ROLE OF SIGNIFICANT OTHERS IN TREATMENT

Brief-TSF includes a ‘Partner Brief-TSF’ program to be used as adjunctive therapy whenever possible when an alcoholic patient is in a relationship.

Partner Brief-TSF can also be applied when the alcoholic is not in treatment.

Like other aspects of Brief-TSF, the partner sessions are focused and aim to meet specific goals.

Partner Brief-TSF is not intended to be used as brief marital or relationship counseling, although one objective of these sessions is to help the patient(s) assess the impact of alcohol abuse on the relationship. Marital therapy may be briefly discussed, and significant others concerns, frustrations, and grievances are validated, but the facilitator also suggests that intensive relationship counseling (along with other therapies such as family therapy or sex therapy) be deferred, at least until the client has completed Brief-TSF and, preferably, 6 months of sobriety.

The Partner Brief-TSF sessions deal with the subjects of enabling and detaching. Both of these concepts have their origins in Al-Anon, a 12-step program similar to AA but for the affected rather than the addicted. A primary goal of the Partner Brief-TSF program is to encourage and briefly facilitate the partner’s use of Al-Anon as a resource for coping with being in a relationship with an alcoholic and also for healing personal wounds that typically derive from that kind of relationship.

Another goal is to assess initially the partner’s use of alcohol or other drugs and make an appropriate referral if necessary. Finally, the goals and objectives of Brief-TSF itself and AA are outlined.

Brief-TSF includes guidelines for handling emergency calls from a partner. The approach emphasizes support and efforts to facilitate the partner’s use of Al-Anon.

Get regular updates by RSS feed

ARBIAS (Alcohol Related Brain Injury Australian Services)

arbias Ltd was established in 1990 to provide services for people with alcohol and other substance related brain impairment. It is a not for profit company managed by a board of directors. arbias is a specialist disability service which works together with families, support networks, employers and service providers to assist people with alcohol and other substance related brain impairments to live and function to their full potential in the community.

arbias provides the following services: Neuropsychological Assessments, Secondary Consultation, Case Management, Accommodation, Lifestyle Support Services, Information Services, Workforce Training and Development.

Membership of Friends of arbias Ltd is open to organizations or individuals who support the aims of arbias Ltd and is endorsed by the arbias Ltd Board of Directors. Friends of arbias Ltd are kept informed of activities of arbias Ltd via newsletters and special events throughout the year. Your financial contribution will greatly assist arbias in preventing a highly prevalent, yet little known disability.

For further information about arbias and that work that they do, please visit their website at www.arbias.org.au.

Brief-TSF Agent of Change

The facilitator in the Brief-TSF treatment model is more truly a facilitator of change than an agent of change. The true agent of change (to sustained sobriety) lies in active participation in AA along with the principles set forth in the 12 steps and 12 traditions that guide this fellowship.

This is truly adjunctive therapy.

Subscribe to updates by RSS feed

Exhaustive Review of the Literature Reveals Even Moderate Alcohol Intake Increases Risk of Cancer

The Cancer Institute of New South Wales, Australia, has released a comprehensive analysis of current evidence for the association between alcohol consumption and risk of cancer. Limited to systematic reviews and meta-analyses of the highest methodological quality, the 194-page monograph, entitled Alcohol as a Cause of Cancer, revealed that even moderate alcohol consumption is associated with an often dramatic increase in the risk of several types of cancer.

Key findings are as follows:

Alcohol intake of approximately 2 drinks per day increases the risk of

• cancer of the oral cavity and pharynx by 75 percent,
• the risk of esophageal cancer by 50 percent, and
• the risk of laryngeal cancer by 40 percent.

Moderate intake also significantly increases the risk of colorectal cancer, liver cancer, and stomach cancer.

• Intake of approximately 4 drinks per day increases the risk of any cancer by 22 percent, while
• 8 drinks per day increases the risk by 90 percent.

The risk of breast cancer is 11 to 22 percent higher in women who drink alcohol than in women who do not.

Comments: The authors were unable to identify levels of consumption associated with no risk of cancer. Although the World Health Organization lists alcohol as a Group-1 carcinogen, as noted in the introduction to this study, few people are aware that even moderate consumption can cause cancer. These findings may be limited by possible underreporting of alcohol use or misclassification of exposure (e.g., light or ex-drinkers classified as nondrinkers).

Nonetheless, information about the association between alcohol and cancer needs to be more widely available so that the public can make informed choices about their behavior.

Richard Saitz, MD, MPH. Research Reference; Lewis S, Campbell S, Proudfoot E, et al. Alcohol as a Cause of Cancer. Sydney, Cancer Institute NSW, May 2008.

See also;

• Brief-TSF can assist patients cease alcohol consumption.
• Twelve Step Facilitation
• 12-Step Treatment More Effective than Alternative
• Subscribe to BriefTSF by e-Mail

Counselling for Alcohol Problems (Counselling in Practice series) by Richard D B Velleman Read more about this title…

Antidepressant Induced Mania (ADM) Among People with Co-Occurring Disorders (COD). Sometimes, informally called Bipolar III disorder.

