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.

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.

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Study Examines Link Between Stress Relapse

A new animal study finds that a stress-related gene and brain chemical may play a role in addiction relapse, according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA).

Researchers from NIAAA and Camerino University in Italy found that rats that showed a preference for alcohol were more sensitive to stress. Those more prone to relapse under stress were examined for genetic patterns that might offer clues to this trait. Researchers found that these rats had higher expression levels of Crhr1, a gene that encodes the stress-related corticotropin-releasing hormone receptor 1 (CRH-R1).

“Our findings demonstrate that the Crhr1 genotype and its expression interact with environmental stress to reinstate alcohol-seeking behavior in this animal model of excessive drinking,” said study leader Anita Hansson, Ph.D., a fellow at NIAAA’s Laboratory of Clinical and Translational Studies.

“This finding helps untangle the complex interplay of genetic and environmental factors that influence relapse,” added NIAAA Director T-K Li, M.D. “It also points to potential approaches for treating individuals at risk for relapse.”

The research appears in the online edition of the Proceedings of the National Academy of Sciences. Research Reference: Hansson, A.C., et al. (2006) Variation at the rat Crhr1 locus and sensitivity to relapse into alcohol seeking induced by environmental stress. Proc. Natl. Acad. Sci.

From Join Together

Brief-TSF addresses relapse prevention as stress relief.

What does the Brief-TSF model look like?

How does the Brief-TSF model work?

Defining the Brief-TSF processes

This model brings together three people to achieve sobriety in one of them. These are the;

• experiential contributor (AA Peer Sponsor) and
• professional care (Twelve Step Facilitator) to collaborate in facilitating self help recovery for the
• alcoholic (normally known as the patient or client).

Each of the three people brings to the intervention knowledge’s and functions known as ‘domains of praxes’. Within each domain are the constituents of experience, training, perceptions, goals and capabilities.

Functional Domain

The Brief Twelve Step Facilitator facilitates self-assessment by the patient, introduces them to a ‘Peer Sponsor’ and facilitates understanding of the ‘Program of Recovery’. In addition the healthcare worker assesses and addresses or refers the patient for any co-morbidities.

The Peer Sponsor shares their ‘experience, strength and hope’ with the patient, provides initial resources to attend meetings, introduces the ‘Newcomer’ to Alcoholics Anonymous members and explains the program of recovery from drinking.

The patient chooses what, when, and how they can use information, from each of the providers. This is true Self help within a paradigm of mutual help.

Additionally, the patient is supported in seeking professional treatment/therapy for other issues.

Recovery Domain

Each participant maintains their integrity and independence within their domain.

The primary goal of Brief-TSF is affiliation with Alcoholics Anonymous as described in the Stages of AA Affiliation.

Recovery includes attending AA meetings and other activities, stopping drinking, ‘working’ the program of recovery and consulting with a peer sponsor within an affiliation scheme.

The whole facilitated process producing a ‘Domain of Recovery’.

Disease Domain

Alcoholism is a primary, chronic, progressive three fold disease – mental, physical and spiritual. Alcohol dependence is fatal if not arrested by abstaining from alcohol.

Each participant has a hand in recovery

In this review;

• First we evaluate evidence on the role of the neurobiological alterations induced by chronic ethanol consumption in the development of ethanol tolerance, dependence and withdrawal.
• Secondly, we describe the neuropathological consequences of chronic ethanol on cognitive functions and on brain structures.

Chronic alcohol consumption can induce alterations in the function and morphology of most if not all brain systems and structures.

While tolerance mechanisms are unlikely to contribute to the neuroadaptive changes associated with ethanol dependence, it is otherwise clear that repeated high, intoxicating doses of ethanol trigger those neuroadaptive processes that lead to dependence and contribute to the manifestation of the abstinence syndrome upon withdrawal.

An unbalance between inhibitory and excitatory neurotransmission is the most prominent neuroadaptive process induced by chronic ethanol consumption.

Due to the diffuse glutamatergic innervation to all brain structures, the neuroadaptive alterations in excitatory neurotransmission can affect the function of most if not all of neurotransmitter systems.

The expression of the withdrawal syndrome is the major causal factor for the onset and development of the neuropathological alterations.

This suggests a link between the neuroadaptive mechanisms underlying the development of ethanol dependence and those underlying the functional and structural alterations induced by chronic ethanol.

In animals and humans, specific alterations occur in the function and morphology of the diencephalon, medial temporal lobe structures, basal forebrain, frontal cortex and cerebellum, while other subcortical structures, such as the caudate nucleus, seem to be relatively spared.

The neuropathological alterations in the function of mesencephalic and cortical structures are correlated with impairments in cognitive processes.

In the brain of alcoholics, the prefrontal cortex and its subterritories seem particularly vulnerable to chronic ethanol, whether Korsakoff’s syndrome is present or not.

Due to the role of these cortical structures in cognitive functions and in the control of motivated behavior, functional alterations in this brain area may play an important role in the onset and development of alcoholism.

Research; Fadda F, Rossetti ZL. Chronic ethanol consumption: from neuroadaptation to neurodegeneration. Prog Neurobiol. 1998 Nov;56(4):385-431.

See also;

• Twelve Step Facilitation
• Brief-TSF can assist patients cease alcohol consumption.

Correlates of alcohol use among methadone-maintained adults

This prospective study (n = 190) examined correlates of alcohol use from baseline data of a longitudinal trial conducted among moderate and heavy alcohol users receiving methadone maintenance therapy (MMT).

