As the public continues to confront corruption and abuses of power tied to the Epstein files involving attorneys, physicians, celebrities, political leaders, and institutions once considered trustworthy, we are forced to face uncomfortable truths about the systems that enable exploitation, sex trafficking, and the abuse of women and girls across generations.
Modern addiction treatment did not originate from scientific research or clinical medicine. Its philosophical roots trace back to the Oxford Group, a religious movement whose ideology shaped the foundation of today’s 12-Step model. Despite enormous advances in neuroscience, psychology, and evidence-based mental health care, many treatment programs continue to rely heavily on this nearly century-old format. Rather than modernizing treatment, systems have often doubled down, mandating 12-Step participation, expanding non-clinical peer roles tied to insurance reimbursement, and creating administrative titles that critics argue prioritize billing structures over actual clinical care.
Alcoholics Anonymous and related programs are frequently described as spiritual, yet their foundational texts reference “God” approximately 315 times, 142 times in the Big Book and 173 times in Twelve Steps and Twelve Traditions. While many Americans hold spiritual beliefs, millions do not identify with God or organized religion, and a significant number identify as atheist or agnostic. Spiritual practice may provide personal meaning, but it is not classified as an evidence-based treatment for mental health or substance use disorders.
Concerns about safety within peer-led recovery environments are not new. The term “13th-stepping,” widely recognized within recovery culture, refers to experienced members pursuing sexual or romantic relationships with newcomers who are often emotionally vulnerable in early recovery. Historical criticisms of AA founder Bill Wilson include allegations of boundary violations that critics argue helped normalize problematic dynamics still reported today.
Reliable statistics are difficult to obtain in loosely regulated or peer-run environments, particularly in groups described as high-control organizations where reporting mechanisms are limited. However, broader healthcare research provides context: Clemons et al. (2021) found that approximately 1 in 22 women report experiencing sexual misconduct by a healthcare professional during their lifetime. Recovery-specific research by Bogart and Pearce (2003), surveying women involved in AA, found that most participants reported witnessing “13th-stepping” behaviors ranging from persistent sexual comments to feeling pressured into relationships.
For those seeking additional perspectives or safety awareness, the documentary The 13th Step: The Dark Side of Alcoholics Anonymous (available free on Tubi) and an editorial, The Remarkable Recovery Movement You Haven’t Heard About, by Howard Rosenthal, EdD, CCMHC, MAC, NCC, LPC, provide further discussion on these issues.
Dotti Howe
Hamden
