The social ontology of twelve-step recovery

Twelve-step recovery is the most common form of recovery from addiction to alcohol and other drugs.
Groups exist in most countries of the world and meetings vary in size between two/three and several
dozen members. The structure and format are consistent across the vast majority of meetings.
Individual groups belong to a larger fellowship, the three most common being Alcoholics Anonymous,
Narcotics Anonymous and Cocaine Anonymous. The fellowships also exist as social groups through
various organisational committee at regional, national and international levels and all literature used
in group meetings is standardised within each fellowship. Empirical quantitative methodologies have
helped to establish the efficacy of twelve step recovery and the approach is now recommended by
the National Institute for Clinical Excellence and Public Health England. Qualitative approaches have
been utilised to develop an explanation for this efficacy in terms of social networks between
intersubjectively constituted individuals. Consequentially, our understanding of the twelve-step
recovery process remains decontextualized, reductionist and rooted in atomistic individualism.
Twelve step groups and fellowships should be of particular interest to social ontology for two reasons.

Firstly, twelve step groups and fellowships provide a unique opportunity to increase our
understanding of the metaphysics of the social world. An investigation of how twelve-step group and
fellowship practices function as open-ended, transformational processes to provide coherence for
members could further current understanding of how social groups can be ontologically and causally
irreducible to their activities. The extent to which individuals can be ontologically derivative on the
social could be examined by investigating the downward causation effect of twelve step groups and
fellowships on recovery initiation among new members. Investigation of the role of twelve step groups
and fellowships in maintaining abstinence of their members could improve our understanding of
collective intentionality and group agency. The popular twelve-step maxim “I can’t, we can” also
provides a useful case study for further investigation of the I mode/we mode distinction in social
ontology.

Secondly, having established the status of twelve step groups and fellowships as ontologically distinct
from individual members and their activities, a more appropriate epistemology must be developed to
better understand the twelve-step recovery process and inform treatment practice. The social
practices and social tokens that can be found in 12-step groups and fellowships provide a coherent
set of cognitive maps and interpretive schemes that orient the behaviour of individual members. They
are too rich and complex for analysis simply through the monitoring of recovery outcomes at an
individual level. “Thick description” is required to begin to understand the social context and cultural
patterns from which these cognitive maps and interpretive schemes derive their meaning. Dynamic,
interpretive and contextualising accounts of twelve step recovery that can provide insights to improve
existing therapeutic interventions, and develop new ones, necessitates the use of ethnographic
methodologies rather than the traditional approaches that have been employed.