A patient says, “I don’t do religion.”

And the conversation about 12-step programs usually ends there.

That moment comes up more often than we admit.

Not because patients don’t want help—but because we don’t always explain what these programs actually are.

In the latest issue of The Carlat Addiction Treatment Report, Drs. Draghmeh and Fuehrlein make a point that’s easy to overlook:

A lot of us refer to AA or NA without really understanding how they work.

Patients pick up on that.

When we say “try AA,” it often comes across as vague or outdated—especially if the patient thinks it’s religious or some kind of group therapy.

But the model itself is more practical than most people expect.

Meetings are structured, but low pressure.

Patients don’t have to speak.They can just listen.

The “higher power” piece is flexible. Some people interpret it as the group, or just a sense of connection. It doesn’t require a specific belief system.

And the core elements are familiar:

▸ Regular meetings that create structure

▸ Sponsors who provide accountability

▸ Repetition and routine early on (“90 in 90”)

▸ A shift in identity through community

None of that is especially foreign to how we think about treatment.

The evidence lines up with that.

When patients actually engage—show up regularly, get a sponsor, work the steps—outcomes improve, including abstinence and even healthcare costs.

But simply telling someone to go isn’t enough.

Showing up once or twice isn’t the same as getting involved.

That’s where we matter.

There’s a line from the article I’ll probably start using:

“The best meeting is one you can get to.”

It shifts the focus away from whether the program fits perfectly and toward whether the patient can actually try it.

We don’t need to be experts in 12-step programs.

But we should know enough to explain them in plain terms.

Because the difference between a vague referral and a concrete one is often the difference between “no” and “I’ll try it."

How do you usually introduce 12-step programs to patients who are hesitant? 

Share this with a colleague who refers to AA or NA but hasn’t revisited how they frame it.

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