Running head: 12-STEP FACILITATION APPROACH FOR EATING DISORDERS 1

Skills Development: 12-Step Facilitation Approach for Eating Disorders

Samantha McDaniel

University of South Carolina

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Skills Development: 12-Step Facilitation Approach for Eating Disorders

For many decades, 12-step based programs have been used as a mechanism of support for

individuals recovering from alcoholism. Throughout these decades, this recovery support

framework has been adapted for many other communities in addiction recovery, from those

struggling with drug addictions to those struggling with disordered eating. The purpose of this

paper is to review and analyze this framework from a clinical lens, as it relates to individuals

with disordered eating habits. Because there are multiple significant differences between a

substance addiction, eating disorders, and how they factor into the 12-step approach to recovery,

there is still much debate and much left uncertain about the effectiveness of this intervention for

this population.

The Basic Framework

In beginning more research into this topic, one of the more obvious initial questions

might be this: what are the 12 steps? In order to understand the overall concept of this

intervention strategy, one must first have a clear concept of the basic framework. While tailored

slightly different for each individual addiction population, the steps remain fundamentally the

same.

“1) We admitted we were powerless over food – that our lives had become

unmanageable.

2) We have come to believe that a Power greater than ourselves could restore us to sanity.

3) We made a decision to turn our will and our lives over to the care of God as we

understood him.

4) We made a searching and fearless moral inventory of ourselves.

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5) We admitted to God, to ourselves, and to another human being the exact nature of our

wrongs.

6) We were entirely ready to have God remove all these defects of character.

7) We humbly asked Him to remove our shortcomings.

8) We made a list of persons we had harmed, and became willing to make amends to

them all.

9) We made direct amends to such people wherever possible, except when to do so would

injure them or others.

10) Continuously conducting self-inventory, and facing mistakes with honesty.

11) The practice of prayer or meditation to have the strength and honesty to continue the

recovery path.

12) Using skills and insights gained to help others find recovery as well.” (oa.org 2017)

Overeaters Anonymous, along with other 12-step groups related to disordered eating, operates

under many universal guidelines. These groups are at no-cost, they do not endorse or subscribe to

any specific organization, agency, or political agenda, they are most often lead by people who are

also in recovery, and operate under a system of sponsorship (eatingdisordersanonymous.org).

Members in the groups are encouraged to turn to their sponsor (another member in recovery) for

support and guidance in the process (eatingdisordersanonymous.org). Another key tenet in this

intervention strategy is anonymity and confidentiality. The groups intention is to function as a

safe place for people to be honest about their struggles with addiction, and to cultivate a

community of support based on the strength in recovery.

As a framework, while 12-step groups do have a general structure, there is much

flexibility in how the process is implemented or regulated. There is universal terminology used,
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often referring to addiction or compulsion as a “disease” from which we have little control over.

Recovery and support are key principles in this terminology as well, however the interpretations

and definitions of these concepts are not universally understood. Members are free to define what

recovery looks like for themselves in their own lives, as well as what their struggle is. According

to eating-disorders-research.com, “the only requirement for membership is a desire to stop eating

compulsively”. This means that even individuals struggling with anorexia are completely

welcome in an Overeaters Anonymous group because what “eating compulsively” looks like can

refer to any sort of obsessive behaviors regarding food or body image. Many may view this

particular ambiguity regarding standards as a weakness, a study done by Russell-Mayhew, von

Ranson, & Masson (2009) suggests that this precise ambiguity in and of itself, that is what helps

its members reach their success. “Members may identify with aspects of the program that fit their

world view and then associate any success they have with the whole program.” (Russell-

Mayhew, et al. 2009). This openness to allowing members to take what they need in order to

reach the goal they are aiming for, falls very in line with many key principles in Social Work.

Some parallels are seen in the application of the client’s right to self-determination, meeting the

client where they are, and the understanding that the client is the expert of their life.

