Therapeutic Alliance

In Brief-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 Brief-TSF the facilitator is not regarded as the primary agent of change; rather, it is the 12 step fellowship (AA) that is seen as the agent of change. Accordingly, the Brief-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 (but simply to disturb denial), or to provide all support needed to stay sober, or to take the client to meetings, and so forth.

Even in emergencies, the facilitator’s role and responsibilities are limited in the Brief-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.

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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.

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The Co-Occurrence of Depression and Alcohol Dependence Symptoms in a Community Sample of Lesbians

Numerous studies have found an association between depression and alcohol use disorders in women.

Little is known, however, about the relationship between depression and alcohol use among lesbians.

We examined the prevalence of depression and alcohol dependence symptoms as well as the co-occurrence of these two health problems in a large community-based sample of women who self-identified as lesbian.

Past year alcohol dependence symptoms were significantly associated with both past year and lifetime depression.

Lifetime depression was higher among White and Latina lesbians than among African American lesbians.

Younger women and those not currently in a committed relationship more commonly reported past year depression.

Younger age was the strongest predictor of the co-occurrence of depression and alcohol dependence symptoms.

Research report; Wendy B Bostwick, Tonda L. Hughes & Timothy Johnson. The Co-Occurrence of Depression and Alcohol Dependence Symptoms in a Community Sample of Lesbians. Journal of Lesbian Studies, Volume: 9 Issue: 3, 2005

Strategies for Dealing with Common Clinical Problems

Brief-TSF includes information on troubleshooting, which helps the facilitator anticipate and plan for common problems such as lateness, coming to sessions under the influence, and client resistance to new material.

Most often these strategies are consistent with AA philosophy and encourage the client to utilize the resources of 12-step fellowships. For example, the client who arrives drunk or high is asked how he or she will "not drink again for the rest of today."

Clients are never punished, rejected, or scolded within the Brief-TSF model for drinking, since it is accepted that loss of control is the essence of their illness.

However, sessions are cut short if the client is drunk. He or she will be strongly encouraged to call an AA hotline or a recovering friend and to go to a meeting immediately.

Chronic lateness or cancellations are dealt with as denial.

As a rule, the BriefTSF facilitator places ultimate responsibility for recovery on the client. The facilitator is a guide and a source of support, but the key to recovery is always seen as active involvement in one or more 12-step fellowships.

A common strategy for dealing with resistance in BriefTSF is to ask the client to keep an open mind or just give it an honest try.

The facilitator maintains a position of unconditional positive regard and acceptance of the client’s illness, regardless of whatever resistance emerges.

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Spirituality religiosity promotes acceptance based responding and 12-step involvement.

BACKGROUND: Previous investigations have observed that spirituality/religiosity (S/R) is associated with enhanced 12-step involvement. However, relatively few studies have attempted to examine the mechanisms for this effect. For the present investigation, we examined whether acceptance-based responding (ABR) - awareness or acknowledgement of internal experiences that allows one to consider and perform potentially adaptive responses - accounted for the effect of S/R on 12-step self-help group involvement 2 years after a treatment episode.

METHODS: Data were collected as part of a multi-site treatment outcome study with 3698 substance-dependent male veterans recruited at baseline. Assessments were conducted at baseline, discharge, 1-year follow-up, and 2-year follow-up. We utilized structural equation modeling to examine the relationships among latent variables of S/R, ABR, and 12-step involvement over time.

RESULTS: In the final model, S/R was not directly related to 12-step involvement at 2-year follow-up. However, S/R predicted enhanced ABR at 1-year follow-up after accounting for discharge levels of ABR. In turn, ABR at 1-year follow-up predicted increased 12-step involvement at 2-year follow-up after accounting for discharge levels of 12-step involvement.

CONCLUSIONS: S/R promotes the use of post-treatment self-regulation skills that, in turn, directly contribute to ongoing 12-step self-help group involvement.

Research report; Carrico AW, Gifford EV, Moos RH. Spirituality religiosity promotes acceptance based responding and 12-step involvement Drug Alcohol Depend. 2007 Jun 15;89(1):66-73.

Conversations with God : An Uncommon Dialogue (Book 1)

Lesbian Alcoholics were Unloved, Unwanted and Alcoholic had Parents; Social Supports and Lesbian Alcoholics

The purpose of this study was to investigate the relationship between social support and alcoholism among lesbians.

