Twelve Step

Education for Twelve Step Facilitation of alcoholism and addiction

  • Getting active in AA

    Living SoberGetting active in Recovery in AA

    This is an extract from the book ‘Living Sober’ target=_blank>Living Sober’ by Alcoholics Anonymous.

    It is very hard just to sit still trying not to do a certain thing, or not even to think about it. It’s much easier to get active and do something else-other than the act we’re trying to avoid.

    So it is with drinking. Simply trying to avoid a drink (or not think of one), all by itself, doesn’t seem to be enough. The more we think about the drink we’re trying to keep away from, the more it occupies our mind, of course. And that’s no good. It’s better to get busy with something, almost anything, that will use our mind and channel our energy toward health.

    Thousands of us wondered what we would do, once we stopped drinking, with all that time on our hands. Sure enough, when we did stop, all those hours we had once spent planning, getting our drinks, drinking, and recovering from its immediate effects, suddenly turned into big, empty holes of time that had to be filled somehow.

    Most of us had jobs to do. But even so, there were some pretty long, vacant stretches of minutes and hours staring at us. We needed new habits of activity to fill those open spaces and utilize the nervous energy previously absorbed by our preoccupation, or our obsession, with drinking.

    Anyone who has ever tried to break a habit knows that substituting a new and different activity is easier than just stopping the old activity and putting nothing in its place.

    Recovered alcoholics often say, "Just stopping drinking is not enough." Just not drinking is a negative, sterile thing. That is clearly demonstrated by our experience. To stay stopped, we’ve found we need to put in place of the drinking a positive program of action. We’ve had to learn how to live sober.

    Fear may have originally pushed some of us toward looking into the possibility that we might have a drinking problem. And over a short period, fear alone may help some of us stay away from a drink. But a fearful state is not a very happy or relaxed one to maintain for very long. So we try to develop a healthy respect for the power of alcohol, instead of a fear of it, just as people have a healthy respect for cyanide, iodine, or any other poison. Without going around in constant fear of those potions, most people respect what they can do to the body, and have enough sense not to imbibe them. We in A.A. now have the same knowledge of, and regard for, alcohol. But, of course, it is based on firsthand experience, not on seeing a skull and crossbones on a label.

    We can’t rely on fear to get us through those empty hours without a drink, so what can we do?

    We have found many kinds of activity useful and profitable, some more than others. Here are two kinds, in the order of their effectiveness as we experienced it.

    A. Activity in and around A.A.

    When experienced A.A. members say that they found "getting active" helpful in their recovery from alcoholism, they usually mean getting active in and around A.A.

    B. Activity Not related to A.A.

    It’s curious, but true, that some of us, when we first stop drinking, Seem to experience a sort of temporary failure of the imagination.

    It’s curious, because during our drinking days, so many of us displayed almost unbelievably fertile powers of imagination. In less than a week, we could dream up instantly more reasons (excuses?) for drinking than most people use for all other purposes in a lifetime. (Incidentally, it’s a pretty good rule of thumb that normal drinkers-that is, nonalcoholics-never need or use any particular justification for either drinking or not drinking!)

    When the need to give ourselves reasons for our drinking is no longer there, it often seems that our minds go on a sit own strike. Some of us find we can’t think up nondrinking things to do! Perhaps this is because we’re just out of the habit.

    The following list is just a starter for use at that time. It isn’t very thrilling or adventurous, but it covers the kinds of activity many of us have used to fill our first vacant hours when we were not at our jobs or with other nondrinking people. We know they work. We did such things as:

    • Taking walks
    • Reading
    • Going to museums and art galleries.
    • Exercising swimming, golfing, jogging, yoga, or other forms of exercise your doctor advises.
    • Starting on long-neglected chores
    • Trying a new hobby
    • Revisiting an old pastime
    • Taking a course.
    • Volunteering
    • Doing something about your personal appearance.
    • Taking a fling at something frivolous! Not everything we do has to be an earnest effort at self-improvement, although any such effort is worthwhile and gives a lift to our self-esteem. Many of us find it important to balance serious periods with things we do for pure fun.
    • Fill this one in for yourself. Let’s hope the list above sparked an idea for you which is different from all of those listed. . . . It did? Good! Go to it.

    One word of caution, though. Some of us find we have a tendency to go overboard, and try too many things at once. The best approach is called "Easy Does It."

    Living Sober’ target=_blank>Living Sober by AA

    Posted in Alcoholics Anon, Alcoholism and tagged , . Use this permalink for a bookmark.

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    Seventeen Percent of Hospital Patients Drink Too Much

    The severity of unhealthy alcohol use in hospitalized medical patients; The spectrum is narrow

    BACKGROUND: Professional organizations recommend screening and brief intervention for unhealthy alcohol use; however, brief intervention has established efficacy only for people without alcohol dependence. Whether many medical inpatients with unhealthy alcohol use have nondependent use, and thus might benefit from brief intervention, is unknown.

