AA and Al-anon

Recovering from alcohol and other drug dependency.

AA describes itself as a program of spiritual recovery from alcoholism. Its philosophy and methods have strongly influenced formal treatment programs.

AA’s 12 steps, beginning with an admission of powerlessness over alcohol, provide a structured series of self-examination and improvement tasks to help overcome alcoholism.

Although AA is difficult to evaluate because of its informality, subjectivity, and lack of control groups, formal treatment programs often involve AA participation as an adjunct.

AA’s reputation has led to the development of similar organizations for other types of psychological problems.

Al-Anon is modeled after AA and offers a similar 12-step program for codependents to help them realize their powerlessness over the drinking of their alcoholic family members.

This is seen as necessary before codependents can recover from their own addiction of trying to control their alcoholic family members’ drinking.

They are led to focus primarily on their own recovery, not that of the alcoholic.

Spontaneous recovery from alcohol and other drug dependency apparently occurs, and though most of the evidence is anecdotal, it does suggest that formal treatment is not always necessary.

It is possible that some types of personalities or environmental circumstances are more likely to be associated with such successes.

Research; Jung, J. Recovering from alcohol and other drug dependency. In: J. Jung, Psychology of Alcohol and other Drugs: Research Perspective, Thousand Oaks, CA: Sage Publications, 2000. 634 p. (pp. 398-421)

How Al-Anon Works for Families & Friends of Alcoholics

Alcoholics & Addicts Can’t ‘Just Say No’

Brain research shows why long-term drug users just canâ€™t say no

Groundbreaking research from the University of Melbourne has shed new light on why long term drug users find it hard to say no, despite dire consequences to their health.

A study into the frontal cortex, the key region of the brain involved in decision making, has shown that drug users have to place much greater demand on the brain to control impulses.

The two year study was conducted by researchers Dr Murat YÃ¼cel and Dr Dan Lubman of the ORYGEN Research Centre and the Melbourne Neuropsychiatry Centre, based at the University of Melbourne and was recently published in the July edition of the prestigious international journal Molecular Psychiatry.

â€œDrugs can capture and hijack some parts of the brain,â€ said Dr Murat YÃ¼cel a lead researcher in the study.

â€œIn this study we found the frontal cortex, an area that is essential for exercising control over thoughts and behaviours, was working inefficiently.â€

â€œThese findings may help explain why it takes addicted individuals enormous effort to exercise control over their drug-taking behaviour in the face of adverse consequences, and why they are vulnerable to relapse back into uncontrolled, compulsive patterns of use.â€

The studies involved brain-imaging technology to probe the physiological and biochemical properties of a key region of the brain, the frontal cortex.

Participants were asked to complete a test of self-control in which they had to overcome an automatic response in favour of a more controlled alternative response, thus requiring them to control their impulsive tendencies.

They researchers discovered two important differences between the opiate-using group and a group who have never used heroin.

Firstly, the opiate-using group needed to activate more of their brain by placing greater physiological demand on it to avoid making an error on a test of self control.

At the same time, brain cells in the frontal region were revealed to be less healthy than the non opiate-using group.

â€œWhat people donâ€™t tend to understand about long term drug users is that this is not a matter of choice. They have a reduced level of biological resources and find it hard to stop.â€

Dr Dan Lubman, an addiction psychiatrist and a senior investigator on the project, says this new evidence is likely to lead to the development of innovative strategies for the treatment of addiction

â€œThese findings tell us that we need to provide a combination of pharmaceutical and psychological treatments that will help bolster the efficiency of the frontal cortex and hence the individualâ€™s ability to stop their urge to use drugs.â€ Dr Lubman said.

â€œTo improve treatments for long term drug users we need to understand at what stage these brain deficits occur. The next question we need to ask is are these latest research findings a consequence of addiction or do they explain peopleâ€™s vulnerability to problematic drug use?â€ he said.

In future, the researchers would like to examine whether these processes recover with abstinence.

From a press release of the University of Melbourne, Australia.

