Atlas›Domain V · Systemic, relational, group & community›Guide 101
Guide V-101

Behavioural twelve-step fellowships

A 27 · L 65 · M 818 interventions in the Trinity explorer
Client cardCompare
[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: each fellowship's current World Service literature as published on its own website in 2026: GA Combo Book (2025 large-print edition); OA "Working the Program" (nine Tools) and the OA Professional Community Courier (2024); FA "For the Health Care Professional" and the booklet Living Abstinently; DA "Twelve Tools" reprintable leaflet; WA Tools and Principles from the Workaholics Anonymous Book of Recovery, 2nd ed. (2015); CLA "Tools of Recovery" and newcomer page; UA's twelve Tools, Symptoms and Promises as read in a 2020 UA group meeting format (a group document, not from UA's world-service site) [uncertain]. The clinician procedures are adapted from the Twelve Step Facilitation (TSF) manual (Nowinski, Baker & Carroll, 1992, Project MATCH vol. 1). That manual was written for alcohol and AA, so its use with these fellowships is [synthesis].

What these are. Gamblers Anonymous (GA), Overeaters Anonymous (OA), Food Addicts in Recovery Anonymous (FA), Debtors Anonymous (DA), Underearners Anonymous (UA), Workaholics Anonymous (WA) and Clutterers Anonymous (CLA) are peer-run mutual-aid fellowships, not therapies. A clinician does not deliver them. Each one adapts the Twelve Steps and Traditions of Alcoholics Anonymous to a behaviour: gambling, compulsive eating, food addiction, compulsive debting, underearning, compulsive working, or clutter. They charge no fees, are self-supporting and are led by members rather than professionals [source: GA-Combo; FA-HCP; OA-WP]. Your role as a clinician is to assess fit, refer, prepare the client, use the fellowship alongside treatment, and handle problems that come up. This guide is written for that role.

How change is thought to happen (the fellowships' own account). The member admits powerlessness over the behaviour and stops it "one day at a time". For gambling and debting that means stopping completely: no gambling at all, or no new unsecured debt. For eating, working and cluttering, where stopping entirely is impossible, abstinence is a behaviour boundary the member defines, often with a sponsor. The member then works the Twelve Steps with a sponsor, uses a set of daily practical "Tools", identifies with peers at meetings, and does service. Recovery is described as spiritual, emotional and physical [source: OA-WP; GA-Combo; DA-Tools; WA-Tools2; FA-LA]. In the TSF model, the fellowship is the main agent of change and the therapist's job is to get the client actively involved in it [source: TSF].

2. Framework

The fellowship pathway. The fellowships do not publish formal phases. The sequence below comes from their newcomer guidance, and its stage labels are [synthesis]:

  • Self-identification. Each fellowship offers a self-assessment that only the member scores: GA's Twenty Questions (the Combo Book says most compulsive gamblers answer yes to at least seven) [source: GA-Combo]; OA's Fifteen Questions, at oa.org/quiz [source: OA-PC]; FA's Twenty Questions [source: FA-HCP]; CLA's leaflet "How Do I Know If I Am a Clutterer?" [source: CLA-New]; UA's list of Symptoms of underearning [source: UA-Fmt]. WA publishes Twenty Questions in its pamphlet A Brief Guide [uncertain]. DA's equivalent is [uncertain]. These are not diagnostic instruments.
  • Newcomer stage. Attend many meetings; GA advises "as many meetings as possible" [source: GA-Combo]. The UA format asks newcomers to try at least six meetings [source: UA-Fmt]. Collect members' phone numbers, read the literature, and avoid triggers. GA names gambling venues, gambling friends, and online and mobile betting [source: GA-Combo; GA-Albany; CLA-New].
  • Committed recovery. Get a sponsor, define abstinence or bottom lines, and start daily Tool use. Examples are the OA plan of eating, the FA daily food commitment to a sponsor, DA and UA record keeping, and WA top and bottom lines. Pressure Relief meetings come in for GA and DA [source: OA-WP; FA-LA; DA-Tools; WA-Tools2; GA-Combo].
  • Step work and service. Work through the Steps with a sponsor, sponsor others (WA counts this as part of Step Twelve), take service roles, and attend business meetings (a DA tool) [source: WA-Tools2; DA-Tools].
  • Ongoing membership. Membership is open-ended. There is no graduation.

Formats. Meetings run in person, by phone and on video. OA reports more than 6,400 meetings worldwide [source: OA-WP]. FA holds meetings daily [source: FA-HCP]. CLA runs phone meetings and Phone Activity Sessions [source: CLA-New]. Additional formats are Pressure Relief Groups (GA, Gam-Anon, DA), action meetings (UA), and buddy or bookending contact (CLA, UA, WA) [source: DA-Tools; GamAnon-Tools; UA-Fmt; CLA-Tools]. Sample UA meeting sequence: opening silence and prayer; readings of the Preamble, Steps, Symptoms and Tools; timed shares of up to 3 minutes with no crosstalk; a Seventh Tradition collection; members state their action plans; closing with a confidentiality reminder and the Promises [source: UA-Fmt].

Clinician framework (TSF structure, adapted) [synthesis].

