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.

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

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

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.

• 12-Step Recovery Theory And Application
• AA And Al-Anon
• AA And The Disease Concept Of Alcoholism
• Adolescent Children Of Alcoholics
• Al-Anon Offers New Life
• Alcohol Consumption In Patients Pancreatitis
• Alcohol Metabolization
• Alcohol Related Brain Injury
• Alcoholic Brain Damage And Thiamine
• Alcoholic Jealousy
• Alcoholics Anonymous
• Alcoholics Can Benefit From Al-Anon
• Alcoholism And Personality Disorders
• Alcoholism Is Also Genetic
• Alcoholism Myths
• Anti-Craving Naltrexone Injection Reduce
• Benefits Of Alcoholics Anonymous
• Beyond Codependency
• Brief-TSF Description
• Children With Alcohol Dependent Fathers
• Counselor Characteristics
• Craving Reduction
• Effective Professional Interventions
• Effects Of Gambling Addiction
• Free Inhalant Abuse Education
• Just For Today Card
• Mindfulness Can Help Recovery
• Prescription Drug Overdose Becomes Big Killer
• Process Of Recovery For Alcoholic Women
• Research Evidence For TSF  .
• Return To Drinking After Liver Transplantation For Alcoholic Liver Disease
• Role Of Significant Others
• Screening Can Decrease Teen Risk Behaviour
• Sleep Problems Affect Alcoholism Recover
• Spirituality And Helping In Alcoholics Anonymous
• Strategies For Dealing With Common Problems
• Strategies For Dealing With Denial
• Sweet Tooth And Alcoholism
• Symptoms Of Alcoholism
• Teen Drinking Leads To Risk Of Alcoholism And Social Exclusion
• The Aging Alcoholic
• The Classification Of Alcoholics
• The Dry Drunk
• Thyroid Function In Depression And Alcohol Abuse
• TSF Description
• Twelve Step Recovery Is Spiritual
• Twelve Steps To Recovery From Burnout
• What About Partners Of Alcoholics?

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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.

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.

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.

Under diagnosis of alcohol misuse in the older adult population

Alcohol abuse in older adults is common, yet it is often under detected and misdiagnosed, and as a result associated with considerable morbidity.

There is growing concern that as the population ages, there will be a substantial increase in the number of older adults needing treatment for alcohol misuse and currently, little is done to identify and address this situation.

Factors contributing to under diagnosis include, but are not limited to,

• depression,
• dementia,
• physical changes associated with age,
• life events,
• late onset of alcoholism and
• lack of screening.

A case report is presented and existing research findings are discussed in the article cited below.

• The importance of assessment,
• the use of screening tools,
• treatment issues and
• identification of other comorbidities are presented.

The focus on increased awareness among clinicians as well as their role in identifying and addressing alcohol abuse issues in the older adult population is explored.

Loukissa D. Under diagnosis of alcohol misuse in the older adult population Br J Nurs. 2007 Nov 8-21;16(20):1254-8.

Brief-TSF can assist patients cease alcohol consumption.