TSF ASSESSMENT

The assessment session in TSF runs 1-1/2 hours. The goals are to:

Establish client-facilitator rapport.
Conduct a collaborative assessment of alcohol and other drug abuse(history).
Discuss the client’s prior efforts to stop or control use.
Discuss negative consequences associated with use.
Share a diagnosis with the client and attempt to have it be a collaborative decision.
Outline the TSF program.
Attempt to get a commitment from the client to give TSF and AA/NA and try and to keep an open mind.

Assessment within the TSF model has both an informational and a motivational goal.

It is recommended that periodic alcohol tests be done either randomly or when the facilitator suspects that the client may have been drinking or using.

Consistent with 12-step philosophy, no client is excluded from treatment as a consequence of drinking or using, although with some clients it may become appropriate to discuss inpatient treatment. Sessions with clients who are found to be (or who admit to being) drunk or high are terminated, and arrangements are made to get the client home safely.

Professional Relationship

TSF CLIENT-COUNSELOR RELATIONSHIP

What Is the Counselor’s Role?

The facilitator’s role in TSF is broadly defined as including education and advocacy, guidance and advice, and empathy and motivation. Each of these broad goals is broken down further into a series of specific guidelines or objectives. For example, guidance and support include monitoring client involvement in AA/NA, encouraging clients to volunteer for basic service work, identifying appropriate social events the client might participate in, locating appropriate meetings, and clarifying the role of a sponsor.

Who Talks More?

Clients and facilitators talk about equally in effective TSF sessions. Since TSF is an active intervention, facilitators who are passive may not succeed in maintaining focus or accomplishing basic goals. At the same time, success in TSF is dependent on monitoring client activity and reactions, which requires soliciting active client involvement in sessions.

How Directive Is the Counselor?

TSF is similar to many cognitive-behavioral therapies in that it is focused and requires the facilitator to be fairly directive while still maintaining good rapport. The TSF facilitator is directive in the following ways:

The focus of therapy is on early recovery. The facilitator does not allow the focus to drift onto other issues (e.g., relationship or work problems) even if these are significant. The facilitator validates other concerns and helps the client develop an overall treatment plan to deal with them but maintains the focus of TSF.
The client’s reactions to assignments and meetings are considered very important. In TSF the facilitator needs to solicit specific feedback from the client.
Each TSF session has a specific topic (core, elective, or conjoint) that includes a specific agenda to be covered. Although a given topic may require more than one session to cover, and while the facilitator needs to be somewhat flexible in his or her agenda, the facilitator must also take responsibility for controlling the content and flow of sessions.
Each TSF session follows a set format that the facilitator is responsible for following. Again, there is some flexibility, but the facilitator does not simply follow the client’s agenda.
Every TSF session ends with the facilitator making specific suggestions to the client (recovery tasks). In addition, the facilitator is expected to make specific suggestions (e.g., which meetings to attend, how to ask for a sponsor) throughout treatment.

Therapeutic Alliance

In TSF, the facilitator is seen as an expert in interpersonal counseling techniques and as knowledgeable in the principles and practicalities of 12-step fellowships.

However, in TSF the facilitator is not regarded as the primary agent of change; rather, it is the 12-step fellowship (AA or NA) that is seen as the agent of change.

Accordingly, the TSF facilitator needs to conceptualize treatment as the product of a collaborative relationship and should assume responsibility for doing the best he or she can to establish that collaborative relationship.

However, it is not the facilitator’s goal to breakdown the client’s denial, to provide all support needed to stay sober, to take the client to meetings, and so forth. Even in emergencies, the facilitator’s role and responsibilities are limited in the TSF model. For this reason the word "facilitator" was chosen rather than therapist or counselor, as it seems to describe the role better than those labels.

Teen drinking leads to risk of alcoholism and social exclusion

A recent study reports that teen binge drinkers are more likely to use drugs, to become alcoholics and to be convicted of a criminal offense.

The Institute of Child Health released a study of 11,000 children who were born in 1970 and monitored at the age of 16 and 30. At the age of 30, participants were asked to describe their levels of heavy drinking based specific criteria:

Weekly consumption
Illicit drug use
Mental health problems
Educational achievement and employment
Personal history

Binge drinking was defined as two or more episodes in which four or more drinks were consumed in a row. One in four of the 16 year old were habitual drinkers, drinking more than two to three times a week.

Experts called the findings of this study, which was published in the Journal of Epidemiology and Community Health, worrying.

Binge drinkers were;

more likely to be alcoholics and
have criminal records,
were 40% more likely to use illegal drugs,
40% more likely to suffer from mental health problems and
60% more like to be homeless.

Social Exclusion

Binge drinkers were found to be

40% more likely to be involved in accidents and
almost four times as likely to be excluded at school.

Dr. Russell Viner, lead researcher, said, â€œAdolescent binge-drinking is a risk behaviour associated with significant later adversity and social exclusion.â€ The authors of the study conclude, “Binge-drinking may contribute to the development of health and social inequalities during the transition from adolescence to adulthood.”

Researchers suggest that efforts to decrease the rate of binge drinking be set within the wider context of adolescent risk behaviour rather than concentrating specifically on alcohol use, access and availability.

From Binge to Blackout: A Mother and Son Struggle with Teen Drinking
by Chris Volkmann, Toren Volkmann

Thank You for Visiting My Blogs

After just 4 months of operation my blogs have hit the 20,000 visitor mark. To me this is astounding. Thank you.

The statistics for September are;

Visitors – 20,002

Pages viewed – 49,968

Posts – 95

Comments – 90. Well, we can push this up next month.

Blogging For Dummies (For Dummies (Computer/Tech))
by Brad Hill

Cognitive Concepts of Craving

By Stephen T. Tiffany, Ph.D.

Traditional models of craving have been based primarily on the concept of classical conditioning.

In recent years, however, researchers increasingly have introduced cognitive concepts, such as memory, expectancies, interpretation, and automatic behavior, into their conceptualizations of craving.

These efforts have culminated in the development of four cognitive models of craving:

cognitive labeling,
outcome expectancy,
dual-affect, and
cognitive processing.

The cognitive processing model posits that although many alcohol use behaviors have become automatized processes in the course of an alcoholic’s drinking career, craving is a non-automatic process that requires mental effort and is limited by a person’s cognitive capacity. This model also implies that alcohol use and alcohol-seeking behavior can occur in the absence of craving.

In addition to introducing various new concepts and models into craving research, the cognitive sciences also offer well established methodologies for testing these models and analyzing craving processes.

Alcohol Research & Health Vol. 23, No. 3, 1999

Implementing alcohol screening and intervention

Implementing alcohol screening and intervention in a family medicine residency clinic.

The purpose of this study was to evaluate the impact of simultaneous systems interventions and clinician training on management of hazardous and harmful drinking in a residency clinic.

Systems interventions included forming a multi-disciplinary implementation team, training registration clerks to distribute health risk questionnaires using the AUDIT-C alcohol screen, and training nurses to score the AUDIT-C and administer the AUDIT to screen-positive patients.

Clinicians were trained to perform brochure-based interventions on screen-positive patients.

Research staff provided compliance feedback.

Over 12 months,

8.0% (241/3014) of patients screened positive and
3.8% (115/3014) received brief interventions.

For screen-positive patients, comparisons with baseline measurements found

increased rates of alcohol assessment (50% vs. 0%, p < .0001) and
intervention (48.1% vs. 9.4%, p < .0001).

Clinicians intervened more often when prompted with completed AUDITs (72% vs. 23%, p < .0001).

Program modifications resulted in progressive increases in numbers of patients screened. This model shows promise for use in other residency programs.