In terms of population, this intervention is meant to be guided by someone in recovery,

for people seeking recovery, with the sponsorship of other recovering members. One of the more

well known 12-step groups regarding disordered eating is Overeaters Anonymous. Though this

organization maintains that anyone wishing to change their compulsive eating habits (a concept

adaptable to just about every technically defined eating disorder), the groups are often not

targeted to address any one specific eating disorder. Members struggling with anorexia nervosa

and members struggling with binge-eating disorder would be receiving the same general content,
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and guidance. There also exists other 12-step eating disorder related groups specific to

individuals struggling with the same exact issue, however these are not as widely known or

studied, as they are not as widely used. Oftentimes, members of OA begin their attendance under

the impression that the group is focused on weight-loss (Russell-Mayhew, et. al, 2009).

Therefore, many members of its population may become involved in the intervention without a

clear initial understanding of the purpose. Overall, since these 12-step facilitation groups are

self-supporting and independent, there is the potential for them to serve almost any person

seeking help with eating-related struggles. That being said, they are not considered a replacement

for more formal physical and psychological related healthcare. 12-step groups are designed as an

attempt to help provide an environment for social and spiritual growth. However, members

struggling with disordered and destructive eating behaviors must find other treatment approaches

in order to properly address their physiological and psychological needs, as well. In a study done

by McAleavey (2010), it was concluded that there is not one specific approach to eating disorder

treatment that has proved to work reliably or effectively. However, an integrative intervention

has been suggested as a proposal for long-lasting treatment effectiveness, combining multiple

treatments approaches at different levels, and allowing flexibility to the uniqueness of each case

(McAleavey, 2008 & McAleavey, 2010).

Client Interaction with Intervention

One of the more unique aspects of eating disorders in relation to other addictions is the

concept of “abstinence” and “recovery”. Because unlike alcohol or drugs, food is a necessity to

human life, the goal of abstinence has to be modified. Because the object of recovery is related to

something which group members still must use every day, the definition of recovery must also be

modified. It is a common cliché specifically among the eating disorder community that those
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who struggle with disordered eating habits or thoughts about food will always be in continuous

recovery. Recovery in this community, since it is difficult to truly measure, is a constant process

that does not stop. This must be understood first, in order to look at termination, evaluation, and

success rates. According to McAleavey (2008) and McAleavey (2010), both anorexia and

bulimia have “substantial treatment failure rates, as well as relapses following short-term,

apparently successful, outcomes”. Weinstein, Zlatkes, Gingis & Lejoyeux (2015) measured

different levels of recovery (food craving, anxiety, depression, and self-efficacy), at the start of

the 12-step program, after 1 year spent in the program, and finally after 5 years in the program.

The study explained that there is evidence of addictive qualities in certain types of foods, such as

those with high levels of sugar and fat. While it can help to explain these qualities to group

members as a backing for abstinence from those particularly addictive foods, members still have

to face the hurdle of how, when, and what to eat every single day. The results of this particular

study implicated that “people who suffer from compulsive eating do not recover completely from

this addiction, and they are at high risk for compulsive eating…. the goal of the program is to

handle high levels of craving for food and not to eliminate it” (Weinstein, et. al, 2015). The study

did find that the measured conditions for members recovery, did improve after 1 year in the

program, as well as after 5 years in the program. However, after 5 years, the measure of self-

efficacy did not improve. Weistein et. al (2015) explained that this could be because of the fact

that food addiction is a “chronic relapsing condition”. According to eating-disorders-

research.com, those that struggle with compulsive eating are “never cured” and therefore there is

no “graduation or finish date”. This is what makes the 12-step facilitation a particularly good fit

for those struggling with these issues, because meetings are free, accessible, and focus on

constant reevaluation of recovery skills. The final three steps, which are continuing to do moral
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inventories, adjusting as necessary, and promoting the recovery path to others who struggle, are

key in helping those who must recommit every day to their recovery.