  • Length. 12 weekly individual sessions. When the client has a stable partner: 10 individual plus 2 conjoint sessions. Up to 2 extra sessions for genuine crises [source: TSF].
  • Session 1 (up to about 90 minutes). Program introduction: history and consequences of the behaviour, the fellowship's view of the problem, and an outline of the work.
  • Core topics, in order. (1) Introduction; (2) Acceptance, Step 1; (3) Surrender, Steps 2–3; (4) Getting Active. Then elective topics chosen per client: genogram; enabling; people, places and things; HALT (hungry, angry, lonely, tired); Steps 4–5 (inventory); living in recovery. Conjoint topics: enabling and detaching. The final session is termination [source: TSF].
  • Format of sessions 2–11.
    • Review, 10–15 minutes: journal, slips, urges, abstinent days, reactions to meetings and reading.
    • New topic, about 30 minutes.
    • Recovery tasks for the week, about 10 minutes.
    • Summary and check of willingness, about 5 minutes [source: TSF].
  • Meeting target. TSF starts at daily attendance (90 meetings in 90 days) and negotiates down only when needed [source: TSF]. For behavioural fellowships with fewer local meetings, use phone and online meetings to reach the target [synthesis].
  • Moving on [synthesis].
    • From Introduction to Acceptance: the client has attended at least one meeting, or has a dated plan to attend.
    • From Acceptance to Surrender: the client can describe their own pattern of loss of control, in their own words.
    • From Surrender to Getting Active: the client uses at least one Tool between meetings and has some contact with a member.
    • To termination: the client has a sponsor or temporary sponsor, a home group, a written abstinence definition, and a plan for slips.

3. Guiding principles

Fellowship principles (as the fellowships publish them):

  • One day at a time. Abstinence is a commitment for today only. In session, frame goals as daily commitments, not lifelong vows [source: GA-Combo; DA-Tools; OA-WP].
  • Abstinence defined by behaviour.
    • GA: stop gambling.
    • DA: no new unsecured debt.
    • UA: solvency, one day at a time.
    • OA: no compulsive eating or compulsive food behaviours.
    • FA: no flour or sugar, with weighed and measured meals committed to a sponsor.
    • WA: each member defines their own abstinence, with bottom lines set with a sponsor.
    In session, help the client know exactly which boundary their chosen fellowship uses [source: as listed; FA-LA; WA-Tools2].
  • The only requirement for membership is a desire to stop. Readiness is enough; the client does not need to agree with every belief before attending [source: UA-Fmt; GA-Combo].
  • Anonymity and confidentiality. Never ask a client to report on other members [source: OA-WP; DA-Tools; WA-Tools2].
  • Self-supporting, non-professional, no stars. Members claim no expertise. OA states it has no medical, nutritional or psychological expertise and sends members to qualified professionals. So the clinician keeps clinical decisions; the fellowship does not make them [source: OA-PC; GA-Combo].
  • Sharing your own experience, with no crosstalk. Prepare clients for meetings where no one gives advice or replies to shares [source: UA-Fmt; FA-LA].
  • Progress, not perfection (CLA) and gentleness, acceptance and forgiveness (WA). Use these to counter all-or-nothing shame after slips [source: CLA-Tools; WA-Tools2].
  • Higher Power of one's own understanding. CLA says agnostics and atheists can benefit. Explore what this phrase means to the client rather than avoiding it [source: CLA-New].

Clinician stance (from TSF, adapted):

  • Facilitator and advocate, not sponsor. Never become the client's sponsor. Help them find one [source: TSF].
  • Active and frank but not judgmental. Name denial respectfully. Do not lecture or scold [source: TSF].
  • First things first. Keep the sessions focused on the target behaviour. Refer other problems on, or schedule them for later. The exception is risk, which always comes first [source: TSF; risk exception is synthesis].
  • Know the fellowship. The therapist does not need to be in recovery but should know the literature and attend open meetings. FA explicitly invites professionals to observe any meeting [source: TSF; FA-HCP].
  • Never end treatment because a client won't attend meetings. Explore the refusal instead [source: TSF].
  • Slips are information, not failure. Review them openly and plan responses consistent with the fellowship [source: TSF].
  • Choice and alternatives [synthesis]. Fellowship attendance is offered, not mandated. Present secular or professional alternatives if the fit is poor.
  • The clinician owns medical safety [synthesis]. For the eating fellowships, screen for eating disorders and keep medical and dietetic oversight. FA recommends consulting a health care provider before joining; Living Abstinently advises members with medical issues to discuss their food plan with their doctor [source: FA-HCP; FA-LA].
  • Co-occurring risk [synthesis]. Gambling and debt crises raise risk of suicide. Screen at intake and at each financial crisis, using standard risk assessment practice.

4. Intervention inventory

Part A covers clinician procedures that apply to any of these fellowships, adapted from TSF [source: TSF; adaptation to behavioural fellowships is synthesis]. Part B gives a profile of each fellowship and the Tools it publishes, with clinician procedures specific to it. The fellowship Tools are things members do, so the clinician's job is to explain them and support their use, not to run them.

