The profile of abstinence-based recovery has been heightened in recent UK national strategies (1 2 3), with renewed attention falling on one of the best-known and most widely implemented programmes for achieving this goal – 12-step ‘anonymous’ mutual aid fellowships such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA). This hot topic keys into what qualities have preserved 12-step as the dominant model, despite its reliance on a ‘higher power’ and abstinence clearly not suited to everyone, what conclusions can be drawn about its effectiveness given the tensions inherent when ‘faith meets science’, and the extent to which confidence in the 12 steps comes from “consistency with established mechanisms of behavior change” as opposed to some of its more distinct components.