The sample included MMT clients who were 18–55 years of age, and were receiving MMT from five large methadone maintenance clinics in the Los Angeles area.

Half of the sample was heavy drinkers and nearly half (46%) reported heroin use. Using a structured questionnaire, correlates of heavy alcohol use included White and Hispanic ethnicity, and fair or poor physical health combined with older age (?50 years). We also found that MMT clients who were younger than 50 years, regardless of health status, were more likely to be heavy drinkers.

Compared with moderate alcohol consumers, a greater number of heavy alcohol users also experienced recent victimization.

To optimize MMT, alcohol screening should be part of routine assessment and alcohol treatment should be made available within MMT programs.

Moreover, special consideration should be provided to the most vulnerable clients, such as the younger user, those with a long-term and current history of heavy drug use, and those victimized and reporting fair or poor health. In addition, promoting attention to general physical and mental health problems within MMT programs may be beneficial in enhancing health outcomes of this population.

Research report; Adeline Nyamathi, Allan Cohen, Mary Marfisee, Steven Shoptaw, Barbara Greengold, Viviane de Castro, Daniel George and Barbara Leake. Drug and Alcohol Dependence. Volume 101, Issues 1-2, 1 April 2009, Pages 124-127. Correlates of alcohol use among methadone-maintained adults

Se also;

• Twelve-Step Programs as an Adjunct to Psychotherapy and Psychopharmacology
• Treating Alcoholism
• AA and Treatment Work Better Together

Clinical Guide to Alcohol Treatment: The Community Reinforcement Approach

A comparative evaluation of substance abuse treatment

This article first explains the conceptual framework and plan of a naturalistic, multisite evaluation of Department of Veterans Affairs (VA) substance abuse treatment programs. It then examines the effectiveness of an index episode of inpatient treatment and the effectiveness of continuing outpatient care and participation in self-help groups.

The study was conducted among 3018 patients from 15 VA programs that emphasized 12-Step, cognitive-behavioral (CB), or eclectic treatment.

Casemix-adjusted 1-year outcomes showed that patients in 12-Step programs were the most likely to be abstinent, free of substance abuse problems, and employed at the 1-year follow-up.

Patients who obtained more regular and more intensive outpatient mental health care, and those who participated more in 12-Step self-help groups, were more likely to be abstinent and free of substance use problems at the 1-year follow-up.

These findings support the effectiveness of 12-Step treatment and show that patients with substance use disorders who become more involved in outpatient care and self-help groups tend to experience better short-term substance use outcomes.

Moos RH, Finney JW, Ouimette PC, Suchinsky RT. A comparative evaluation of substance abuse treatment. Alcohol Clin Exp Res. 1999 Mar;23(3):529-36.

Brief-TSF Theoretical Rationale/Mechanism of Action

The theoretical rationale is based in the 12 steps and 12 traditions of AA and includes the need to accept that willpower alone is not sufficient to achieve sustained sobriety, that self-centredness must be replaced by surrender to the group process/conscience, and that long-term recovery consists of a process of spiritual renewal. The primary mechanism action is active participation and a willingness to accept a higher power, even if it is the AA group at first, as the locus of change in one’s life.

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.

The National Institute on Alcohol Abuse and Alcoholism has established through years of clinical research the effectiveness of the following interventions to treat alcohol problems.

Professional delivery of these interventions follows established protocols that have been published in manual form.

Cognitive behavioral therapy (CBT) primarily targets alcohol dependent individuals. It assumes that alcoholism is learned problematic behavior that begins and continues with the patient’s distorted belief that alcohol helps him or her cope with stress.

CBT therapists usually try to change how a patient thinks about alcohol, and to assist a patient in identifying stressful situations and alternative ways of coping with these situations. CBT allows patients to establish the goals of treatment. These can range from controlled drinking to abstinence.

Motivational enhancement therapy (MET) targets all problem drinkers, including alcohol dependent individuals.

It is based on principles of motivational psychology and focuses on increasing a patient’s internal motivation to change his or her drinking behavior.

MET doesn’t try to guide the patient through recovery step-by-step. Instead, it uses objective feedback and empathic listening techniques to influence positive change.

MET is a less intensive intervention, requiring only four sessions to complete.

Twelve-step facilitation therapy (TSF) primarily targets alcohol dependent individuals. It is grounded in the concept of alcoholism as spiritual and medical disease.

Patients are encouraged to accept an alcoholic identity and to become involved in support group activities (going to Alcoholics Anonymous meetings, getting a sponsor and working the 12 steps of AA). Abstinence is the goal of TSF.

Behavioral marital therapy (BMT) and other couples and family therapies primarily target alcohol-dependent individuals.

They recognize that spouses, significant others and family members of patients being treated for alcoholism can play a critical role in recovery.

These therapies seek to enhance communication between couples and among family members to improve the functioning of relationships.

This leads to longer retention in treatment for patients, longer periods of abstinence among patients, and less anxiety and enabling behavior among nonalcoholic spouses, significant others and family members.

Research Sources: Project MATCH Research Group. 1997; National Institute on Alcohol Abuse and Alcoholism. 2003. List of Alcohol Interventions for Substance Abuse and Mental Health Services

From; www.ensuringsolutions.org

Brief-TSF follows the principles of full TSF and is designed for non-specialist healthcare workers as an earlier intervention.