What Is 12-Step Facilitation in Rehab?

At some point in your search for a rehab, you may have heard treatment professionals use the term “12-Step facilitation.” But what does it mean?

12-Step facilitation, or TSF, is a method used in clinical settings to promote participation in the 12 Steps as a core part of addiction treatment. Aspects of TSF are often used in 12-Step rehab.

According to the Recovery Research Institute, a nonprofit research arm of Massachusetts General Hospital, “Twelve-Step Facilitation (TSF) treatments¹ are a set of semi-structured therapies designed to help people abstain from alcohol and other drugs by systematically linking them to, and encouraging their active participation in, community-based 12-step mutual-help organizations.”

In this approach, addiction treatment professionals in a formal treatment setting help you adopt the 12 Steps and apply them throughout your recovery journey. Recovery success is directly related to ongoing participation in AA and other 12-Step groups. TSF is based on the disease model,² which sees addiction as a lifelong illness. It focuses on Steps 1 through 5.³

Goals of TSF

The goals of TSF⁴ involve embracing the tenets of the 12 Steps—acceptance of addiction as an uncontrollable disease, and surrender to a higher power—and using them to achieve treatment outcomes:

• abstinence (staying sober)
• long-term recovery
• integrating with the 12-Step community
• emotional and spiritual growth

What This Means for Your Treatment Experience

Meetings are encouraged.

You may track your meeting attendance and progress through the Steps in a journal, which you’ll then review with your therapist.

According to Project Match’s 12-Step facilitation therapy manual,⁴ “Patients are actively encouraged to attend AA meetings and to maintain journals of their AA attendance and participation. Therapy sessions are highly structured, following a similar format each week that includes symptoms inquiry, review and reinforcement for AA participation, introduction and explication of the week’s theme, and setting goals for AA participation for the next week. Material introduced during treatment sessions is complemented by reading assignments from AA literature.”

At some rehabs, meetings are mandatory. Learn to Live in Hermann, Missouri implements “12-Step immersion and engagement” by encouraging patients to attend weekly meetings. These can include house meetings (which take place on-site at the treatment facility), community meetings (local meetings outside of rehab), virtual meetings, or recovery community events, and must total 5 meetings per week.

The extent to which a rehab uses TSF varies from program to program: they may only apply aspects of it, or base their program entirely on AA’s model. It’s important that your rehab’s treatment philosophy makes sense to you. Ask admissions staff for more details on how they use the 12 Steps in treatment.

Your therapists integrate the 12 Steps into your treatment plan.

In TSF, you and your therapist might track your progress to see how you’re adapting to the AA community, reflect on what came up in a specific meeting, or talk through your feelings about the program so far. Part of their job is to help you overcome barriers to attending meetings and reservations you may have about the program.

United Recovery Project explains how TSF can support the recovery journey,⁵ even after rehab:

“The goal isn’t to get them to show up to one session but rather to immerse themself to a point where they thrive.12-Step facilitation therapy may occur while someone is in a rehabilitation center or after they have finished substance abuse treatment. Participating in 12-Step facilitation therapy after leaving rehab is often most advantageous as doing so encourages you to stay on track.”