Brain Damage, Brain Repair
by James W. Fawcett, Anne E. Rosser, Stephen B. Dunnett

Professional education

Designed By Professionals for Professionals

Brief-TSF is a professionally written continuing professional education program for healthcare workers.

All disciplines of the helping profession who come in contact with patients may benefit from Brief-TSF training for alcoholism.

The professions included are nurses, doctors, psychiatrists, psychologists, social workers, faith based workers (pastors, priests, ministers, Rabbis, and other clergy) and counselors.

Brief-TSF may also be used by trained and supervised volunteers.

UK Alcohol and Drug Professional Training

Â The Federation of Drug & Alcohol Professionals (FDAP) is the professional body for the substance use field and works to help improve standards of practice across the sector. It is part of NAADAC, a registered charity.

FDAP offers a range of training courses – online, distance learning and face-to-face – aimed at developing the competence of workers and managers in line with the DANOS-based competence framework and relevant workforce development targets.

Introductory Certificate for Counsellors

We have launched a new introductory certificate for drug and alcohol counsellors, in partnership with Alcohol Concern. The new award is aimed at counsellors in training and volunteer counsellors. See training for more details.

FDAP Qualifications

FDAP provide a range of qualifications & certifications designed to recognise and demonstrate the competences of managers and practitioners in the drugs and alcohol field – in line with the DANOS-based competence framework and relevant workforce development targets.

Practitioners (general)

FDAP Drug & Alcohol Professional Certification [DANOS-based]

A competence-based certification for practitioners, covering 10 units from DANOS and related national occupational standards, and providing externally-validated evidence of workplace competence. Cost: Â£75 (reductions available for FDAP affiliate agencies, no charge for FDAP NCAC Accredited Counsellors). [Open to FDAP members/associates only.] more…

OU/FDAP Professional Awards for Drug & Alcohol Practitioners

Open University qualifications providing evidence of competence against units from DANOS – including a 10 unit Professional Award for Drug & Alcohol Practitioners and smaller Professional Development Awards. Cost: from Â£245 (10% off for FDAP members/affiliates). [Open to all.] more…

Â Counsellors

FDAP National Counsellor Accreditation Certificate (NCAC)

Specialist certification for drug & alcohol counsellors, conferring eligibility to the United Kingdom Register of Counsellors and complementing FDAP’s Drug & Alcohol Professional Certification. Cost: Â£150 (reductions available to FDAP affiliates). [Open to FDAP members/associates only.] more…

FDAP/AC Introductory Certificate for Drug & Alcohol Counsellors

A certification from FDAP and Alcohol Concern, aimed at counsellors in training and volunteer counsellors working in alcohol and drugs services. Cost: Â£75 (Â£50 for FDAP members/affiliates and AC members). [Open to all.] more…

Managers

OU/FDAP Awards for Managers of Drug & Alcohol Practitioners

Open University qualifications based on an assessment of competence against national occupational standards units relevant to line managers. Cost: Â£440 (10% off for FDAP members/affiliates). [Open to all.] more…

Brief-TSF professional training is adjunctive to all these courses.

Craving Reduction

Craving Reduction Medications

What medications are used in the direct treatment of alcoholism?

Anti-craving drugs and Brief-TSF, a good combination.

The process of Brief-TSF supports the use of anti-craving medications to aid in alcoholic relapse prevention. Most prescribing authorities require that alcohol craving medications be accompanied with counseling. Evidence based best practice guidelines recommend the use of craving reduction drugs where appropriate

Alcoholics Anonymous has a clear policy on the use of medications to help restore health. As always AA makes suggestions to its members;

During their drinking days, many alcoholics made their problems worse by mixing liquor with sedatives, tranquilizers, marijuana, or other drugs. They may cling to the pill or drug habit even after they stop drinking. It will probably also be wise if you encourage the alcoholic to seek medical advice from a physician knowledgeable about the special problems recovering alcoholics experience. Using medications or discontinuing their use without proper professional guidance may be dangerous, and either course may lead a sober alcoholic back to the first drink.

(The pamphlet "The A.A. Member – Medications and Other Drugs" discusses the problem in detail.) (AA, 1976).

’Alcoholics Anonymous and the Use of Medications to Prevent Relapse’.