A1. Assessing fit and choosing the fellowship [synthesis]

  • Purpose: Match the client to the right fellowship and screen out situations where the fellowship would be unsafe or a poor primary support.
  • Steps:
    1. Name the target behaviour in the client's own words. Map it to a fellowship: gambling to GA; binge or compulsive eating to OA or FA; debt to DA; chronic low earning or self-sabotage around work to UA; compulsive overwork to WA; clutter to CLA. Note overlaps. For example, gambling debt can fit both GA and DA, and FA's own list of how food addiction shows itself includes undereating, purging and compulsive exercise [source: FA-HCP].
    2. Screen for conditions that need professional treatment first or alongside: eating disorders, especially restriction, purging or medical instability; hoarding disorder; mood disorder; suicide risk; and active substance use.
    3. Ask about the client's beliefs: religion, a Higher Power, groups, and anonymity at work.
    4. Look at practical access: in-person, phone or online meetings, time zones and language.
    5. Give the client the fellowship's own self-assessment to complete privately. Discuss what they noticed rather than the score. (See section 2 for each fellowship's questionnaire.)
    6. Agree the plan in writing: which fellowship, which meetings, and by when.
  • Example language (illustrative): "Some people who struggle the way you describe find it helps to be around others who've been through the same thing. There are free peer groups built around exactly this. Want to look at which one fits?"
  • Watch for: relief or curiosity, which suggest good fit. Strong shame or a religious objection calls for A9. An eating disorder with restriction calls for coordination with the eating-disorder team before any food-plan fellowship (see B2 and B3).

A2. Program introduction session (TSF Core Topic 1)

  • Purpose: Build a shared picture of the problem and explain how the fellowship and therapy will work together [source: TSF].
  • Steps:
    1. Take a history of the behaviour and its consequences across work, home, money, health and emotions. These are the areas GA's Twenty Questions cover [source: GA-Combo].
    2. Give your clinical impression.
    3. Explain the fellowship's view of the problem in neutral terms, as a pattern that willpower alone has not fixed. This is FA's framing [source: FA-HCP].
    4. Outline the 12-session plan and the weekly recovery tasks.
    5. Set the first recovery tasks: the first meeting(s), a journal, and one piece of the fellowship's literature [source: TSF].
  • Example language (illustrative): "My role is to help you get the most out of the group, not to replace it. Each week we'll look at how meetings went and what got in the way."
  • Watch for: minimising ("it's only money"). Note it and come back to it in A4.

A3. Preparing for the first meeting [synthesis, using fellowship sources]

  • Purpose: Remove practical and emotional barriers to attending.
  • Steps:
    1. Use the fellowship's online meeting finder together in session. Choose two or three specific meetings, preferring newcomer meetings, literature meetings or open meetings. CLA recommends its literature-discussion phone meetings and a weekly Newcomers 101 call as starting points [source: CLA-New].
    2. Describe a typical meeting: readings, timed shares, no crosstalk, a voluntary Seventh Tradition collection, and an exchange of phone numbers at the end [source: UA-Fmt].
    3. Rehearse a short self-introduction and tell the client they can say "I'll just listen".
    4. Plan to arrive early and to talk to one person. FA recommends arriving early and talking with members [source: FA-LA].
    5. Coach the client, but do not take them to the meeting yourself [source: TSF].
  • Example language (illustrative): "You don't have to share or sign up for anything. The job tonight is just to sit in the room or on the call and notice where you relate."
  • Watch for: "I'm not like them" after the first meeting. Ask what was similar as well as what was different. Encourage several different meetings before deciding; UA suggests six [source: UA-Fmt].

A4. Acceptance (TSF Core Topic 2, Step 1)

  • Purpose: Help the client see their own loss of control and unmanageability, and work through denial [source: TSF].
  • Steps:
    1. Draw up a list of attempts to control the behaviour, such as betting limits, diets, budgets, cleaning sprees and "no work on Sundays", and what happened to each.
    2. List the consequences.
    3. Look at forms of denial (minimising, blaming, comparing) as they appear in the client's language.
    4. Ask the client to write their own Step 1 statement, in their own words.
  • Example language (illustrative): "Look at this list of ways you've tried to keep it under control. What does it tell you?"
  • Watch for: acceptance shows as shifts from "I should be able to" to "I haven't been able to". Watch for despair after acceptance; respond with hope and contact with peers.

A5. Surrender (TSF Core Topic 3, Steps 2–3), with secular options

  • Purpose: Help the client accept help from outside the self: the group, a sponsor, or a Higher Power of their own understanding [source: TSF; CLA-New].
  • Steps:
    1. Ask what "a power greater than yourself" could mean to them. Options include the group, the program, nature, values or God.
    2. Find a time they let others help them.
    3. Agree one concrete act of reliance, such as calling a member before a risky situation.
  • Example language (illustrative): "Plenty of members use the group itself as their 'higher power'. Does anything like that fit for you?"
  • Watch for: religious trauma, or a client who feels coerced into a belief. Do not push. Reframe toward reliance on peers, or consider alternatives (see section 5).

A6. Getting active (TSF Core Topic 4)

  • Purpose: Turn attendance into involvement: a home group, phone contacts, a sponsor and service [source: TSF; DA-Tools; WA-Tools2].
  • Steps:
    1. Set a target number of meetings, starting high and negotiating down [source: TSF].
    2. Ask the client to collect three phone numbers this week and make one call [source: CLA-New suggests collecting numbers; the specific number is synthesis].
    3. Ask them to choose a home group.
    4. Ask them to take one small service role. Examples are reading at a meeting or keeping time, which WA lists [source: WA-Tools2].
    5. Help them identify a possible sponsor by listening at meetings for whose recovery they would like to have.
    6. Set a date by which they will ask someone to be a temporary sponsor [synthesis].
  • Example language (illustrative): "You don't need the perfect sponsor. Who have you heard share where you thought, 'I want what they've got'?"
  • Watch for: isolation, such as attending online with the camera off and never making contact. Ask specifically about calls made, not just calls intended.