Since this type of intervention is very independently led, it can be suggested that

immediate short-term treatment may be necessary initially, and then should be followed by

participation in the 12-step process in order to continue recovery skill building and support, long-

term. While evaluation within the actual groups is not likely to occur, since it allows for a long of

independent goal setting and flexible definitions, researchers are still able to continue evaluation

of the effectiveness and success of this intervention by measuring characteristics of recovery.

Theory Application

There are three major social work theories that are applicable to this intervention

technique: the biopsychosocial theory, systems theory, and the strengths based approach to

treatment.

As stated previously, studies have shown that this intervention is most effective when

approached as part of team of integrated treatment models (McAleavey, 2010). This means that

effective short and long term eating disorder recovery is more likely to be successful if treated

from all of the biological, psychological, and social levels. The 12-step model of treatment is

specifically useful for its aspects of spiritual and social support in recovery, and when utilized in

conjunction with psychological therapy and nutritional counseling.

This model of intervention also applies the systems theory, which is very relevant to the

overall issue of eating disorders. Many individuals who struggle with compulsive eating have

many different systems at play which affect their thoughts and habits toward food. Family

systems, religious systems, the diet culture and beauty standards in America, the way in which

healthier, less addictive foods are generally not as accessible to people of low-income
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(governmental and corporate systems), and also the healthcare systems in place. The 12-step

facilitation intervention asks members to look at all of these aspects in their lives that potentially

contribute to their issue. This holistic approach to self-reflection and recovery is important as it

helps member address the root and the symptoms of their compulsive thoughts and behaviors

toward food, to help them better face their struggles in the future.

Lastly, the 12-step intervention is very deeply rooted in a strengths based approach to

treatment. The overall intention of 12-step groups is to take the focus away from problems that

members have little control over. Instead focuses on the hope that comes with members’ power

over their recovery path (McAleavey, 2008). It is an empowering model of treatment, which give

members the opportunity and guidance to take the strengths that they do have and utilize them to

find healing and recovery. In 12-step groups, members recognize the importance of small

victories and provide positive reinforcements for reaching personal goals. This is a perspective

that is crucial to social work, and that plays a very significant role in the success of 12-step

intervention.

Strengths and Limitations

The 12-step process, like all interventions, has many beneficial aspects as well as some

possible limitations to success. Willow Place for Women, a treatment center for women

struggling with substance abuse, eating disorders, and/or trauma, describes many benefits to the

12-step method, such as “creating a supportive and like-minded circle of friends”, “the learning

of highly beneficial coping skills”, “the fostering of a sense of purpose in life”, “access to a wide

array of resources”, and “a safe place to talk through difficult emotions and real-life situations”

(willowplaceforwomen.com). Other strengths discussed earlier, include the aspect of tailoring the

program to each individual’s personal world-view. This allows for members to take what works
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best for them and leave whatever does not, thus allowing a sense of personal freedom, control,

and empowerment over one’s own success. The most prominent strength mentioned in much of

the research is the aspect of social support. The 12-step program cultivates a network of

individuals struggling with similar issues, allowing a sense of unity in recovery, a sense of

support in struggles, and a place to process situations with others who have a personal capacity

to understand.

One of the initial limitations that exists in this method of intervention is the focus on

spirituality. At first glance, one may easily assume that there is a religious aspect that is

foundational to the 12-step intervention, since many of the steps mention “god” or a “higher

power”. This first glance assumption may have the capacity to turn off those who are non-

religious and seeking recovery. Through personal correspondence with a member of the recovery

community, this has been noted as a limitation. This individual who was seeking recovery, but

practices Buddhism, found it more difficult to find a comfortable fit in a 12-step group. As a rule

in the fundamentals of this intervention, 12-step groups generally do not endorse or submit to

any specific denomination or religion. “God” or this “higher power” is for each individual

member to identify with on a personal level, howsoever they choose. However, it may leave

room for bias within the group if multiple members identify their concept of “god” in the same

capacity. This may potentially make it harder for other group members to make social

connections at this level.

