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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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

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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arbias Ltd was established in 1990 to provide services for people with alcohol and other substance related brain impairment. It is a not for profit company managed by a board of directors. arbias is a specialist disability service which works together with families, support networks, employers and service providers to assist people with alcohol and other substance related brain impairments to live and function to their full potential in the community.

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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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Aim: To learn the opinion of primary care physicians (PCPs) on healthcare provision for the drug addict population and to determine their knowledge and needs as regards to continuing training and their attitudes towards drug addiction.

Methods: We conducted a cross-sectional survey of 301 PCPs in Castilla-La Mancha, Spain using a questionnaire designed to elicit physician’s opinions about drug addiction.

Results: The response rate was 85.0% (256 cases). 84.2% of the doctors considered that 10% of patient visits to primary care centres were related to drug addiction.

The doctors frequently experienced difficulty in:

• the diagnosis and treatment of organic diseases associated with addiction (18.4%),
• the assessment of the situation and level of dependence (36.7%),
• support to treatment of some aspects of drug addiction (51.3%) and,
• above all, the treatment of these addictions (62.9%).

Of all respondents, 53.8% reported they had received some form of postgraduate training in drug addiction issues.

Only 28.5% considered they had received sufficient information on specialised drug addiction services.

Conclusions: As regards to PCPs’ attitudes to drug addiction, we observed a positive attitude regarding the needs of those who abuse drugs, and the development of intervention programmes.

PCPs believe that addicts deserve treatment, that there should be more treatment programmes and that primary healthcare centres should establish links with specialised services.

José Latorre;  Jesús López-Torres;  Trinidad Sanchez-Nuñez;  Juan Pedro Serrano;  Juan Montañés; Francisco Escobar. Primary care doctors’ perception of treatment demand and need for training in drug addiction issues. Primary Care & Community Psychiatry, Volume 12, Issue 1 January 2007 , pages 33 – 41.

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.

Strategies for dealing with resistance within the Brief-TSF model all begin with an assumption that the client has an illness that is characterized by loss of control over alcohol or other drug use, which leads him or her to want to resist accepting that loss of control.

Though the only viable treatment goal from the Brief-TSF and 12 step perspective is abstinence from all alcohol, it is expected that the client will have a hard time accepting this limitation, as anyone has difficulty accepting limitation. Viewed in this light, resistance is seen as a natural part of the course of early recovery. Indeed, the Brief-TSF facilitator should be suspicious if too little resistance is encountered (a phenomenon known as compliance).

Eschers ‘Intersection’ illustrates the split motivation of the alcoholic

The BriefTSF facilitator seeks to deal with resistance through open discussion and through a process of shaping the client’s behavior and attitudes. The methods employed for this shaping include consistent reinforcement of progress, acceptance of resistance, reframing of 12-step concepts (which are not dogmatically set), and compromise.

The client is often asked to keep an open mind, to listen, and to try to identify with one or more of the people they hear at meetings. This is then discussed in the review part of any Brief-TSF session. The client is consistently told that he or she can accept or reject an aspect of 12-step philosophy and that the fellowship can still be a vital source of support for early recovery.

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In Brief-TSF, the facilitator is given specific guidelines for dealing with crises ranging from suicidal ideation to spouse abuse to divorce.

As a rule, only psychiatric emergencies and acute intoxication or overdose are grounds for suspending Brief-TSF. Otherwise, crises are assessed and triaged.

In many instances the facilitator will direct the client to the resources of 12-step fellowships (including Al-Anon and Alateen for partners and children of clients) as a means of coping with acute stressors.

Clients are encouraged to discover how ubiquitous their own problems are among people who have alcohol and how such issues are common topics of discussion at meetings. Indeed, the facilitator may very well be a less useful resource in this regard than the support of fellow recovering persons, many of whom have dealt with or are actively dealing with similar problems.

If an emergency session is deemed necessary, Brief-TSF includes specific facilitator guidelines.

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