A7. Weekly review of journal and recovery tasks (TSF standard session format)

  • Purpose: Track involvement and catch slips early [source: TSF].
  • Steps:
    1. The client keeps a journal of meetings attended, reactions, reading, urges, slips and how they handled them.
    2. Review the journal at the start of each session (10–15 minutes). Acknowledge abstinent days without encouraging overconfidence.
    3. Explore any slip without judgment. Find what came before it and which fellowship-consistent response they could use next time: calling a sponsor or member, going to a meeting, or using a Tool [source: TSF].
    4. At the end of the session, set the next week's tasks and check willingness.
  • Example language (illustrative): "Let's walk through the hour before the slip. Where was the first point you could have picked up the phone?"
  • Watch for: journals reported only verbally, or vague answers. DA's Awareness Tool names "vagueness" as a thing to watch for [source: DA-Tools].

A8. Elective topics (TSF) adapted to the behaviour

  • Purpose: Address the client's particular high-risk areas [source: TSF; adaptation is synthesis].
  • Steps (choose per client):
    • People, places, things. List triggers and plan avoidance. GA names gambling venues, gambling friends, and online and mobile betting [source: GA-Combo]. DA's Awareness Tool covers lender and card advertising [source: DA-Tools].
    • HALT. Check for hungry, angry, lonely and tired states before urges.
    • Genogram. Map the behaviour, and attitudes to money, food and work, across generations.
    • Enabling. Identify who bails the client out.
    • Steps 4–5 inventory. Support the client's work with their sponsor. Do not duplicate it. Process any material that comes up in therapy.
    • Living in recovery. Structure, leisure and relationships.
  • Example language (illustrative): "Before last week's binge, were you hungry, angry, lonely or tired?"
  • Watch for: inventory work that brings up trauma. Slow down and treat it clinically; it is not sponsor territory.

A9. Conjoint sessions and family fellowships

  • Purpose: Educate the partner about the problem and the fellowship, work on enabling, and encourage the partner to use their own support [source: TSF].
  • Steps:
    1. Hold two conjoint sessions: one on enabling, one on detaching [source: TSF].
    2. For gambling, refer the partner or family to Gam-Anon. Its tools are meetings, telephone and email, literature, writing, sponsorship, service, Pressure Relief Group meetings, and anonymity. It is open to spouses, parents, children, friends and employers, whether or not the gambler is in GA [source: GamAnon-Tools; GA-Albany].
    3. For the other fellowships, family groups are [uncertain]. Use general family support or couples work instead [synthesis].
  • Example language (illustrative): "This group is for you, not for fixing him. People go whether or not their partner is gambling right now."
  • Watch for: financial abuse, coercion or violence. Assess safety before any joint session about money [synthesis].

A10. Coordinating with other care [synthesis]

  • Purpose: Keep clinical, medical, financial and legal decisions with qualified professionals while the client uses the fellowship. OA itself directs members to qualified professionals [source: OA-PC].
  • Steps:
    1. With the client's consent, liaise with their GP or physician, dietitian, eating-disorder team, psychiatrist, debt or credit counsellor, or legal advisor.
    2. Record which decisions belong where. For example, the food plan is reviewed by the medical team, and debt negotiations are handled with a qualified debt adviser.
    3. For gambling, add self-exclusion from venues and online sites, blocking software, and money-management protections the client chooses.
  • Watch for: fellowship advice that conflicts with medical advice. Help the client raise it with both parties. Do not undermine either.

A11. Termination and maintenance (TSF final session)

  • Purpose: Consolidate gains and hand the client over to the fellowship as their long-term support [source: TSF].
  • Steps:
    1. Review progress.
    2. Confirm the client's sponsor, home group and Tool routine.
    3. Write a slip-response plan.
    4. Offer referral for issues that were set aside during treatment.
    5. Agree when the client would come back. Ongoing step work and service carry on in the fellowship.
  • Example language (illustrative): "What's your plan the first time you feel the pull and don't want to call anyone?"
  • Watch for: a client attending only because of therapy. Ask what they will keep doing once sessions end.