A recent study of medical charts at a bipolar specialty clinic gives new support to the idea that antidepressants can induce mania in some bipolar patients.

For some time, clinicians have been concerned about the problem of antidepressant-induced mania (ADM), but most research has not supported the connection between antidepressants and manic or hypomanic episodes.

This study looked at ADM and examined differences between patients with bipolar disorder and a substance use disorder (SUD) and patients without SUD.

The article presents solid evidence for a significantly increased risk of ADM in patients with co-occurring bipolar disorder and SUD. The article also comments about why the increased risk to these clients may not have been identified in prior research.

Manwani and colleagues investigated medical charts from 98 patients who were treated at a bipolar clinic between 2000 and 2004. These patients accounted for 335 antidepressant trials during that period. Of the sample, 55 patients (accounting for 184 of the trials) had a lifetime history of a SUD.

For this study, an episode of ADM was defined as hypomanic or manic symptoms within 12 weeks of beginning a new antidepressant medication.

There were some substantial differences between patients who did and did not have a SUD history—e.g., clients with SUD were almost twice as likely as those without SUD to be prescribed lithium (48.3% vs. 28.5%), and clients without SUD were twice as likely to receive divalproex as those with SUD (43% vs. 20.1%) and almost three times as likely to be prescribed an antipsychotic (31.8% vs. 11.4%).

The univariate analysis of differences in the number of antidepressant trials leading to ADM between patients with and without a SUD history showed little difference in the percentage of ADM episodes they experienced (20.7% of trials for those with SUD and 21.4% of trials for those without).

However, using a multivariate regression model of analysis, the authors found that:

• Patients with a lifetime SUD were five times as likely to experience ADM,
• The incidence of an antidepressant trial leading to an ADM was greater for clients with Type II or with bipolar disorder not otherwise specified than for Type I,
• Females were more likely than males to have an episode of ADM in response to an antidepressant trial, and
• Bupropion was the antidepressant least likely to cause an ADM.

The authors surmise that older research studies excluding people with a SUD might have led to subject pools that underrepresented individuals considerably more likely to experience an ADM than the subjects studied. Additionally, they describe how other confounding factors might have served to hide the effects of having a history of SUD on the likelihood of suffering an ADM.

A discussion of the limitations of their study (e.g., it was non-randomized, non-blind; concomitant therapy may have obscured treatment effect; no measures of adherence to medication regimens) is also given.

Research; Manwani, S. G., Pardo, T. B., Albanese, M. J., Zablotsky, B., Goodwin, F. K., & Ghaemi, S. N. (2006). Substance use disorder and other predictors of antidepressant-induced mania: a retrospective chart review. Journal of Clinical Psychiatry, 67(9), 1341–1345.

Co-Occurring Disorders Research and Resources Monthly Review. The Co-Occurring Center for Excellence (COCE), of the Substance Abuse and Mental Health Services Administration (SAMHSA), Vol. 1, No. 5, December 2006. Readers interested in finding out more about COCE should visit the Web site: http://coce.samhsa.gov/

See also;

• Double Trouble in Recovery
• Double Trouble in Recovery for Alcoholics
• Dual Recovery Anonymous
• Dual Diagnosis Anonymous
• Subscribe to BriefTSF by e-Mail

Dual Diagnosis, Counseling the Mentally Ill Substance Abuser by Katie Evans, J. Michael Sullivan Read more about this title…

Acamprosate efficacy in alcohol-dependent patients: summary of results from three pivotal trials.

In 2004, the United States Food and Drug Administration (FDA) approved acamprosate for use in conjunction with psychosocial support in the maintenance of abstinence in alcohol-dependent patients who are abstinent at treatment initiation.

That approval was based primarily on a re-analysis of three European double-blind, placebo-controlled trials in which complete abstinence was the primary outcome measure.

The current report presents data from the re-analysis of the pivotal trials, which were 13-, 48-, and 52-week studies. A total of 998 DSM-III-R alcohol-dependent patients were included in the studies, with the majority abstinent at randomization. Using a more stringent definition of abstinence, re-analysis of the rate of complete abstinence, percent days abstinent, and the time to first drink confirmed the original findings for the efficacy of acamprosate in the treatment of alcohol dependence.

Rate of complete abstinence was significantly higher with acamprosate than placebo (p < .05); both percent days abstinent and time to first drink were also significantly greater among acamprosate-treated than placebo-treated patients (p < .01).

These findings support the use of acamprosate in the treatment of alcohol dependence and illustrate some of the issues that can arise in the FDA process for approval of medications to treat the disorder.

Am J Addict. 2008 Jan-Feb;17(1):70-6. Acamprosate efficacy in alcohol-dependent patients: summary of results from three pivotal trials. Kranzler HR, Gage A.

