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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TSF & 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-centeredness 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.

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Impulsivity May Trigger Addiction, Researchers Say

British researchers say that impulsivity seems to trigger addiction and not the other way around, Science magazine reported June 6.

People with addictions are known to be more impulsive and engage in more thrill-seeking behaviors than non-addicts, but it has been unclear whether those behaviors predated drug use or were the result of addiction.

Researchers David Belin and Barry Everitt of the University of Cambridge attempted to answer the question by studying rats known to have thrill-seeking or impulsive personalities. The researchers connected the rats to a device that delivered cocaine directly to their brains and then gave the rats control over their drug use. They found that the thrill-seeking rats tried the drug immediately and in high doses, while the impulsive rats used the drug less quickly and in greater moderation.

However, the authors found that after 40 days of access to the drug the impulsive rats had become addicted and could not stop using cocaine even when punished with an electric shock, while the thrill-seeking rats had grown tired of the drug and stopped using.

The research study is published in the June 6, 2008 edition of Science magazine.

See also;

• 12-Step Treatment More Effective than Alternative
• AA and Treatment Work Better Together
• Abstinence from Heroin Addiction Works
• Subscribe to BriefTSF by e-Mail

Theory and Practice of Group Counseling by Gerald Corey Read more about this title…

Patterns of Alcohol Consumption and Related Behaviour in Great Britain:

A Latent Class Analysis of the Alcohol Use Disorder Identification Test (AUDIT).

AIMS: Attempts have been made to develop typologies to classify different types of alcoholism. However, limited research has focused on classifications to describe general patterns of alcohol use in general population samples.

METHODS: Latent class analysis was used to create empirically derived behaviour clusters of alcohol consumption and related problems from the Alcohol Use Disorder Identification Test (AUDIT) based on data from a large stratified multi-stage random sample of the population of Great Britain. Multinomial logistic regression was performed to describe these resultant classes using both demographic variables and mental health outcomes.

RESULTS: Six classes best described responses in the sample data.

• Three were heavy consumption groups,
• one with multiple negative consequences,
• one experiencing alcohol-related injury and social pressures to cut down and
• an additional class with memory loss.
• There was one moderate class with few negative consequences.
• There were two mild consumption groups,
• one with alcohol-related injury and social pressure to cut down and
• one with no associated problems.

CONCLUSIONS: Alcohol use in Great Britain can be hypothesized as reflecting six distinct classes, four of which follow a continuum of increased consumption leading to increased dependence and related problems and two that do not.

Differences between alcohol use classes are apparent with;

• reduced risk of depressive episode in moderate classes and
• an increased risk of anxiety disorders for the highest consumers of alcohol.

Research report; Alcohol Alcohol. 2008 May 22; Patterns of Alcohol Consumption and Related Behaviour in Great Britain: A Latent Class Analysis of the Alcohol Use Disorder Identification Test (AUDIT). Smith GW, Shevlin M.

See also;

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

Drugs, Brains, and Behavior: The Science of Addiction

This new, 30-page, full-color booklet explains in layman’s terms how science has revolutionized the understanding of drug addiction as a brain disease that affects behavior. 

The ‘Science of Addiction’ booklet discusses the reasons people take drugs, why some people become addicted while others do not, how drugs work in the brain, and how addiction can be prevented and treated.

The booklet is available to read, download or order at: http://www.drugabuse.gov/scienceofaddiction/

http://www.drugabuse.gov/scienceofaddiction/sciofaddiction.pdf

Publication Year: 2007

Publisher

National Institute on Drug Abuse (NIDA)
6001 Executive Boulevard
Bethesda, md 20892
Phone: 301-443-1124
Website: http://www.nida.nih.gov

An empowerment process: successful recovery from alcohol dependence.

Aims. The purpose of this study was to explore the concepts and processes for successful abstinence from alcohol for Taiwanese Alcoholics Anonymous members.

Background. Attempting to identify the psychological and social influences upon alcohol consumption remission outside of alcoholism treatment could help professionals to engage in a broad array of community interventions in an informed fashion. Methods. Grounded theory method was utilized in this study. The study chose nine participants who had succeeded in abstinence, using theoretical sampling and conducted in-depth interviews by an open-ended questionnaire.

Results. The results of this study indicated that the core of the process during which alcoholic individuals succeeded in abstaining from further alcohol consumption was an empowerment process for the involved individual.

Alcoholics felt that their

• family,
• interpersonal relationships,
• jobs and
• personal finances all had been at ‘rock-bottom’ level following a long period of alcohol dependence.

This feeling caused the individual to experience an emotion of a loss of control and provoked the arousal of an alcoholic’s inner consciousness levels, this then resulting in the generation of a driving force for abstinence from alcohol for these individuals.

Conclusions. The expansion of an individual’s internal awakening power helps the individual to obtain assistance and to resist the temptation of further alcohol consumption.

Therefore, the power derived by individuals form the

• stages of repositioning,
• releasing,
• active sharing,
• resistance and
• assistance are the maintenance factors for an individual’s empowerment process that help maintain the successful recovery from alcohol for the involved individual.

Relevance to clinical practice. A good comprehension of the recovery processes for alcoholics, we believe, will trigger clinical professionals to pay appropriate attention to the specific problems and needs of alcoholic individuals, to build an effective resource network for treatment and to help solve alcoholics’ physical and psychosocial problems.

Yeh MY, Che HL, Lee LW, Horng FF. An empowerment process: successful recovery from alcohol dependence. J Clin Nurs. 2008 Apr;17(7):921-9.

See also;

• Twelve-Step Programs as an Adjunct to Psychotherapy and Psychopharmacology
• Brief-TSF ASSESSMENT

Concept of Alcoholism

In TSF and Brief-TSF alcoholism is considered an illness that affects individuals both mentally and physically in such a way that they are unable to control their use of alcohol. Viewed from this perspective, the concept of controlled use of alcohol amounts to denial of the primary problem, that is, loss of control. Specific causative factors (ie, stress) are of less relevance in recovery than is acceptance of both the loss of control and the need for abstinence and a willingness to follow the pathway laid out in the 12-steps.

Benefits of Alcoholics Anonymous attendance

This study compared findings on the benefits associated with Alcoholics Anonymous (AA) attendance across 11 clinical sites in Project MATCH.

The largest benefit associated with AA attendance was increased abstinence, followed by reductions in alcohol-related consequences.

The magnitude of these benefits did not differ between sites.

A positive association was also found between AA attendance and increased purpose in life

A positive association was also found between AA attendance and increased purpose in life, but the size of this relationship was very small and was statistically significant only after controlling for measurement error.

Tonigan, J.S. Benefits of alcoholics anonymous attendance: Replication of findings between clinical research sites in Project MATCH. Alcoholism Treatment Quarterly, 19(1):67-78, 2001.

This article describes the manifold factors involved in the process regarding a counselors sending a client to Alcoholics Anonymous (AA).

Pastoral counselors and mental health advocates need to educate themselves on the types of AA meetings available within one’s local community.

In addition, it is advisable to explore the reputation for recovery each AA meeting has before making a referral.

Workers should be aware of the spiritual experience in recovery and the dynamics which promote conversion.

Diversity in group style, ethnic mix and the type of meeting should be considered.

Sandoz, C.J. Making a referral to alcoholics anonymous. Journal of Ministry in Addiction and Recovery, 7(2):37-42, 2001.

Brief-TSF addresses these issues.

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