B1. Gamblers Anonymous (GA): profile, tools and Pressure Relief Groups

  • Profile: GA began in January 1957, when two men met by chance and stayed abstinent by meeting regularly. The first group met in Los Angeles on 13 September 1957. GA has a Recovery Program (12 Steps, including a moral and financial inventory) and a Unity Program (12 principles) [source: GA-Combo]. Abstinence means not gambling at all.
  • Tools and suggestions as GA publishes them (paraphrased):
    • Attend as many meetings as possible.
    • Use the phone list between meetings.
    • Avoid gambling places and gambling people, and online and mobile betting.
    • Live one day at a time.
    • Reread the Steps and the Twenty Questions often.
    • Get a sponsor.
    • Do service.
    • Join a Pressure Relief Group. GA says these give guidance toward normal thinking and living and may ease legal, financial, employment and personal pressures.
    • Be patient.
    • On money: recover through hard work and repaying debts. GA discourages bankruptcy, borrowing, and members lending to each other or bailing each other out [source: GA-Combo; GA-Albany].
  • Pressure Relief Groups, what is known: The sources describe their purpose but not how they run. Who attends, what papers to bring and how a budget or restitution plan is drawn up were not described [uncertain]. Ask the local GA group how its Pressure Relief meetings work. Gam-Anon's own Pressure Relief meetings help family members work toward a livable budget that covers normal needs and all debts [source: GamAnon-Tools].
  • Purpose (clinician): Combine GA attendance with financial containment and risk management.
  • Steps:
    1. Introduce the Twenty Questions (A1).
    2. Prepare the client for the first meeting (A3).
    3. Ask the client to contact their group about a Pressure Relief meeting in the first weeks [timing: synthesis].
    4. In session, help the client gather what they will need there: a full list of debts, income and essential expenses. The list is [synthesis]: plan for honesty, because hidden debt is common.
    5. Plan barriers to gambling: self-exclusion, blocking, and limits on access to cash. The client chooses these [synthesis].
    6. Refer the family to Gam-Anon (A9).
    7. Screen for suicide risk at intake and whenever debts surface [synthesis].
  • Example language (illustrative): "GA suggests a Pressure Relief meeting where experienced members help you face the debts. Would it help to put the numbers on paper here first, so that meeting feels less frightening?"
  • Watch for: "one last win" thinking aimed at clearing debts; borrowing from other members, which GA discourages [source: GA-Combo]; acute shame or hopelessness when debts are disclosed, which calls for a risk assessment.

B2. Overeaters Anonymous (OA): profile and the nine Tools

  • Profile: A Twelve-Step fellowship "much like Alcoholics Anonymous", with more than 6,400 meetings worldwide, in person and online. OA's literature lists compulsive eating, undereating, food addiction, anorexia, bulimia, binge eating and overexercising, whatever a person's weight. Abstinence means stopping compulsive eating and compulsive food behaviours while working toward or keeping a healthy body weight [source: OA-WP; OA-PC]. Founding details are [uncertain].
  • The nine Tools (paraphrased):
    1. Plan of eating: a daily guide for avoiding trigger foods and destructive eating behaviours. The sources do not say OA prescribes a particular diet, and OA claims no nutritional expertise [source: OA-WP; OA-PC].
    2. Sponsorship: a member who has worked the program guides the newcomer through the Steps.
    3. Meetings: teach the Tools and Steps and give fellowship.
    4. Telephone: contact between meetings.
    5. Writing: putting difficulties on paper to see them clearly.
    6. Literature: OA books and pamphlets.
    7. Action plan: uses the other Tools to bring structure and balance to daily life.
    8. Anonymity.
    9. Service [source: OA-WP].
  • Purpose (clinician): Support OA involvement while keeping eating-disorder care and medical oversight with professionals.
  • Steps:
    1. Screen for an eating disorder and medical risk before referral. Check restriction, purging, compensatory exercise and medical instability.
    2. With consent, involve the physician or eating-disorder dietitian.
    3. Ask the client to bring their OA plan of eating to the dietitian or eating-disorder team for review. Agree that the medically agreed plan takes priority [synthesis; OA itself directs members to qualified professionals, source: OA-PC].
    4. Use OA's writing and telephone Tools as between-session coping for urges.
    5. Bring action-plan content into session for problem-solving.
  • Example language (illustrative): "Your OA plan of eating and your dietitian's plan need to be the same plan. Let's bring them together."
  • Watch for: a plan of eating that becomes restrictive or rigid. Signs are long lists of forbidden foods, skipped meals, or an abstinence slip followed by compensatory restriction. Weight talk that feeds body-image distortion [synthesis]. Rising shame after slips.

B3. Food Addicts in Recovery Anonymous (FA): profile and the daily food commitment

  • Profile: An international Twelve-Step program adapted for food addiction. It calls itself neither a diet program nor a religious group, and charges no dues and holds no weigh-ins. FA defines food addiction by comparison with alcoholism. Its list of how the problem shows itself includes obsession with food, weight or body image; overeating; undereating; laxative use or vomiting; and compulsive exercise or dieting. Meetings run daily by phone, on Zoom and in person [source: FA-HCP]. Founding details were not verified [uncertain].
  • The program as FA publishes it (paraphrased):
    • Abstinence: no flour and no sugar, with measured portions from the main food groups [source: FA-HCP]. Members weigh and measure their food. Each day they commit a food plan to their sponsor in advance, so they know what, when and how much they will eat. Meals are at regular times without long gaps, eaten without distraction, and kept simple. Practical habits include packing meals, writing grocery lists, and eating out without scales [source: FA-LA].
    • Sponsor: guides physical, mental and spiritual recovery, explains which foods are abstinent, and hears the daily food commitment. Contact is frequent at first and tapers as recovery grows.
    • Phone calls: a committed morning call to the sponsor, then calls to other members during the day, especially at cravings or low mood.
    • Meetings: chosen and committed to. Members arrive early, take part, and reach out to newcomers [source: FA-LA].
    • Medical: FA states it is not a medical group and recommends consulting a health care provider before joining. Members with medical issues are told to explain to their doctor that they are in recovery and to discuss the food plan [source: FA-HCP; FA-LA].
    • Professional access: professionals may observe any FA meeting. FA's public information service answers questions [source: FA-HCP].
  • Purpose (clinician): Decide whether FA's highly structured, abstinence-based food plan is safe and suitable for this client, and monitor it if so.
  • Steps:
    1. Screen carefully for an eating disorder. A weighed-and-measured plan that removes whole food categories can conflict with eating-disorder treatment, which generally works to reduce food rules [synthesis]. For a client with anorexia, bulimia or significant restriction, get the eating-disorder team's view before FA referral. Consider OA, or treatment alone, as alternatives [synthesis].
    2. Ask the client to see their doctor before starting, as FA itself recommends [source: FA-HCP].
    3. Ask the doctor or dietitian to review the plan's structure.
    4. Observe an open FA meeting yourself so you know what the client will experience [source: FA-HCP invites this].
    5. Monitor the client's mood, social eating and flexibility. Do this without focusing on weight numbers [synthesis].
  • Example language (illustrative): "FA is very structured, which some people find freeing. Before you start, I'd like your doctor and your dietitian to look at the plan with you."
  • Watch for: social withdrawal around meals; anxiety when weighing isn't possible; purging or overexercise after a slip; a sponsor's food guidance overriding medical advice. If any of these appear, return to the eating-disorder team [synthesis].

