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The Science of Step 1: How Being Powerless Empowers Your Recovery

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Alcoholics Anonymous (AA) has helped millions of people reach and maintain sobriety.1 Yet, working the 12 Steps of AA can sometimes seem like it goes against the recommendations of formal addiction treatment. In Step 1, AA members “admit [they] are powerless over alcohol, that [their] lives have become unmanageable.”

On the surface, this concept can make it sound as though you have absolutely no control in whether or not you recover from alcohol addiction. However, AA still holds this idea for a reason and, in fact, the idea of powerlessness fits in many ways with the current scientific understanding of addiction.

Why Does AA Use the Idea of Powerlessness?

Alcoholics Anonymous began as a Christian fellowship. In the original form of Step 1, AA members acknowledged they alone could not manage their alcohol use and, therefore, must turn to God for help.2

Today, AA does not associate itself with any religious organization. As a member of AA, you are encouraged to look to your own higher power. Your higher power could be God, another deity, or any force outside yourself, even if that force is AA. Some peer support groups have adopted or adapted the 12 Steps and retained the original Christian meaning of “God” and “higher power.” For example, Celebrate Recovery pairs the 12 Steps of AA with the Beatitudes from the Bible.

In effect, taking Step 1 means that you acknowledge you cannot tackle your alcohol addiction without outside help. That help can include scientifically driven treatments as well as the support of other AA members.2

Why Don’t Other Peer Support Groups Identify With the Idea of Powerlessness?

In Step 1, AA members focus on a higher power.Not all peer-led mutual support organizations believe in this idea of powerlessness. For example, LifeRing Secular Recovery, SMART Recovery, HAMS, and Secular Organizations for Sobriety (SOS) focus on self-empowerment rather than looking outside yourself for help. While many peer support groups have adopted or adapted the 12 Steps to fit their philosophies, LifeRing and these other secular organizations have not.

While AA meetings encourage members to tell their stories, including ones that involve drinking and negative consequences, LifeRing discourages sharing any experiences that include explicit details about drinking or drug use. The goal of LifeRing is to focus on and celebrate the positives that you are capable of realizing.3

LifeRing and other support groups based on self-empowerment focus on the importance of making different decisions, such as by:

  • Creating a harm reductive drinking plan (HAMS)
  • Using cognitive-behavioral exercises to examine your reactions to triggers (SMART Recovery)
  • Choosing sobriety over any other priority (SOS)

However, by the nature of the disorder, alcohol addiction does involve some lack of control, particularly when symptoms are most severe. Research has found that as an AA member, you can benefit from telling your personal story because it can remind you of a painful past and reinforce the importance of your recovery.4 Storytelling can also help to facilitate honesty with yourself and to experience the therapeutic nature of being with others who share your struggles, understand what you’re going through, and listen nonjudgmentally.5

Finding a peer support group that emphasizes the supports that you need at your current place in recovery can be important—AA is not a perfect fit for everyone. None of the groups listed discourage you from using whatever help or resources that work for you. For example, you could be part of both AA and LifeRing, while also participating in psychotherapy and medical treatments.3

Is Powerlessness Part of Alcohol Use Disorder Criteria?

Step 1 is simply the first step in AA’s 12-step program. By taking this step, you acknowledge that your alcohol use has come to a point where you cannot control it.

“Unsuccessful attempts to stop or cut down use or continuing to use alcohol despite it causing problems in your life” is one of the alcohol use disorder criteria that mental health professionals use to evaluate and diagnose alcohol addiction.

Therefore, lack of control over alcohol use is part of the disease of addiction; it is not that you have a lack of willpower to control your use. This criteria is mostly likely to be present if you have moderate or severe alcohol use disorder.

Having a lack of control over your alcohol use does not mean you lack control over your recovery.

You must take an active part in recovery. This can be done by engaging in activities such as:

  • Attending detox
  • Completing treatment programs
  • Learning healthy coping skills
  • Establishing and implementing a relapse prevention plan
  • Maintaining progress and sobriety achieved in treatment

Step 1 is the first important step in recovery for many people because when you acknowledge that your alcohol use is no longer completely in your control, you can seek help.

How Does Step 1 Align With the Disease Model of Addiction?

The disease model proposes that addiction is a brain disease where the brain systems involved in reward and pleasure are altered. This model requires addiction treatment to consider the biological aspects of severe alcohol use disorder (AUD) alongside the behavioral. For example, the disease model acknowledges that genetics and brain chemistry can affect the development of addiction.7

This model has caused controversy because, to some, it seems to neglect individual responsibility in overcoming addiction. Some also feel that the disease model does not explain why some people develop mild alcohol use disorder that never progresses to severe AUD. However, the model does explain how mild AUD can develop into severe AUD over time because of changes that chronic alcohol use can make to the brain.8

The idea of Step 1 not absolving an individual of personal responsibility for the choices that may have led to their addiction or to the choices that may help them recover, the disease model does not eliminate the idea of personal responsibility. This is because you still need to take action to overcome addiction.