This study did not find any strong or widespread negative attitudes toward medication for preventing relapse among AA members. Most of those who experienced unfavorable pressure continued taking their health medication (Rychtarik et al, 2000).

Two Craving Reduction Medications

There are two alcohol anti-craving drugs recommended for alcoholism or alcohol dependence. These are; acamprosate tablets (Campralâ„¢) and naltrexone tablets (Reviaâ„¢).

A new formulation – long-acting Injectable naltrexone – is currently under development. May 2007 – Now available in the USA.

Naltrexone Tablets (ReViaâ„¢)

A Cochrane Review of 29 studies from around the world concluded that naltrexone provides real help to people trying to moderate their drinking and "should be accepted as a treatment for alcoholism.â€

This study reported that in comparison to placebo, a short-term treatment of naltrexone (ReViaâ„¢) significantly decreased relapse by as much as 36% over and above normal rates, and significantly reduced withdrawal symptoms.

Naltrexone and intensive psychosocial treatment, such as counseling or attending AA meetings, was superior in the medium-term. (Srisurapanont et al, 2005).

Acamprosate (Campralâ„¢) Tablets

Seventeen randomized, placebo-controlled trials of acamprosate (Campralâ„¢) were reviewed covering 4087 alcoholics. Continuous abstinence rates at 6 months were significantly (54%) higher in the acamprosate-treated patients compared to placebo patients. Acamprosate also had a modest but significant beneficial effect on retention in treatment (Mann et al, 2004).

Overall, patients treated with acamprosate (Campralâ„¢) exhibited a significantly greater rate of treatment completion, time to first drink, abstinence rate, and/or cumulative abstinence duration than patients treated with placebo. The drug’s reliable effect on prolonging abstinence, in conjunction with an excellent safety profile, suggests that acamprosate may be useful for a broad range of patients with alcohol dependence (Mason, 2001).

Drinking and craving alcohol must be addressed first

What is Brief-TSF?

Brief-TSF can be used with males, females and youth of any age and is readily adaptable to various cultures or lifestyles.

Brief-TSF is ideally suited to primary care as well inpatient clinics, outpatient clinics or office practice.

Brief-TSF incorporates screening and assessment instruments and methods for differentiating between alcohol abuse and alcoholism.

Brief-TSF is ideally suited for counseling that is a required component of craving reduction medication prescribing.

The generic spiritual principles are acceptable to most treatment organizations and religions.

The basic Brief-TSF principles can be adapted and applied to drug addiction, excessive gambling, eating disorders and emotional problems that have psychological, emotional, physical, spiritual and mental aspects.

Brief-TSF is a both a Harm Prevention and a Harm Minimization strategy. By intervening earlier in the progression of alcoholism much harm will be prevented.

The overall recovery goal of the program is the restoration of health and freedom from the effects of addiction to the drug alcohol or alcoholism.

Brief-TSF addresses the medical, psychological, social and spiritual effects of alcoholism.

Brief-TSF can be utilized by doctors, nurses, psychologists, social workers, faith based workers, trained volunteers and counselors.

How does Brief-TSF work?

How does Brief-TSF work for the alcoholic?

The process of Brief-TSF disturbs denial and highlights the negative effects of alcohol on their lives, to such an extent, that alcoholics are motivated to take action and to sample Alcoholics Anonymous. Brief-TSF is not a therapy program per se; it is the facilitation of patients helping themselves (self help) in a mutual help paradigm.

Brief-TSF can be utilized in three situations as adjunctive to your normal program of practice:

As a â€˜discrete’ structured intervention.
As an â€˜opportunistic intervention’ or relapse prevention, where you can utilize elements as necessary.
As a â€˜knowledge base’ – You will have an awareness and understanding of Brief-TSF theory and methods, and AA practices and culture; you will be able to respect and support a patients choice of treatment while addressing other issues in your special area of practice.

Professional Intervention Program

BriefTSF is suitable for use by generalist healthcare workers; including doctors, nurses, psychologists, social workers, faith based workers and counselors.