B4. Debtors Anonymous (DA): the twelve Tools, spending plan and Pressure Relief meetings

  • Profile and abstinence: Recovery begins when the member stops incurring new unsecured debt, meaning debt with no collateral behind it, one day at a time [source: DA-Tools]. Founding details are [uncertain].
  • The twelve Tools (paraphrased):
    1. Meetings: share experience, strength and hope.
    2. Record maintenance: record daily income and spending, savings, and debt payments.
    3. Sponsorship: a recovering debtor guides the member through the Steps. Members sponsor others in turn.
    4. Pressure Relief Groups and Meetings: the member meets with two other recovering debtors. Both must have had no new unsecured debt for at least 90 days and usually have more experience. Over a series of meetings they review the member's finances, which usually produces a spending plan and an action plan.
    5. Spending plan: categories for income, spending, debt repayment and savings. Needs come first, and it includes attention to increasing income.
    6. Action plan: concrete steps, made with the Pressure Relief Group, to resolve debts, improve finances and reach goals without new unsecured debt.
    7. Telephone and internet contact: especially before and after hard tasks.
    8. Literature: DA and AA.
    9. Awareness: notice the pull of lender and card advertising, and keep clear on the numbers to avoid vagueness.
    10. Business meetings: held monthly.
    11. Service: at every level.
    12. Anonymity [source: DA-Tools].
  • Purpose (clinician): Help the client start and keep up the DA Tools, and work on the emotional side of money: avoidance, shame and vagueness.
  • Steps:
    1. Start record maintenance this week, even if only by writing down every expense.
    2. Review the records in session as exposure to avoided information. Use a gentle, curious tone [synthesis].
    3. Ask the client to request a Pressure Relief meeting through their group.
    4. Use sessions to process what the meeting brings up.
    5. Help the client follow through on the action plan by breaking it into small tasks. Bookend each task with a call to a member [source: DA-Tools; breakdown is synthesis].
    6. For legal or creditor matters, refer to a qualified debt adviser [synthesis].
  • Example language (illustrative): "You don't have to fix the debt this week. Just write down every amount that goes out, and we'll look at it together without judging it."
  • Watch for: avoiding opening post or bank statements; "vagueness" (DA's own term) about totals; new unsecured debt hidden as "just this once".

B5. Underearners Anonymous (UA): the twelve Tools and action meetings

  • Profile: UA's aim is to stop compulsive underearning one day at a time, and the only requirement for membership is a desire to stop [source: UA-Fmt]. Its symptom list (paraphrased) includes:
    • putting off necessary tasks;
    • turning down ideas that could expand work or income;
    • feeling driven to keep proving competence;
    • keeping things that no longer serve;
    • cycles of overwork, then exhaustion, then stopping;
    • giving away time or services;
    • undervaluing one's work and fearing to ask for more pay;
    • working alone when collaboration would help;
    • fear-related physical complaints;
    • shame about asking for what is needed or owed;
    • leaving projects and leads unfinished;
    • conflict at work that causes money problems.
    The meeting theme is moving from "hiding and biting" to "shining and receiving" [source: UA-Fmt].
  • The twelve Tools (paraphrased):
    1. Time recording: a written log of how time is spent.
    2. Meetings.
    3. Sponsorship: with a member who has worked the Steps in UA.
    4. Possession consciousness: regularly letting go of things no longer needed.
    5. Service.
    6. Goals pages: written goals in every area of life, with progress tracked and achievements rewarded.
    7. Action meetings: meeting with others to plan concrete earning steps.
    8. Action partners: regular check-ins for accountability.
    9. Solvency: no new debt, one day at a time.
    10. Communication: reaching out to other members.
    11. Literature.
    12. Savings: a savings plan at any level the member can manage [source: UA-Fmt].
  • Purpose (clinician): Use the UA Tools as behavioural structure, and treat the underlying fear, shame and avoidance.
  • Steps:
    1. Review the time record in session to find avoidance patterns.
    2. Turn goals-page items into graded tasks.
    3. Rehearse asking for higher fees or pay before the client's action meeting [synthesis].
    4. Screen for depression, ADHD, trauma or disability that could explain the pattern, and treat these [synthesis].
  • Example language (illustrative): "Your time log shows three hours on other people's favours and twenty minutes on your own project. What happens in you when you sit down to your own work?"
  • Watch for: perfectionism about the logs; tipping into overwork; a clinical condition being treated purely as an "underearning" problem [synthesis].