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Many studies support the disease model of addiction. For instance, research shows that heavy alcohol use over a long time can make changes to parts of the brain that increase alcohol-seeking behavior.9 In other words, the longer you frequently engage in heavy drinking, the greater your risk of becoming physically dependent on alcohol.

Additionally, chronic alcohol use and withdrawal have been associated with a decrease in dopamine—a chemical involved in how you think, plan, and experience pleasure. When you have lower levels of dopamine, this can lead to depression, decreased cognitive abilities, and poor judgment, including poor judgment when it comes to alcohol use.9

Genetic studies have also provided support for the disease model of addiction. If AUD exists in your family, you are more likely to have problems with alcohol misuse. No research points to an “alcoholism gene,” but studies do indicate that you may inherit genetic traits associated with a higher risk of addiction, such as increased impulsiveness.10

Which Treatments Complement Working the 12 Steps?

Research shows that attending AA meetings while getting treatment from medical and mental health professionals can have a positive impact on long-term recovery outcomes.5,11


Part of the lack of control supported by the disease model of addiction comes from the observed changes in brain chemistry caused by long-term alcohol misuse. Medication-assisted treatment can help balance neurochemistry, especially in early recovery.

Three medications are approved by the Federal Drug Administration (FDA) to treat alcohol addiction:11

  1. Naltrexone—Naltrexone (Vivitrol, Revia) affects your brain such that drinking alcohol is no longer rewarding and reduces your cravings for alcohol.
  2. Acamprosate—Acamprosate affects various brain systems to reduce your alcohol cravings.
  3. Disulfiram—Disulfiram (Antabuse) causes unpleasant symptoms (e.g., nausea, skin flushing) when you drink alcohol, which can motivate you to avoid alcohol.

These medications are not addictive, so you don’t have to worry about trading one addiction for another—known as “cross-addiction.” They can help you manage your alcohol addiction, just like medications manage other chronic diseases such as diabetes or asthma. Your healthcare provider can help you determine if one of these medications is right for you.11

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Research indicates that a few psychotherapy treatments can improve the symptoms of alcohol use disorder, including the observed lack of control over how much or how often a person uses alcohol.

Cognitive-behavioral therapy (CBT) helps you identify how your thoughts and behaviors contribute to your emotions and alcohol use. The therapist works with you to change your thoughts and behaviors such that you have more positive emotional experiences and, in turn, reduce alcohol use as a way to cope with negative experiences. In CBT, you also learn new ways to cope with life stressors.11

Motivation enhancement therapy, including motivational interviewing, is another type of therapy that helps build your motivation to reduce your alcohol use. The therapist helps you weigh the benefits and costs of alcohol use in your life so that you get closer to reducing your use.11

Couples therapy and family counseling is often a part of alcohol treatment since drinking likely impacts your relationships with those in your life. The therapist would help you, and your family members better communicate with each other and strengthen your relationships. This is particularly important because research has found that those who have the support of family members are more successful in treatment.11 This therapy can help you find “power” in the people who love you most.

AA meetings are helpful for many individuals in recovery from alcohol addiction. These meetings may even be part of the programming at inpatient rehab or outpatient programs you attend. Services offered by your treatment team can work alongside the 12 Steps to help you find your path to recovery.

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  1. Kaskutas, L.A. (2009, April 01). Alcoholics Anonymous effectiveness: Faith meets science. Journal of Addictive Diseases, 28(2), 145-157.
  2. Kass, N. (2015, December 18). The philosophies and practices of Alcoholics Anonymous from a psychodynamic perspective. [Unpublished doctoral dissertation]. The University of Pennsylvania.
  3. LifeRing Secular Recovery. (2021). Frequently Asked Questions (FAQs).
  4. Lederman, L.C. & Menegatos, L.M. (2011, August 29). Sustainable Recovery: The Self-Transformative Power of Storytelling in Alcoholics Anonymous. Journal of Groups in Addiction and Recovery, 6(3), 206-227.
  5. Kastenholz, K.J. & Agarwal, G. (2016). A Qualitative Analysis of Medical Students’ Reflection on Attending an Alcoholics Anonymous Meeting: Insights for Future Addiction Curricula. Academic Psychiatry, 40, 468-474.
  6. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Publishing.
  7. Racine, E., Sattler, S., & Escande, A. (2017). Free Will and the Brain Disease Model of Addiction: The Not So Seductive Allure of Neuroscience and Its Modest Impact on the Attribution of Free Will to People with an Addiction. Frontiers in Psychology, 8,
  8. Volkow, N.D. & Koob, G. (2015, August 01). Brain disease model of addiction: why is it so controversial? Lancet Psychiatry, 2(8), 677-679.
  9. Abrahao, K.P., Salinas, A.G., & Lovinger, D.M. (2017, December 20). Alcohol and the brain: Neuronal molecular targets, synapses and circuits. Neuron, 96(6), 1223-1238.
  10. Edenberg, H.J. & Foroud, T. (2013, May 28). Genetics and alcoholism. Nature Reviews Gastroenterology & Hepatology, 10, 487-494.
  11. US National Library of Medicine. (2021, August 10). Alcohol Use Disorder (AUD) Treatment.
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