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.

Due to their high prevalence in the general population, alcohol use and abuse can be associated with hepatitis B and C virus infections and it has been demonstrated that alcohol plays a role as a co-morbid factor in the development of liver disease.

There is evidence that alcohol abuse accelerates the progression of liver fibrosis and affects the survival of patients with chronic hepatitis C. The mechanism by which alcohol worsens hepatitis C virus-related liver disease has not been fully clarified, but enhanced viral replication, increased oxidative stress, cytotoxicity and impairment of immune response could play a relevant role.

Alcohol abuse also seems to reduce both sensitivity to interferon and adherence to treatment.

It sounds reasonable to presume that the mechanisms enhancing liver damage in patients affected by hepatitis B are similar to those involved in hepatitis C virus infection.

However, more studies are warranted to improve our knowledge about the interaction between alcohol intake and hepatitis B virus infection.

In conclusion alcohol abuse is associated with an accelerated progression of liver injury, leading to an earlier development of cirrhosis, higher incidence of hepatocellular carcinoma, and higher mortality.

Abstinence from alcohol could reverse some of these deleterious effects.

Research report; Gitto S, Micco L, Conti F, Andreone P, Bernardi M. Alcohol and viral hepatitis: a mini-review. Dig Liver Dis. 2009 Jan;41(1):67-70. Epub 2008 Jul 3.

See also;

• Helping an Alcoholic is Possible in Right Circumstances
• Hep C Factsheet
• Hepatitis B
• If you have healthcare training this manual may help.

The Alcoholic

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.

A NATURALISTIC COMPARISON OF OUTCOMES AT SOCIAL AND CLINICAL MODEL SUBSTANCE ABUSE TREATMENT PROGRAMS.

Since the 1970s, much of the public treatment system in California has been based on a social model orientation to recovery for alcoholics, but there has been minimal research on program outcomes. This article reports on follow-up interviews conducted with a representative sample of 722 people who had entered treatment about a year earlier in public and private programs, including publicly-funded social model detoxification and residential programs, and clinical model programs in hospitals and HMO clinics.

higher levels of 12-step program involvement during follow-up, which strongly predicted an absence of alcohol problems

• Social model clients came to treatment with more severe legal and employment problems, whereas those seeking treatment at clinical programs reported more severe family problems.
• At follow-up, clients at both types of programs reported attending a similar number of Alcoholics Anonymous (AA) meetings, but social model clients reported going to more Narcotics Anonymous (NA) meetings and being involved in more AA activities.
• Social model clients were less likely than clinical model clients to report problems with alcohol or drugs at follow-up, but the odds of reporting other problems (e.g., medical, psychological, legal, family/social) were similar.

The program effect for better alcohol outcomes at the social model programs was partially explained by their clients’ higher levels of 12-step program involvement during follow-up, which strongly predicted an absence of alcohol problems.

• Social networks supportive of abstinence also were predictive of reporting no alcohol problems at follow-up.

In contrast, subsequent detoxification treatment events between baseline and follow-up were associated with a higher odds of reporting alcohol, drug, psychiatric and family/social problems at follow-up.

These findings are consistent with the growing body of literature reporting higher rates of abstinence among those who are able to construct more positive social networks, and who attend and become involved in 12-step programs during and following treatment.

It is important that these results be replicated, as they suggest that social model programs are successful in engaging their clients in AA activities and in NA meeting attendance, and could represent for some an effective alternative to clinical model treatment programs.

Research; LEE ANN KASKUTAS, LYNDSAY AMMON, CONSTANCE WEISNER. A NATURALISTIC COMPARISON OF OUTCOMES AT SOCIAL AND CLINICAL MODEL SUBSTANCE ABUSE TREATMENT PROGRAMS. International Journal of Self Help and Self Care; Volume 2, Number 2 / 2003-2004, 111 – 133

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This study analyzed the Alcoholics Anonymous (AA) participation of 55 patients during the 3 months after their discharge from structured treatment, when dropout is high.

Three levels of meeting attendance were discerned:

• low,
• mid-level, and
• “90 meetings in 90 days.”

Of greatest interest, the mid-level group showed mixed interest in AA practices despite substantial meeting attendance, that is,

• they admitted powerlessness over alcohol, but had less enthusiasm for the higher power concept, and relapsed significantly;
• they were likely to have a sponsor, but were less involved with other AA members; and
• they reported working the 12 Steps, but were less interested in the AA literature.

Findings suggest that individuals who are attending AA but having difficulty embracing key aspects of the program need professional assistance that focuses more on AA practices and tenets and meeting attendance.

Barriers to affiliation can also serve as opportunities for furthering both counselling goals and affiliation.

Research; Paul Elliott Caldwell and Henry S.G. Cutter. Journal of Substance Abuse Treatment. Volume 15, Issue 3, May-June 1998, Pages 221-228

• See also:
• Twelve Step Facilitation
• Brief-TSF Description
• AA and Treatment Work Better Together
• Alcohol Related Brain Injury
• THE TWELVE REWARDS OF RECOVERY

Characteristics of suicide attempts preceded by alcohol consumption.