See also;

• 12-Step Treatment More Effective than Alternative
• Brief-TSF is designed to as adjunctive therapy for anti-craving medication.
• Subscribe to BriefTSF by e-Mail

Handbook of Alcoholism Treatment Approaches (3rd Edition) by Reid K. Hester, William R. Miller Read more about this title…

TSF for Dual Diagnosis

The role of 12-step programs and 12-step-oriented treatments for dually diagnosed individuals (DDI) remains unclear. Here are presented the results of a pilot study in a target population of 10 seriously mentally ill patients received an adjunctive modified 12-step facilitation (TSF) therapy emphasizing engagement of DDI in a specialized 12-step program for DDI.

Participants significantly increased their 12-step attendance and decreased their substance use during the 12 weeks of treatment.

Larger and longer-term studies are needed to assess the efficacy of modified TSF for DDI relative to other treatments, and to determine what forms of TSF are most effective in this population.

Research; Bogenschutz MP. Tucker NE Specialized 12-step programs and 12-step facilitation for the dually diagnosed. Community Ment Health J. 2005 Feb;41(1):7-20.

Brief-TSF can be adapted to serve these people.

Six-month changes in spirituality, religiousness, and heavy drinking in a treatment-seeking sample.

OBJECTIVE: This descriptive and exploratory study investigated change in alcoholics’ spirituality and/or religiousness (S/R) from treatment entry to 6 months later and whether those changes were associated with drinking outcomes.

METHOD: Longitudinal survey data were collected from 123 outpatients with alcohol use disorders (66% male; mean age = 39; 83% white) on 10 measures of S/R, covering behaviors, beliefs, and experiences, including the Daily Spiritual Experiences and Purpose in Life scales. Drinking behaviors were assessed with the Timeline Followback interview. Alcoholics Anonymous (AA) participation and attendance were also measured.

RESULTS: Over 6 months, there were statistically significant increases in half of the S/R measures, specifically the Daily Spiritual Experiences scale, the Purpose in Life scale, S/R practices scale, Forgiveness scale, and the Positive Religious Coping scale.

There were also clinically and statistically significant decreases in alcohol use.

• Multiple logistic regression analyses showed that increases in Daily Spiritual Experiences and in Purpose in Life scores were associated with increased odds of no heavy drinking at 6 months, even after controlling for AA involvement and gender.

CONCLUSIONS: In the first 6 months of recovery, many dimensions of S/R increased, particularly those associated with behaviors and experiences. Values, beliefs, self-assessed religiousness, perceptions of a Higher Power, and the use of negative religious coping did not change.

Increases in day-to-day experiences of spirituality and sense of purpose/meaning in life were associated with absence of heavy drinking at 6 months, regardless of gender and AA involvement.

The results of this descriptive study support the perspective of many clinicians and recovering individuals that changes in alcoholics’ S/R occur in recovery and that such changes are important to sobriety.

Robinson EA, Cranford JA, Webb JR, Brower KJ. Six month changes in spirituality religiousness and heavy drinking in a treatment-seeking sample. J Stud Alcohol Drugs. 2007 Mar;68(2):282-90.

Subscribe to Twelve Step Facilitation news feed for regular updates.

Compatibility With Other Treatments

Brief-TSF may be utilised in combination with supportive pharmacotherapy; for example, craving reduction medications.

While recognising the existence of multiple problems of adjustment in most problem drinkers (e.g., marital conflict, family dysfunction), Brief-TSF advocates pursuing the goal of early recovery as primary, delaying most other therapies if necessary, until the client has achieved approximately 6 months of sobriety.

The primary exceptions to this recommendation would be emergency or incapacitating medical treatment, debilitating depression or other major affective disorder, or a psychotic disorder, which would take precedence over Brief-TSF.

Brief-TSF is not compatible with treatments based on notions of controlled use.

Brief-TSF Treatment Setting

Brief-TSF can be used with both individuals who have never sought treatment and those who had previous treatment and aftercare clients. The model is flexible enough to accommodate all of these client groups.

However, since Brief-TSF relies heavily on client involvement in community-based 12 step fellowship and meetings, it would be less ideally implemented in a long-term inpatient setting.

Many Twelve Step Fellowship members are willing to visit ‘Newcomers’ in hospital. Brief-TSF can easily be integrated into a general mental health outpatient clinic setting.

BriefTSF is designed to be used in the context of short-term individual adjunct therapy by general healthcare and other helping profession workers. BriefTSF is specifically intended to be implemented by nurses, doctors, psychologists, social workers, counselors etc while addressing other current issues (ie, medical treatment, relationship counselling, legal issues).

Brief-TSF is not time limited. After assessment support can last as long as the healthcare worker is seeing the client. It is intended to be implemented within a scheduled session often with another focus. The initial assessment session can last up to one hour, and regular support can be incorporated into other sessions.