Alcohol consumption is declining in most developed countries and rising in many of the developing countries, Central and Eastern Europe. Alcohol's abuse significantly contributes to the global burden of disease and in parts of Central and Eastern Europe alcohol abuse has been linked to an unprecedented decline in male life expectancy (WHO 2001). Alcohol dependence one‐year prevalence is around 7% and its life‐time prevalence rates are 14% in the general population (Kessler 1994, Regier 1993). Alcohol dependence (also called alcoholism) is a condition that involves four main symptoms: craving (a strong need to drink); uncontrolled behaviour (after the first drink is impossible to stop); physical dependence (if one do not drink enough, experiences withdrawal symptoms such as nausea, sweating, shakiness and anxiety); and tolerance (the need to increase the amount of alcohol intake to feel satisfied) (NIAA 2003). Substance dependence is defined by the DSMIV as a "cluster of cognitive, behavioural, and physiological symptoms indicating that the individual continues using a substance despite significant substance‐related problems". Dependence on alcohol is characterised by tolerance and withdrawal symptoms. Tolerance is a progressive reduction in the susceptibility to the effects of a substance, resulting from its continued administration. It is present when a person must use an increasing quantity of a given substance, to achieve the same perceived effect as time passes (Gitlow 2001). Tolerance is also experienced when the person notices a decreased sensation with similar doses of a substance over time. Tolerance can be measured objectively a person with high alcohol level in blood who can still perform given tasks such as walking in line, shows sign of tolerance. Withdrawal symptoms are physiological and psychological symptoms associated with withdrawal from a substance after prolonged administration or habituation. Withdrawal is present when a characteristic physiological pattern associated to a certain substance is experienced, or when the person uses the substance to avoid or reduce specific symptoms (Gitlow 2001). People compulsively using alcohol may devote substantial time to obtain and consume alcoholic beverages and continue to use alcohol even if they experience severe psychological and physical consequences such as depression, blackouts, liver disease or other sequel (DSMIV 1994).

There is no unique and known cause of alcohol dependence and several factors may play a role in its development: familiarity, genetic factors, psychological such as high anxiety, ongoing depression, unresolved conflicts within relationship or low self‐esteem, and social factors such availability of alcohol, social acceptance and promotion of the use of alcohol, peer pressure and demanding lifestyle (A.D.A.M. 2002). Risk factors studies conducted on animals suggest that genetic vulnerability to alcohol dependence is multigenic. In humans, evidences about the genetic vulnerability is provided by studies involving monozygotic and dizygotic adult twins, which suggested that alcohol dependence is due in two thirds of cases to genetic factors and one third to environmental factors, without gender differences (Heath 1997). Alcoholic dependence syndrome is is three to four times higher in the relatives of alcoholic dependent people compared with the general population (DSMIV 1994). Stress and emotional problems can play a role in the development of alcohol abuse (NIAA 2000).

Remission is spontaneous in about 20% of people with alcohol dependence. Gender and age do not substantially affect prognosis. Positive prognostic factors are good social functioning (employment, family relationship, absence of legal problems) and good health status. Retention in treatment for at least one month increases the likelihood of remaining abstinent for one year. Psychiatric comorbidity is a negative prognostic factor. The health, social and economic consequences of alcohol abuse are usually devastating. Although many individuals do achieve long‐term sobriety with treatment, others continue to relapse and deteriorate despite multiple courses of treatment. Alcohol dependence contributes to accidents, violent behaviours, suicide, loss of working days, work related accidents and low productivity. Mortality and morbidity are increased in people with alcohol dependence (Hales 1999).

Attendance of self‐help groups is often suggested to people with a diagnosis of alcohol dependence. Participation to self‐help organization meetings can be an adjunct to professional treatment, or a treatment in itself in particular for long periods. Alcoholics Anonymous (AA) is a self‐help groups international organization composed of recovering alcoholics that offers emotional support and an effective model of abstinence for people recovering from alcohol dependence(Alcoholics Anonymous). The practice of AA is the so called Twelve Step Facilitation (TSF), an intervention based on the assumption that substance dependence is a spiritual and a medical disease (Nowinksi 1992). TSF consists of brief, structured, manual‐driven approach to facilitating recovery from alcohol abuse, and it is intended to be implemented on individual basis in 12 to 15 sessions. There are many different types of interventions based on 12‐step type programmes some of them include a spiritual approaches and others do not, some are led by a professional and others are led by former patients.

The aim of the present review is to identify the different types of programmes and to assess the experimental basis for such a frequently prescribed intervention. Besides lots of non‐scientific (mainly spiritual) literature, there is one review which compares studies of heterogeneous design and quality and one large trial (Project MATCH) conducted in the States in the late 90's with the aim of identifying the predictors of success in different non‐pharmacological interventions for alcohol dependence. The present review will consider the results of that trial and any other available experimental studies on the effectiveness of 12‐step based programmes.