Fifteen lesbian alcoholics and 15 lesbian non-alcoholics were administered a questionnaire covering their childhood and adolescent history, social support systems, history of drinking, and demographic information.

The findings suggested that the alcoholic lesbians’ current support systems were not as disrupted as had been anticipated.

However, the alcoholic lesbians more often reported;

• having had a less supportive childhood and adolescence,
• feeling unloved and unwanted,
• experiencing conflict with adults in their families, and
• having had a parent with a drinking problem.

Social Supports and Lesbian Alcoholics. Rebecca Schilit, W. Mark Clark, and Elizabeth Ann Shallenberger. Affilia 1988; 3; 27.

Alcohol intervention may help.

Risk, resilience, and natural recovery: a model of recovery from alcohol abuse for Alaska Natives

Aim; The People Awakening (PA) study explored an Alaska Native (AN) understanding of the recovery process from alcohol abuse and consequent sobriety.

Design; PA utilized a cross-sectional, qualitative research design and community-based participatory research methods.

Setting and participants; The study included a state-wide convenience sample of 57 participants representing all five major AN groups: Aleut/Alutiiq, Athabascan, Inupiaq, Yup’ik/Cup’ik and Tlingit/Haida/Tsimshian. Participants were nominated and self-identified as being alcohol-abstinent at least five years following a period of problem drinking.

Measurements; Open-ended and semistructured interviews gathered extensive personal life histories. A team of university and community co-researchers analyzed narratives using grounded theory and consensual data analysis techniques.

Findings; A heuristic model of AN recovery derived from our participants’ experiences describes recovery as a development process understood through five interrelated sequences:

1. the person entered into a reflective process of continually thinking over the consequences of his/her alcohol abuse;
2. that led to periods of experimenting with sobriety, typically, but not always, followed by repeated cycling through return to drinking, thinking it over, and experimenting with sobriety; culminating in
3. a turning point, marked by the final decision to become sober. Subsequently, participants engaged in
4. Stage 1 sobriety, active coping with craving and urges to drink followed for some participants, but not all, by
5. Stage 2 sobriety, moving beyond coping to what one participant characterized as ‘living life as it was meant to be lived.

Conclusions; The PA heuristic model points to important cultural elements in AN conceptualizations of recovery.

Research; Mohatt GV, Rasmus SM, Thomas L, Allen J, Hazel K, Marlatt GA. Risk, resilience, and natural recovery: a model of recovery from alcohol abuse for Alaska Natives. Addiction. 2007 Nov 27

Brief-TSF is designed to address these issues.

My Name is Funky… and I’m An Alcoholic: A Story About Alcoholism and Recovery by Tom Batiuk Read more about this title…

Concise TSF and Brief-TSF Research Summary

All the elements of TSF have moderate to strong research support, most of which has been replicated.

NB: AA does not participate in research but individual members do. The huge volume of peripheral research supports a strong case for recommending AA participation by alcoholics.

We know: -

• that Twelve Step Facilitation reduces alcohol abuse , improves related consequences, and improves employment prospects.
• that Alcoholics Anonymous has good efficacy, and that Peer Sponsoring/social support is an essential element in AA’s success.
• that recovering people who help recovering people maintain better sobriety and have greater involvement in the general community.
• that men, women, adolescence, African-Americans, Hispanics and gay men benefit from AA. That all socio-demographic groups are represented.
• that AA is suitable for head trauma victims, and methadone patients.
• that AA has wide acceptance and is readily available in almost all communities. The current global membership of AA is approximately 2.06 million.
• that participation in Alcoholics Anonymous improves medication compliance for mental health patients, improves psychological functioning, Improves coping, reduces child abuse and domestic violence, reduces healthcare usage, reduces hospitalisation, reduces medical symptoms, reduces subsequent treatment demand, reduces mortality, and reduces associated costs.
• that healthcare workers have good success rates for substance abuse treatment and recovery from alcoholism that can be improved with AA participation.
• that alcoholics with social networks supportive of drinking have better outcomes if they initiate AA attendance while in treatment.
• that affiliation with AA is enhanced if prospects gain an awareness of the culture and methods used by AA and that sobriety is better than drinking prior to attending AA.
• that 80% of Australian, 87% of USA, and 65% of UK doctors believe that Alcoholics Anonymous is the treatment of choice for alcoholism, but overall they do not understand how AA works.
• that more than 80% of specialist alcohol and drug treatment staff support Alcoholics Anonymous treatment referral and 92% of another specialist A & D service requested training in 12 Step approaches.
• that AA Peer Sponsor contact at the healthcare worker office/institution increases initiation and sustained attendance at AA meetings.
• that active and regular AA participation is one of the more effective ways to effect lifestyle changes for alcoholics.
• that routinely engaging patients in continuing outpatient care is likely to yield better outcomes..
• that most people in the early stages of alcoholism seek help from GP’s or Community Health Centres.
• that individuals with substance abuse medical conditions benefit from integrated medical and substance abuse treatment, and approaches such as TSF can be cost-effective.
• that for every $1.00 invested in intervention $4.30 is saved in future healthcare costs.