    OBJECTIVE: To determine the prevalence and spectrum of unhealthy alcohol use in medical inpatients.

    DESIGN: Interviews of medical inpatients (March 2001 to June 2003).

    SUBJECTS: Adult medical inpatients (5,813) in an urban teaching hospital.

    MEASUREMENTS: Proportion drinking risky amounts in the past month (defined by national standards); proportion drinking risky amounts with a current alcohol diagnosis (determined by diagnostic interview).


    • Seventeen percent (986) were drinking risky amounts;
    • 97% exceeded per occasion limits.
    • Most scored greater than 8 on the Alcohol Use Disorders Identification Test, strongly correlating with alcohol diagnoses.
    • Most of a subsample of subjects who drank risky amounts and received further evaluation had dependence (77%).

    CONCLUSIONS: Drinking risky amounts was common in medical inpatients.

    Most drinkers of risky amounts had dependence, not the broad spectrum of unhealthy alcohol use anticipated.

    Screening on a medicine service largely identifies patients with dependence-a group for whom the efficacy of brief intervention (a recommended practice) is not well established.

    Research; Richard Saitz, Naomi Freedner, Tibor P. Palfai, Nicholas J. Horton and Jeffrey H. Samet. The severity of unhealthy alcohol use in hospitalized medical patients. Journal of General Internal Medicine, Volume 21, Number 4 / April, 2006

    Brief-TSF addresses these issues

    Posted in Alcohol, Alcoholism, Brief-TSF, Research, Target populations. Use this permalink for a bookmark.

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    Adolescents have deficits in frontal brain activation


    Synapse x 10000 Adolescents at risk of developing a substance-use disorder have deficits in frontal brain activation

    < Brain synapse x 10,000

    Children and adolescents at high risk for developing a substance-use disorder (SUD) tend to show deficits in executive cognitive function (ECF). A study using functional magnetic resonance imaging (fMRI) to assess eye movements in adolescents has found a link between brain functioning and risk for developing an SUD.

    “ECF is basically the control center for governing other cognitive processes,” explained Rebecca Landes McNamee, assistant research professor of radiology and bioengineering at the University of Pittsburgh and corresponding author for the study. “For example, in school, ECF would be engaged in the planning and control process required in answering a question; formulating your response, raising your hand, waiting until you are called upon, and stating your answer. A person with low levels of ECF might blurt out the answer. Another example could be interacting with someone on the playground who upsets you. A person with good ECF will think through the actions and consequences of their behavior rather than responding rashly. A person with low levels of ECF may respond with violence.”

    McNamee and her colleagues decided to use an antisaccade task to reflect the inhibitory response required in the actions above.

    “While this eye-movement task may be more basic in nature than an inhibitory response, it still requires control and response suppression, and is thought to use the same basic mechanisms in the brain as those required in more difficult suppression tasks,” she said. “As response inhibition is something that may be deficient in high-risk children, we thought this task would be a beneficial way to study the workings of basic mechanisms in the brain.”

    The researchers employed fMRI with 25 adolescents (15 males, 10 females), ages 12 to 19 years, during a task that required inhibition of an initial eye-movement response as well as a voluntary realignment to an alternate location. The fMRI findings were categorized into regions of activation: total frontal, parietal, occipital, and temporal lobe. Additionally, each subject’s neurobehavioral disinhibition (ND) – their ability to control an immediate impulsive response to a given situation – was assessed, and the drug use/histories were determined.

    “We found that individuals who exhibit a high amount of ND – that is, do not have a good ability to manage their impulsive responses – have less brain activity in the frontal cortex, the region of the brain responsible for ECF, during the antisaccade task,” said McNamee. “In other words, the regions of the brain responsible for these inhibitory processes engaged less energy in individuals with higher ND scores than those with lower ND scores.”

    Normal adolescent development involves an increase in the ability to inhibit impulsive responses, which would be reflected in an increase in brain activation in areas associated with inhibition, said McNamee.

    “Since some of the children show less ability to inhibit responses – observed as higher levels of ND – along with less brain activity in these areas, we can hypothesize that the reason for this is a delay in the development of brain networks associated with inhibition,” she said. “We cannot say for sure what may cause these deficits, but we suspect it has to do with a combination of genetics inherited from the parents and/or the environment in which the individual was raised.”

    One of the key implications of these findings, said McNamee, is that behaviors and actions are directly related to brain functioning.

    “Teachers, caregivers, and other individuals should understand that each adolescent matures at a different rate; they do not always respond like adults because their brains are not at the same level of functioning as an adult,” she said. “Responses and behaviors related to a certain situation are less easy for some adolescents to manage than others.”