Another limitation of this intervention, specific to its approach to eating disorders may be

the grouping of all types of disordered eating under the same umbrella. As previously mentioned,

there are not many accessible 12-step groups specific to any one type of eating disorder. There

are many Eating Disorders Anonymous groups, as well as Overeaters Anonymous groups. Both
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of these types of groups are welcome and open to just about anyone struggling with compulsive

behaviors regarding food. And while there is the opportunity for members to hear from multiple

different perspectives in groups with this kind of diversity, it may leave disorder specific issues

to fall through the cracks. While those who struggle with anorexia can definitely identify with

compulsive struggles of those with bulimia, they may have a more difficult time fitting into a

group more geared toward overeating or binge eating disorder. While these groups do try to

approach the issues from the root causes which may relate to ALL disordered eating patterns, the

lack of disorder specific groups may be something limiting certain individuals from accessing

the kind of help that they require.

Scope of Intervention

In terms of the extent to which this intervention can reach to diverse populations,

limitations have already been discussed regarding diversity of spirituality and of diagnosis. In

terms of basic identifiers such as race, class, gender, sexuality, ability, etc. there is more to be

discussed. While in theory this style of intervention is applicable to just about any population,

there are likely some types of identities which may require specific attention. For example, while

all genders alike are welcome to any 12-step eating disorder group, it may be useful to have

groups to target more underserved identities in the community, such as men or transgender

individuals. Because the intersectionality of multiple identities can play a huge role in a person’s

struggle with eating, it is important to have inclusive spaces (which do currently exist), but it is

also important to have identity specific spaces as well. There is a unity in coming together with

people of all types of backgrounds, struggling with similar issues. However, there is a very

unique unity that can be found in coming together with individuals who have very similar life

experiences as well as their struggle. This type of intervention has incredible capacity to reach all
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types of people at all levels and identities. Since groups are independently led, communities have

the ability to build 12-step rooted groups specific to whichever kind of identities that are relevant

in each area. However, if marginalized groups are more disenfranchised within their community,

they may lack the empowerment to build these groups for themselves. With anything, there is

always space to grow, to cultivate the strengths of the intervention method, and to advocate for

all people to have genuine access.

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References

12-Step Programs for Eating Disorder Recovery. (2016, April 07). Retrieved October 23, 2017,

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Anorexics and Bulimics Anonymous. (2016, February 2). Retrieved October 23, 2017, from

http://aba12steps.org/

Berg, F. M. (1993). Overeaters Anonymous: The 12-step program. Obesity & Health, 7(5), 90.

Dennis, K. (2017). Integrating 12-Step Programs into ED Recovery. Retrieved October 23, 2017,

from http://www.eating-disorders-research.com/integrating-12-step-programs-ed-

recovery/

Eating Disorders Anonymous. (n.d.). Retrieved October 23, 2017, from

http://www.eatingdisordersanonymous.org/

Ekern, J., & Karges, C. (2012, October 17). 12-Step Program Groups for Eating Disorders

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https://www.eatingdisorderhope.com/recovery/self-help-tools-skills-tips/the-12-step-

program-of-recovery-and-eating-disorders

McAleavey, K. (2008). Ten years of treating eating disorders: what have we learned? A personal

perspective on the application of 12-step and wellness programs. [Abstract]. Advances in

Mind-Body Medicine, 23(2), 18-26. Retrieved October 23, 2017, from

https://www.ncbi.nlm.nih.gov/pubmed/20664141.

McAleavey, K. (2010). Short-Term Outcomes of a 12-Step Program among Women with

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737. doi:10.1007/s10826-010-9362-y

Russell-Mayhew, S., von Ranson, K. M., & Masson, P. C. (2010). How does overeaters
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anonymous help its members? A qualitative analysis. European Eating Disorders Review,

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Weinstein, A., Zlatkes, M., Gingis, A., & Lejoyeux, M. (2015). The Effects of a 12-Step Self-

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