B6. Workaholics Anonymous (WA): Tools, Principles and top and bottom lines

  • Profile and abstinence: Abstinence means refraining from compulsive working. It is more than relief from overwork: it includes surrender and freedom from compulsive thinking and worry, rather than simply doing nothing. Each member defines their own abstinence [source: WA-Tools2]. Founding details are [uncertain].
  • The Tools (2nd ed., paraphrased):
    1. Meetings.
    2. Telephone and internet contact, especially around hard tasks.
    3. Sponsors: a sponsor is abstinent from compulsive working. Members may have several sponsors, change sponsors, or co-sponsor each other.
    4. Literature: daily reading of WA material. AA literature also applies if the member reads "compulsive working" in place of the substance.
    5. Prayer and meditation: a daily quiet practice, including asking for guidance before taking on new commitments.
    6. Writing.
    7. Top and bottom lines: top lines are goals and visions. Bottom lines mark where the member crosses from abstinence into work addiction. They are set with a sponsor, who also helps when they are crossed.
    8. Action plan: daily written intentions with scheduled time for self-care, recovery, recreation and relationships. One thing at a time, a comfortable pace, no new task without dropping one, spare time in the schedule, flexibility, and sharing the plan with another member.
    9. Rest and relaxation: rest before exhaustion, notice energy and stress, and leave room for unstructured time and play.
    10. Service: for example listening, reading or timekeeping at meetings. Early in recovery, members may need to step back from large volunteer roles that fed the compulsion [source: WA-Tools2].
  • The Principles (paraphrased):
    • accept outcomes without rushing or perfectionism;
    • be gentle, admit mistakes, ask for help and delegate;
    • forgive yourself and others;
    • keep confidentiality and keep the group safe [source: WA-Tools2].
  • Purpose (clinician): Turn the WA Tools into a workable weekly structure. Address the beliefs that drive overwork.
  • Steps:
    1. Help the client draft bottom lines before they take them to a sponsor, who finalises them [source: WA-Tools2 says lines are set with a sponsor; drafting in session is synthesis]. Make the lines concrete, such as an end-of-day time, no email at certain times, or a maximum number of weekly commitments.
    2. Draft top lines, such as relationships, play and rest.
    3. Review the week's action plan against what actually happened.
    4. Treat the anxiety the client feels when idle as a target for graded tolerance [synthesis].
    5. Think about job demands and the client's livelihood realistically. Bottom lines have to fit the employment they actually have [synthesis].
  • Example language (illustrative): "What would a bottom line look like that you could actually keep in your current job, and that you'd know straight away you'd crossed?"
  • Watch for: recovery itself becoming another overloaded project (too many meetings or roles; WA cautions about this for service [source: WA-Tools2]); "busy" defences; exhaustion that may be depression or burnout needing treatment [synthesis].

B7. Clutterers Anonymous (CLA): the twelve Tools, buddies and Phone Activity Sessions

  • Profile: A 12-Step, 12-Tradition fellowship for people who struggle with clutter, with a sponsor and buddy system. There are about 46 face-to-face meetings in two countries, at least one phone meeting a day, Zoom meetings, Phone Activity Sessions (for commitments, focused action and "release victories"), and a weekly newcomer phone meeting on the booklet Is CLA for You? [source: CLA-New]. CLA's definition of clutter and its founding details are [uncertain].
  • The twelve Tools (paraphrased):
    1. Service: from holding office to helping with cleanup. It is a way out of isolation.
    2. Meetings.
    3. Sponsorship.
    4. Literature: CLA and AA.
    5. Bookending: checking in with another member before and after a hard task.
    6. Buddies: sharing a daily plan or asking for help with a project.
    7. Daily action: something every day, however small. Progress over perfection.
    8. Earmarking: every possession has a home and goes back to it. When something new comes in, something old goes. Some open space is left.
    9. Focusing: one task at a time.
    10. Streamlining: keep only what is used and fits the space.
    11. Telephone.
    12. Trust: simplify, trusting that needed items or information will be there when needed [source: CLA-Tools].
  • Purpose (clinician): Support CLA work while screening for hoarding disorder and other conditions that need specialist treatment.
  • Steps:
    1. Screen for hoarding disorder, including insight, distress, safety and fire risk, and whether there are dependants in the home. Screen also for ADHD, depression, OCD and grief. Where hoarding disorder is likely, offer evidence-based hoarding treatment alongside CLA rather than CLA alone [synthesis; CLA's newcomer page does not mention hoarding disorder, source: CLA-New].
    2. Turn the Tools into graded tasks. Daily action: 15 minutes, bookended [the duration is synthesis]. Earmarking: one category at a time. Focusing: one surface.
    3. Arrange a Phone Activity Session or a buddy for hard tasks.
    4. Process the feelings that come with discarding in session.
  • Example language (illustrative): "What's one small area where you could give things a home this week? Who could you bookend it with?"
  • Watch for: forced mass clear-outs by family members. These can cause severe distress and rupture, so recommend client-led pacing [synthesis]. Also watch for safety hazards that need urgent action, and shame that keeps the client off camera or away from home visits.