    McNamee plans to follow these adolescents as they mature. “We would like to better understand whether the brains of subjects with higher levels of ND display increasing amounts of brain activation in the frontal lobe as they mature, or if they will continue to show reduced brain activity when compared to subjects with lower ND scores throughout later adolescence. This type of data may help to indicate whether inhibition centers in the brains of high ND subjects ‘catch up’ to those of the lower ND subjects, or if they will always have differences with respect to these brain centers.”

    Results are published in the March 2008 issue of Alcoholism: Clinical & Experimental Research.

    Posted in Addiction, Alcoholism, Brain, Youth and tagged , , . Use this permalink for a bookmark.

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    Aggression and hostility in recovered alcoholics

    There is a long-recognized association between alcohol consumption and aggressive behavior. But does aggression and hostility continue into sobriety?

    This study was designed to examine aggression in a group of socially well-adapted recovered alcoholics.

    The question addressed was whether the treatment, together with long-term abstinence from alcohol, could reduce aggression and hostility in recovered alcoholics.

    Sixty four male stable alcoholics with at least 3 years sobriety were compared with 69 non-alcoholics. Neither group had any other psychological problems.

    Both groups were given a questionnaire on general characteristics as well as aggressive and hostility traits.

    After a 3-year abstinence, men from the recovering alcoholics group displayed greater signs of hostility and covert aggression. They were different from non-alcoholics on measures for indirect aggression, irritability, negativism, suspicion, resentment, and guilt.

    Research report; Ziherl S, Cebasek Travnik Z, Kores Plesnicar B, Tomori M, Zalar B. Trait aggression and hostility in recovered alcoholics. Eur Addict Res 2007; 13(2): 89-93.

    Posted in Adjunctive therapy, Alcohol, Alcoholism, Assessment, Disease of addiction, Men, Relapse prevention, Research, Stages of Change, Symptoms of addiction. Use this permalink for a bookmark.

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    AA and a social model of treatment


    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.


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    Posted in 12-Step Groups, Alcohol, Alcoholism, Detoxification, Drugs, Research, Target populations. Use this permalink for a bookmark.

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    TSF and other models


    Most Similar Counseling Approaches

    TSF has its roots in the Minnesota Model first described by Daniel J. Anderson and as implemented in most AA-oriented treatment programs (e.g.,the Hazelden Foundation, the Betty Ford Foundation, the Sierra Tuscan Center, and others). These models assume addiction can be arrested but not cured, ascribe to the AA/NA philosophy as described in AA/NA literature that relies heavily on a combination of spirituality and pragmatism, and advocate peer support as the primary means for achieving sustained sobriety.

    Most Dissimilar Counseling Approaches

    Any approach that advocates controlled use of alcohol or other drugs (as compared with abstinence) is fundamentally dissimilar to TSF with respect to basic treatment goals. Cognitive-behavioural approaches that are based on the idea that problem drinking and other drug use stem primarily from inadequate stress management skills and that aim to enhance problem solving and coping skills differ from TSF with respect to the assumption of peer support as fundamental to recovery. TSF also assumes that alcoholism and other drug addiction are primary diagnoses and not symptoms of another diagnosis (e.g., depression, antisocial personality).

    Posted in Contrast to other models, Theory, TSF. Use this permalink for a bookmark.

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    Attitudes and Beliefs About 12-Step Groups

    Attitudes and Beliefs About 12-Step Groups Among Addiction Treatment Clients and Clinicians: Toward Identifying Obstacles to Participation.

    Abstract; Participation in 12-step groups during and after formal treatment has been associated with positive outcome among substance users. However, the effectiveness of 12-step groups may be limited by high attrition rates and by low participation, areas on which there has been little research.

    Clinicians play an important role in fostering 12-step participation, and the insights which they develop in their practice can greatly contribute to informing the research process. Yet, little is known about clinicians’ attitudes about 12-step groups or about their experiences in referring clients.

    This study surveyed clients (N = 101) and clinicians (N = 102) in outpatient treatment programs to examine 12-step-related attitudes and to identify potential obstacles to participation. Data collection was conducted between May 2001 and January 2002 in New York City.

    Both client and clinician samples were primarily African-American and Hispanic; 32% of clients reported substance use in the previous month, with crack and marijuana cited most frequently as the primary drug problem. On average, clinicians had worked in the treatment field for 8 years.

    Both staff and clients viewed 12-step groups as a helpful recovery resource.

    Major obstacles to participation centered on motivation and readiness for change and on perceived need for help, rather than on aspects of the 12-step program often cited as points of resistance (e.g., religious aspect and emphasis on powerlessness).

    Clinicians also frequently cited convenience and scheduling issues as possible obstacles to attending 12-step groups.

