A twelve-step program is a set of guiding principles (accepted by members as 'spiritual principles,' based on the approved literature) outlining a course of action for recovery from addiction, compulsion, or other behavioral problems.

Twelve-step methods have been adopted to address a wide range of substance-abuse and dependency problems. Over 200 self-help organizations (often known as fellowships) with a worldwide membership of millions now employ twelve-step principles for recovery. Narcotics Anonymous was formed by addicts who did not relate to the specifics of alcohol dependency. Similar demographic preferences related to the addicts' drug of choice has led to the creation of Cocaine Anonymous, Crystal Meth Anonymous, Pills Anonymous and Marijuana Anonymous. Behavioral issues such as compulsion for, and/or addiction to, gambling, crime, food, sex, hoarding, debting and work are addressed in fellowships such as Gamblers Anonymous, Overeaters Anonymous, Sexual Compulsives Anonymous, Sex and Love Addicts Anonymous, Sexaholics Anonymous, Clutterers Anonymous, Debtors Anonymous and Workaholics Anonymous.

Recovery is sought in several areas: physical, mental, emotional, and spiritual.

For addicts and alcoholics the physical dimension is best described by the allergy-like bodily reaction resulting in the compulsion to continue using substances after the initial use. For groups not related to substance abuse this physical manifestation could be more varied including, but not limited to: compulsive hoarding, distractibility, eating disorders, dysfunctional enabling, hyperactivity, hypomania, insomnia, irritability, lack of motivation, laziness, mania, panic attacks, psychosomatic illnesses, poor impulse control, procrastination, self-injury and suicide attempts. The statement in the First Step that the individual is "powerless" over the substance-abuse related behavior at issue refers to the lack of control over this compulsion, which persists despite any negative consequences that may be endured as a result.

The emotional obsession is described as the cognitive processes that causes the individual to repeat the compulsive behavior after some period of abstinence, either knowing that the result will be an inability to stop or operating under the delusion that the result will be different. The description in the First Step of the life of the alcoholic or addict as "unmanageable" refers to the lack of choice that the mind of the addict or alcoholic affords concerning whether to drink or use again.

The illness of the spiritual dimension, or "spiritual malady," is considered in all twelve-step groups to be self-centeredness. This model is not intended to be a scientific explanation, it is only a perspective that twelve-step organizations have found useful. The process of working the steps is intended to replace self-centeredness with a growing moral consciousness and a willingness for self-sacrifice and unselfish constructive action. In twelve-step groups, this is known as a spiritual awakening or religious experience. This should not be confused with abreaction, which produces dramatic, but ephemeral, changes. In twelve-step fellowships, "spiritual awakening" is believed to develop, most frequently, slowly over a period of time.

It is suggested that members regularly attend meetings with other members who share their particular recovery problem. In accordance with the First Step, twelve-step groups emphasize self-admission by members of the problem they are recovering from. It is in this spirit that members often identify themselves along with an admission of their problem, e.g. "Hi, I'm Wendy and I'm an alcoholic." Such catchphrases are now widely associated with support groups. Some meetings are known as dual-identity groups which encourage attendance from certain demographics. Some areas have, for example, women's groups; men's groups; and groups for gay, lesbian, and transgender people. There are also in some areas beginner's groups as well as "old-timer" groups that limit who can share, or speak during the meeting, by the length of time the members have in that fellowship.