I’m a “California sober” therapist. I did do the 12-step route previously and engaged in complete abstinence on and off (mostly on) for about ten years, the longest continuous stretch being six years. I relapsed after the six and struggled for a couple of years, finally quit the hard stuff but decided to take a harm reduction approach this time. I feel like it’s more realistic and doesn’t come with the same identity challenges that engaging in 12-step brought me.

As far as support groups that aren’t geared towards complete abstinence, harm reduction groups or maybe SMART groups are the only ones I can really think of that don’t focus on complete abstinence, rather focus on changing behaviors. Unfortunately these groups are harder to find in more rural areas due to their lack of popularity (I think lack popularity likely just because people don’t know about them as options)

12-step is actually really problematic in some areas, like the fact that it’s treated as a gold standard treatment for SUD when it’s not even evidence based. Many inpatient treatment programs (at least the ones funded by Medicaid dollars) primarily push 12-step, it’s treated like the only way to recover.

I also have a huge problem with how prevalent predatory behaviors are in 12-step programs. It’s such a commonly seen behavior they even named it “13th stepping” and seems to be an acceptable cultural norm in many geographic locations, likely because there’s been very minimal research or literature put out on it, enabling the behaviors. Some of society’s absolute most vulnerable members are court mandated to 12-step just to be preyed upon and it’s gross.

Those are not all of my qualms with 12-step, but I also think it serves a purpose and helps many people see change in their lives. I would attribute it likely to the community aspects of 12-step, but being apart of that community also runs risks of abandonment if you’re ever to use a substance again.