Acute alcohol ingestion and alcohol dependence are known to increase the risk of impulsive suicide attempt even in non-depressed patients.

The relation between alcohol and suicide risk needs, however, to be clarified. We assessed for this purpose prevalence of recent alcohol intake among suicide attempters and compared suicide attempts preceded (“Alcohol + “) or not by alcohol intake.

We included 160 patients examined in the emergency service of a French general hospital after a suicide attempt. Psychiatric disorders were identified according to the DSM-IV criteria. Patients were rated for depression and alcohol use disorder (MAST).

• Prevalence of alcohol consumption was 40%.
• Patients from the “Alcohol + ” group were significantly older (40 versus 34.8 years, p = 0.03).
• Alcohol abuse was more frequent among suicide attempters with prior alcohol ingestion (49% versus 12%,).
• Alcohol dependence was also more frequent in the “Alcohol + ” group (43% versus 9%).
• Patients from the “Alcohol + ” group
• drank more alcohol each day (6.1 versus 1.3 drinks) and
• more often during the week (3.6 days per week versus 1.4). They had a
• higher number of alcohol intoxications each week (0.9 versus 0.3). They
• drank more often alone (41% versus 12%, p < 0.005) and in the
• morning (21% versus 3%).
• They had higher scores on the Michigan Alcohol Screening test (14.8 versus 2.9).
• Prevalence of drug dependence was higher in the “Alcohol + ” group (21% versus 3%, respectively).

Suicide attempts must be asked about their recent alcohol intake. This alcohol intake is often the symptom of an alcohol abuse or dependence disorder.

Research report; Lejoyeux M, Huet F, Claudon M, Fichelle A, Casalino E, Lequen V. Characteristics of suicide attempts preceded by alcohol consumption. Arch Suicide Res 2008; 12(1): 30-8.

See also;

• Twelve Step Facilitation
• Screening for Alcohol Problems

Research Summary; Women and men appear to have different genetic and environmental risk factors for alcoholism, Reuters reported Jan. 24/2006.

A quartet of new family studies on alcoholism show, for example, that while both sexes are more likely to develop alcoholism if they have a history of aggressive behavior in childhood, women who experienced severe physical punishment in childhood were also at elevated risk, while men were not.

“Clearly, there are some common antecedents (to alcoholism), such as conduct disorder or symptoms, but there are also predictors unique to each gender,” said researcher Aruna Gogineni of the Johns Hopkins University School of Medicine. “These are the kinds of findings that call out for many more studies on women in order to determine how the mechanisms of alcoholic parental risk may differ in men and women.”

Researchers affirmed that children of alcoholics were generally more likely to have alcohol problems themselves, but said that genetic makeup may be more important for men, while environmental factors may have more of an impact on women. For example, one study comparing children of biological and adopted parents with alcoholism found that male children of alcoholics related by blood were more likely to be alcoholics themselves.

The research appears in the February 2006 issue of the journal Alcoholism: Clinical & Experimental Research.

From; Join Together Online

See also;

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

Understanding and Counseling: Persons With Alcohol, Drug, and Behavioral Addictions : Counseling for Recovery and Prevention Using Psychology and Religion by Howard Clinebell Read more about this title…

Special populations in Alcoholics Anonymous.

The vast majority of Alcoholics Anonymous (AA) members in the United States are white, and only a few studies have investigated the program’s effectiveness for ethnic minorities. Other demographics need to be examined.

Project MATCH, a multisite research study aimed at developing guidelines for assigning alcoholics to appropriate treatment approaches, also assessed AA effectiveness for minority clients.

Some differences in AA attendance existed among white, African-American, and Hispanic Project MATCH participants who had received some inpatient treatment before entering the study, but not among participants who had not received inpatient treatment.

Further analyses of white and Hispanic Project MATCH participants demonstrated that although Hispanic clients attended AA less frequently than white clients, their involvement with and commitment to AA was higher than among white clients. For these target populations, both Hispanics and whites, AA involvement predicted increased abstinence.

Research; Tonigan JS, Connors GJ, Miller WR. Special populations in Alcoholics Anonymous. Alcohol Health Res World. 1998;22(4):281-5.

Patient-Provider E-mail Communication as an Adjunctive Tool in Addiction Medicine

Frequent electronic mail communication between patients and their addiction specialist can be utilized as an adjunct in the treatment of alcohol or substance dependency.

Selected patients benefit from mandatory daily electronic mail communications with their provider through enhanced accountability, frequent self-assessment, deterrents to isolation, and a sense of continuous access to care. Participants have found the experience easy and enjoyable and all have maintained continuous sobriety.

We present our experience using this modality as a series of illustrative case reports and a discussion of the implications of using electronic mail with patients in addiction medicine.

Research report; Patient-Provider E-mail Communication as an Adjunctive Tool in Addiction Medicine. Gregory B. Collins, Mark S. McAllister, Donald B. Ford. Journal of Addictive Diseases, Volume: 26 Issue: 2