Universality of BriefTSF

The basic Brief-TSF principles can be adapted and applied to drug addiction, excessive gambling, eating disorders and emotional problems that have psychological, emotional, physical, spiritual and mental aspects.

Spirituality and Helping in Alcoholics Anonymous

Psychiatric severity and spirituality, helping, and participation in Alcoholics Anonymous during recovery.

Although helping others is a critical part of Alcoholics Anonymous (AA) and many treatment programs, measures for assessing helping and describing its relationship with sobriety are lacking.

A sample of 200 subjects completed a Helper Therapy Scale including three subscales: Recovery Helping (alpha = 0.78), Life Helping (alpha = 0.62), and Community Helping (alpha = 0.60).

A previous analysis using structural equation modeling found that length of sobriety predicted measures of spirituality, helping, and AA participation.

The analysis reported here examined whether psychiatric severity was associated with these variables.

Results indicated significant relationships between psychiatric severity and measures of spirituality (Self Transcendence, Forgiveness, Positive Coping, and Negative Coping) and AA Achievement (defined as completing the 12 steps and serving as a sponsor).

However, no relationships were found between psychiatric severity and length of sobriety, the three Helper Therapy subscales, or AA involvement.

The findings suggest that individuals with higher psychiatric severity may need assistance from their peers or professional service providers to develop a spiritual life, serve as a sponsor for others, or complete the steps of AA.

Polcin DL, Zemore S. Psychiatric severity and spirituality, helping, and participation in alcoholics anonymous during recovery. Am J Drug Alcohol Abuse. 2004 Aug;30(3):577-92.

AA Recommendations

AA is often recommended as adjunctive to formal alcoholism treatment

The following are some governments and significant organizations who recommend Alcoholics Anonymous and craving reduction medication as an adjunctive components of professional alcoholism treatment. Some examples are -

Australia ;

McCabe D., and Holmwood C. (2003), Co morbidity of mental disorders and substance use in General Practice. Commonwealth of Australia, Department of Health and Ageing.
Shand F, Gates J, Fawcett J, and Mattick R. (2003), Guidelines for the Treatment of Alcohol Problems, Australian National Drug and Alcohol Research Centre (NDARC).
Dale A. , and Marsh A. (2000), Evidence Based Practice Indicators for Alcohol and Other Drug Interventions; Literature Review, Best Practice in Alcohol and Other Drug Interventions Working Group. Western Australian Government.

Britain ;

Strang J., (Chair) , (1999), Drug Misuse and Dependence – Guidelines on Clinical Management. Department of Health, England, Scotland, Wales and Northern Ireland.
Slattery J, Chick J, Cochrane M, Craig J, Godfrey C, MacPherson K, Parrott S. (2002), Health Technology Assessment of Prevention of Relapse in Alcohol Dependence. Health Technology Board for Scotland. National Health Service.

Canada ;

Roberts G & Roberts A., (1999), Best Practices in Substance Abuse Treatment and Rehabilitation. Office of Alcohol, Drugs and Dependency Issues, Health Canada.

New Zealand;

Bushnell J., (1999). Guidelines for Recognizing, Assessing and Treating Alcohol and Cannabis Abuse in Primary Care. New Zealand National Health Committee. July 1999.

United States;

The National Institute on Drug Abuse (NIDA), (July 2002), Principles of Drug Addiction Treatment; A Research Based Guide. National Institute Health Publication No. 00-4180.
American Society of Addiction Medicine (ASAM).
USA – National Institute on Alcohol Abuse and Alcoholism (NIAAA)

What about partners of alcoholics?

Partner Brief-TSF

Brief-TSF includes intervention with significant others in an alcohol dependents life. Significant others may be family members such as partners of alcoholics, children of alcoholics, adult children of alcoholics, parents of alcoholics, grand parents of alcoholics and work colleagues. These are sometimes known as co-dependents of alcoholism.

Partner Brief-TSF has similar goals and methods to Brief-TSF. The overall goal is referral of the significant other to Al-anon or Alateen. This is achieved by disturbing the denial of enabling behaviors, promotion of selfhood and making contact with an Al-anon peer sponsor.