Affiliation with 12-step groups has been found to facilitate remission from alcohol and other drug problems. Clinicians play a critical role in fostering clients' engagement in 12-step, yet, little is known about addiction professionals’ attitudes and beliefs about 12-step groups, or about how the attitudes and beliefs may influence referral practices. This exploratory study investigates this association to gain a greater understanding of determinants of referral practices. Participants were 100 clinicians working within publicly funded outpatient treatment programs in New York City. Participants viewed 12-step groups as highly helpful to recovery, but many also endorsed items describing potential points of resistance to 12-step groups, especially the emphasis 12-step fellowships place on spirituality and on powerlessness. More positive attitudes toward 12-step were associated with greater rates of referral, while resistance to the concepts of spirituality/powerlessness was associated with lower referral rates. Implications of findings for clinical settings are discussed as well as areas where more research is needed to more fully elucidate determinants of clinicians' 12-step referrals.