But while treatment has evolved significantly, community connection remains a powerful, evidence-supported tool for healing.

Why Fellowship Hall Still Uses the 12 Steps Today

Fellowship Hall has been serving individuals and families in Greensboro, North Carolina since 1971. Throughout that time, we’ve seen treatment change, new therapies emerge, and our understanding of addiction deepens.

The 12 Steps remain part of our core programming because they continue to help people heal. They fit naturally within our mission: to offer evidence-based care wrapped in compassion, dignity, and hope.

The Steps Support Evidence-Based Care

The 12 Steps are widely used, but at Fellowship Hall, they’re not used alone. They’re one part of a broader clinical foundation that includes:

• Cognitive Behavioral Therapy (CBT)
• Motivational Interviewing
• Trauma-informed care
• Medication-assisted treatment (when appropriate)

This combination creates a balanced approach where the Steps offer structure and support, and clinical therapy helps you address the psychological and emotional layers of substance use. You can see this blend in our Primary Treatment Program. Many guests tell us the Steps give them clarity when everything else feels overwhelming. Therapy is the tool; the Steps are the path.

The Steps Create a Sense of Belonging

Addiction often convinces people they’re alone — the Steps help undo that.

When you sit with others who understand what you’re facing, you feel something shift. Judgment fades. Shame quiets. You start to breathe again. That sense of connection carries through your time in treatment and into the fellowship you build afterward.

Fellowship Hall’s community is built around that spirit of support. It’s something you can feel the moment you walk in.

The Steps Encourage Ongoing Growth

Recovery isn’t something that ends. It grows with you.

The Steps offer guidance long after treatment is complete:

• Step 4 helps you reflect honestly on your life.
• Step 8 supports repairing relationships and rebuilding trust.
• Step 10 encourages daily accountability, which many people find grounding.
• Step 12 shifts the focus toward helping others.

Many guests appreciate that the Steps keep offering direction even after formal treatment.

The Steps Meet You Where You Are

Every person enters treatment with their own history, beliefs, fears, and hopes. The Steps don’t require you to be someone you’re not. You move at your own pace. You interpret the spiritual components in a way that aligns with your life.

At Fellowship Hall, we honor your individuality. Recovery should feel personal. It should reflect who you are and who you want to become.

How the 12 Steps Fit into Your Treatment Experience

You might wonder how the Steps show up during treatment. Here’s a closer look at what they look like in practice at Fellowship Hall.

Learning the Foundation of the Steps

Guests begin by exploring what the Steps are, why they were created, and how they’ve helped millions of people find recovery. This groundwork helps you understand how the Steps can support your own journey.

Engaging in Step-Based Groups and Therapy

Throughout your stay, you’ll participate in:

• 12-Step–focused group work
• Individual counseling sessions
• 12-Step meetings
• Step study and guided reflection
• Peer support and mentorship opportunities

These aren’t high-pressure experiences. They’re gentle, supportive spaces that help you connect your story with the deeper work of recovery.

Support for Co-Occurring Concerns

Many people entering treatment are also living with anxiety, depression, trauma, or other mental health challenges. Our licensed clinicians use evidence-based strategies to support both substance use disorder recovery and mental health.

You can see more about our approach on our page covering what we treat.

Preparing for Life After Treatment

Before you leave treatment, you’ll work with clinicians to develop a continuing care plan that may include:

• A list of 12-Step meetings near your home
• Recommendations for outpatient therapy
• Relapse-prevention strategies
• Community support resources

If you’re unsure where to begin, our Admissions team is always here to help.

Why the 12 Steps Still Matter for Families and Loved Ones

Families often feel lost when someone they love is struggling. They want to help but aren’t sure how. The 12-Step model includes families through programs like Al-Anon, giving them a safe place to learn, connect, and heal.

At Fellowship Hall, we support families throughout treatment. When loved ones understand addiction as a disease and not a personal failure, they can show up with more compassion and clarity.

The Steps help families find steadiness during a time that can feel anything but steady.

Your Path Forward

If you’re trying to decide whether the 12 Steps are right for you or your loved one, take a breath. You don’t have to have it all figured out today.

What matters is finding a treatment approach that feels supportive, grounded, and human. At Fellowship Hall, the 12 Steps continue to guide our work because they help people rediscover hope, community, and possibility.

Recovery is possible. We see it every day. And when you’re ready, we’re here to walk with you.

FAQs

Do the 12 Steps require me to believe in God?

No. The Steps refer to a “higher power,” but how you define that is completely up to you.

Are the 12 Steps backed by research?

Yes. Studies such as the 2020 Cochrane Review show that 12-Step Facilitation can support long-term abstinence in ways similar to other evidence-based therapies.

Can I attend 12-Step meeting while doing residential treatment?

Yes. Many people combine therapy or residential programs with 12-Step meetings to strengthen their recovery network.

Are the 12 Steps integrated into every program at Fellowship Hall

The Steps guide our residential programming and support aftercare planning, but they’re always paired with clinically sound treatment based on your individual needs.

Sources

• Alcoholics Anonymous. (n.d.). AA History. Retrieved from Alcoholics Anonymous
• Humphreys, K., & Kelly, J. (2020). Alcoholics Anonymous and other 12-step programs for alcohol use disorder. Cochrane Database of Systematic Reviews. Retrieved from Cochrane Review
• National Institute on Drug Abuse. (2023). Mutual Support Groups. Retrieved from NIDA