    Clinical implications of these findings are discussed, including

    • the importance of fostering motivation for change,
    • the need to assess clients’ beliefs about and experiences with 12-step groups on a case-by-case basis, and to
    • find a good fit between clients’ needs and inclinations on the one hand, and
    • the tools and support available within 12-step groups on the other.

    Research; Alexandre B. Laudet, Attitudes and Beliefs About 12-Step Groups Among Addiction Treatment Clients and Clinicians: Toward Identifying Obstacles to Participation, Substance Use & Misuse, Volume 38, Issue 14 December 2003, pages 2017 – 2047

    Posted in 12-Step Groups. Use this permalink for a bookmark.

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    Purpose in life in alcoholism recovery

    lanternSpirituality and purpose in life in alcoholism recovery.

    We examined the relationship between spirituality and recovery from alcoholism.

    Spirituality was defined as the extent of practice of Alcoholics Anonymous Steps 11 and 12 and was measured by a Step Questionnaire developed for this study.

    AA Step 11 suggests prayer and meditation, and Step 12 suggests assistance of other alcoholics. It was postulated that the extent to which Steps 11 and 12 were practiced would be positively correlated with the extent of purpose in life reported by 100 AA members.

    Positive correlations between practice of Step 11 and purpose in life scores and between Step 11 and length of sobriety were found.

    Number of AA meetings attended was significantly correlated with purpose in life scores and length of sobriety.

    Carroll, Stephanie. Journal of Studies on Alcohol, Vol 54(3), 297-301.

    Posted in 12-Step Groups, Alcoholics Anon, Alcoholism, Recovery, Spirituality and tagged , , , . Use this permalink for a bookmark.

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    Common Problems in Recovery

    Common Problems in Patients Recovering from Chemical Dependency

    Chemical dependency is a common, chronic disease that affects up to 25 percent of patients seen in primary care practices.

    The treatment goal for patients recovering from chemical dependency should be to avoid relapse.

    This requires physicians to have an open, nonjudgmental attitude and specific expertise about the implications of addiction for other health problems.

    Firstline treatment for chemical dependency should be nonpharmacologic, but when medication is necessary, physicians should avoid drugs that have the potential for abuse or addiction.

    Medications that sedate or otherwise impair judgment also should be avoided in the recovering patient.

    Psychiatric illnesses should be aggressively treated, because untreated symptoms increase the risk of relapse into chemical dependency.

    Selective serotonin reuptake inhibitors may help to lower alcohol consumption in depressed patients, and desipramine may help to facilitate abstinence in persons addicted to cocaine.

    If insomnia extends beyond the acute or postacute withdrawal period, trazodone may be an effective treatment.

    If nonpharmacologic management of pain is not possible, nonaddictive medications should be used.

    However, if nonaddictive medications fail, long-acting opiates used under strict supervision may be considered. Uncontrolled pain in itself is a relapse risk.

    Research; Fam Physician 2003;68:1971-8. Common Problems in Patients Recovering from Chemical Dependency. EDNA MARIE JONES, DOUG KNUTSON, and DANELL HAINES.

    Dual Disorders : Counseling Clients With Chemical Dependency and Mental Illness

    Posted in Addiction, Alcohol, Alcoholism, Drugs, Research. Use this permalink for a bookmark.

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    The Personality Traits of Alcoholics


    Psychopathological symptoms and personality traits in alcohol-dependent patients: a comparative study.

    Pensive The aim of this paper was to describe the psychopathological and personality profile associated with alcohol dependence and to compare it with those of non-addictive disorders and the normal population.

    The sample consisted of

    • 158 alcohol-dependent participants attending a psychiatric outpatient clinic,
    • 120 psychiatric patients with non-addictive disorders and
    • 103 participants from the general population chosen to match the patient samples for age, gender and socioeconomic level.

    All participants were assessed with different instruments related to


    • Impulsiveness Scale,
    • Sensation-Seeking Scale and
    • STAI,


    • SCL-90-R,
    • BDI and
    • Maladjustment Scale and

    personality disorders

    • MCMI-II.

    Patients from the clinical groups presented more symptoms of anxiety and depression than the healthy participants and had more problems adjusting to everyday life, but there were no differences between the two clinical groups.

    Alcohol-dependent patients were more impulsive and sensation-seeking than the other two groups.

    Histrionic, narcissistic and antisocial personality disorders were specific to the alcohol-dependent patients.

    The implications of this study for further research are discussed.

    Research report; Psychopathological symptoms and personality traits in alcohol-dependent patients: a comparative study. Adicciones. 2007;19(4):373-81. Bravo de Medina R, Echeburua E, Aizpiri J.

    See also;

                        Our Devilish Alcoholic Personalities.
    by Eddie Webster (The Author of the Little Red Book).

    Read more about this title…

    Posted in Alcoholism, Assessment, Research, Symptoms of addiction and tagged , , , , , , . Use this permalink for a bookmark.

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