Abstract Twelve Step Programs such as AA play a major role in addictions treatment, and their members are increasingly accepting of psychotherapy and medication. However, many clinicians question the role of an approach defined by these Programs as spiritual. This paper explores the nature, indications, and limitations of a spirutual approach to addiction and the implications for collaboration with mental health professionals. It suggests that Twelve Step Programs not only provide accessible group support and a clear ideology regarding addiction but address individuals' needs for identity, integrity, an inner life and interdependence within a larger social and moral, or spiritual context. It examines the ways in which the religious connotations of the Program remain an obstacle for many patients and clinicians. Clarification of the different needs met by modalities such as AA can improve the specificity and the comprehensiveness of treatment for patients with substance use disorders.