5. Handling problems

TSF sources are tagged. Everything else is [synthesis] unless a fellowship source is cited.

  • Refuses to attend, or quits after one meeting.
    • Explore what happened: fear, shyness, "not like them", or practical barriers. TSF reads lateness and excuses as possible denial, and also as fear of failure or social shyness [source: TSF].
    • Never end treatment over it [source: TSF].
    • Offer a different format (phone, online, newcomer or literature meeting) and suggest trying six meetings [source: UA-Fmt; CLA-New].
    • If the client still declines, make the fellowship optional. Continue professional treatment, or offer secular peer alternatives [synthesis].
  • Objects to the spiritual language.
    • Use A5: the group as a power greater than the self. CLA says agnostics and atheists can benefit [source: CLA-New].
    • Do not argue theology.
    • Respect a firm no, and refer to alternatives [synthesis].
  • Slips and relapse.
    • Review without judgment and plan a fellowship-consistent response: call, meeting, Tool [source: TSF].
    • Counter all-or-nothing thinking with the fellowships' "progress, not perfection" and gentleness principles [source: CLA-Tools; WA-Tools2].
    • For gambling slips, check the financial damage and suicide risk the same day [synthesis].
  • Arrives at the session intoxicated or acutely dysregulated. TSF does not see a client who arrives intoxicated and reschedules [source: TSF]. For other acute states, use standard crisis management [synthesis].
  • Overwhelm.
    • Too many Tools at once: pick one Tool and one meeting for the week.
    • Debt or clutter that feels overwhelming: use graded exposure to the information or the space, with bookending.
  • Non-adherence to Tools (no records, no food commitment, no time log).
    • Look for shame and perfectionism.
    • Shrink the task: one line a day.
    • Bring the record into session.
    • Use the fellowship's own bookending or action partners [source: CLA-Tools; UA-Fmt].
  • Problems with the sponsor. Examples: a controlling sponsor, advice that conflicts with medical or financial advice, or exploitation.
    • Remind the client that WA says members may change sponsors or have more than one [source: WA-Tools2].
    • Help the client set limits.
    • Medical, nutritional and legal decisions stay with professionals. OA itself says it has no such expertise [source: OA-PC].
    • Romantic, sexual or financial exploitation by a sponsor or member is a safeguarding issue. Help the client end the relationship, and say that reporting to group trusted servants is an option [synthesis].
  • Rupture with the therapist over the fellowship. Examples: the client feels pushed toward groups, or the client complains that the therapist contradicts the sponsor.
    • Name the rupture and own your part.
    • Restate the client's choice.
    • Clarify roles: you are facilitator, not sponsor [source: TSF role].
  • Eating fellowships and eating disorders.
    • If a food plan becomes restrictive, or purging or overexercise appears, pause any change to the plan.
    • Involve the eating-disorder team or physician urgently if there are medical signs.
    • Consider whether a plan without food rules, or specialist eating-disorder treatment, should come first.
    • Never set weight or calorie targets. Leave food-plan details to the medical team [synthesis; FA and OA both point members to their doctors, source: FA-HCP; FA-LA; OA-PC].
  • Gambling: hidden debts, legal problems, family conflict.
    • Pressure Relief meeting for the gambler; Gam-Anon for the family [source: GA-Combo; GamAnon-Tools].
    • A qualified debt or legal adviser.
    • A safety assessment for domestic abuse.
    • A risk assessment for suicide, with lethal-means counselling if risk is present [synthesis].
  • "Switching" behaviours. Examples: stopping gambling then overworking, or decluttering then overspending. Look at the shared function of the behaviours and consider a second fellowship [synthesis].
  • Fellowship becomes compulsive or isolating. Examples: workaholics overloading on service, or recovery displacing family life. Use WA's own caution about large service roles early on, and help the client set balanced limits [source: WA-Tools2; synthesis].
  • Confidentiality worries (a work colleague at the meeting, online exposure). Explain the anonymity traditions [source: OA-WP; DA-Tools]. Choose meetings outside the client's work circle, or phone meetings without camera.

Sources

Source tags used in the text, with the pages used:

Books cited:

  • Nowinski, J., Baker, S., & Carroll, K. M. (1992). Twelve Step Facilitation Therapy Manual: A Clinical Research Guide for Therapists Treating Individuals with Alcohol Abuse and Dependence. NIAAA Project MATCH Monograph Series, Vol. 1.
  • Workaholics Anonymous World Service Organization (2015). Workaholics Anonymous Book of Recovery, 2nd ed. Only the Tools and Principles excerpt is drawn on.

Further reading (not drawn on), marked [uncertain] in the text:

  • founding dates and places for OA, FA, DA, UA, WA and CLA;
  • how GA Pressure Relief Groups run in detail;
  • WA's Twenty Questions (A Brief Guide);
  • DA's self-assessment;
  • CLA's definition of clutter;
  • family fellowships for the non-gambling groups.
← Previous · V-100Drug-focused twelve-step fellowshipsNext · V-102 →Sex and love addiction fellowships