Predictors of changes in alcohol-related self-efficacy over 16 years.

Self-efficacy is a robust predictor of short and long term remission after treatment.

This study examined the predictors of self-efficacy in the year after treatment and 15 years later.

A sample of 420 individuals with alcohol use disorders was assessed five times over the course of 16 years.

Predictors of self-efficacy at 1 year included

• improvement from baseline to 1 year in heavy drinking,
• alcohol-related problems,
• depression,
• impulsivity,
• avoidance coping,
• social support from friends, and
• longer duration of participation in Alcoholics Anonymous (AA).
• Female gender,
• more education,
• less change in substance use problems, and
• impulsivity during the first year predicted improvement in self-efficacy over 16 years.
• Clinicians should focus on keeping patients engaged in AA,
• addressing depressive symptoms,
• improving patient’s coping, and
• enhancing social support during the first year and reduce the risk of relapse by monitoring individuals whose alcohol problems and impulsivity improve unusually quickly.

Predictors of changes in alcohol- efficacy- over 16 years. J Subst Abuse Treat. 2007 Nov 23. McKellar J, Ilgen M, Moos BS, Moos R.

Understanding And Counseling Persons With Alcohol, Drug, And Behavioral Addictions by Howard Clinebell Read more about this title…

Alcohol-dependent patients attempting and not attempting suicide: a comparison.

Background:

Alcohol dependence is a psychiatric disorder associated with an increased risk of suicidal behaviour. This is also associated with an increased number of suicide risk factors.

Objective:

The current study examined the sociodemographic and clinical characteristics of a number of alcohol-dependent patients who attempted suicide.

Methods:

We studied a consecutive series of 377 alcohol-dependent patients in our in-patient clinics. Their alcohol-use histories were assessed through semi-structured interviews. The Suicidal Behaviors Questionnaire, the Childhood Trauma Questionnaire, the Michigan Alcoholism Screening Test and the Hamilton Depression Rating Scale were administered to all patients. Serum total cholesterol levels, mean corpuscular volume, the liver enzymes gamma glutamyl transferase, aspartate aminotransferase and alanine aminotransferase were routinely measured. In the statistical analyses, Student’s t-test and chi-squared tests were applied.

Results:

• Of the 377 alcohol-dependent patients, 89 (23.6%) had histories of attempted suicide.
• Thirty-four (42.5%) of the 80 female alcohol-dependent patients and
• 55 (18.5%) of the 297 male alcohol-dependent patients had attempted suicide;
• this gender difference was statistically significant (2 = 27.7, P < 0.001).
• A greater proportion of the suicide attempters than of the non-attempters met the Diagnostic Statistical Manual IV criteria for another psychiatric disorder (60.6%, n = 54, vs. 40.6%, n = 117; 2 = 14.8; df = 6; P < 0.05).
• The difference of total cholesterol levels between female (mean = 144.0, SD = 58.3; mean = 158.0, SD = 83.9; t = 4.5; P < 0.05) and male (mean = 133.7, SD = 50.5; mean = 163.6, SD = 69.7; t = 11.7; P < 0.01) attempters and non-attempters was statistically significant.

Conclusion: These results suggest that suicide attempts in alcohol-dependent patients are associated with more profound biopsychosocial pathology and decreased serum cholesterol levels.

Research; Pektas O; Mirsal H; Kalyoncu A; Ünsalan N; Beyazyürek M. Alcohol-dependent patients attempting and not attempting suicide: a comparison. Acta Neuropsychiatrica, August 2004, vol. 16, no. 4, pp. 204-211(8). Alcohol-dependent patients attempting and not attempting suicide: a comparison.