The goal of this chapter is to help clinicians better engage and support patients who have co-occurring or primary alcohol or drug problems through use of 12-step programs to enhance treatment outcomes and recovery. Twelve-step facilitation (TSF) is an evidence-based practice with a large research base, a therapy manual (Nowinski et al. 1995), and a Web-based training site (Sholomskas and Carroll 2006). It is a valuable technique easily available to the practicing psychiatrist and other mental health professionals. The research base of TSF is reviewed in other chapters of this book. This chapter is a condensed presentation of some of the key techniques and concepts of TSF, with some special adaptations for psychiatric practice. An important concept to recognize at the outset is that TSF is a therapist's technique to help patients engage in and maximize their response to 12-step meetings, such as Alcoholics Anonymous (AA). (TSF is not AA, nor is it, as far as we know, officially endorsed by AA or other 12-step programs.) TSF can also be applied to treat individuals who are dependent on substances other than alcohol, such as narcotics. Such individuals can be encouraged to go to Narcotics Anonymous (NA) meetings, where the 12 steps are applied as well.