What is Brief-TSF?

Brief-TSF can be used with males, females and youth of any age and is readily adaptable to various cultures or lifestyles.

Brief-TSF is ideally suited to primary care as well inpatient clinics, outpatient clinics or office practice.

Brief-TSF incorporates screening and assessment instruments and methods for differentiating between alcohol abuse and alcoholism.

Brief-TSF is ideally suited for counseling that is a required component of craving reduction medication prescribing.

The generic spiritual principles are acceptable to most treatment organizations and religions.

The basic Brief-TSF principles can be adapted and applied to drug addiction, excessive gambling, eating disorders and emotional problems that have psychological, emotional, physical, spiritual and mental aspects.

Brief-TSF is a both a Harm Prevention and a Harm Minimization strategy. By intervening earlier in the progression of alcoholism much harm will be prevented.

The overall recovery goal of the program is the restoration of health and freedom from the effects of addiction to the drug alcohol or alcoholism.

Brief-TSF addresses the medical, psychological, social and spiritual effects of alcoholism.

Brief-TSF can be utilized by doctors, nurses, psychologists, social workers, faith based workers, trained volunteers and counselors.

Related Reading:

Alcohol screening brief intervention and referral in the emergency department an implementation study

INTRODUCTION: Alcohol is the single greatest contributor to injury in the United States. Numerous studies have reported that a standardized screening, brief intervention, and referral to treatment (SBIRT) intervention can effectively minimize future alcohol consumption, reduce injury recurrence, and decrease the number of repeat ED visits. To date, SBIRT studies have been conducted in settings in which physicians or research assistants carried out SBIRT. Little is known about ED nurses carrying out SBIRT. The purpose of this study was to examine ED nurse training needs and identify both barriers to, and enablers of, SBIRT implementation in the emergency department.

METHODS: Two coordinators from each of the 5 ED sites selected for the study attended a 1-day SBIRT educational session. Site coordinators then trained their staff nurses to conduct SBIRT. Site coordinators were surveyed at the midpoint and end of the 6-month implementation study period. Patient data from each facility was collected.

RESULTS: Ten site coordinators were trained and held subsequent training sessions with nursing staff in their respective emergency departments. All sites encountered barriers to implementation, but 2 of 5 sites were able to implement the SBIRT process fully by the end of the evaluation period. A total of 3265 patients were screened for alcohol use problems. Of those screened, 678 (21%) were classified as hazardous drinkers. Overall, 56% of the positive-screened patients received 3 to 5 minutes of a brief intervention. After the brief intervention, between 9% and 82% of patients were referred for further care.

DISCUSSION: The SBIRT process can be conducted successfully by emergency nurses. However, substantial operational barriers to widespread routine implementation exist. These barriers need to be addressed before emergency nurses incorporate SBIRT as routine part of ED care.

Desy PM, Perhats C. Alcohol screening brief intervention and referral in the emergency department an implementation study. J Emerg Nurs. 2008 Feb;34(1):11-9. Epub 2007 Dec 3.

See also;

• Brief-TSF can assist patients cease alcohol consumption.
• Twelve Step Facilitation

Related Reading:

How does Brief-TSF work for the alcoholic?

The process of Brief-TSF disturbs denial and highlights the negative effects of alcohol on their lives, to such an extent, that alcoholics are motivated to take action and to sample Alcoholics Anonymous. Brief-TSF is not a therapy program per se; it is the facilitation of patients helping themselves (self help) in a mutual help paradigm.

Brief-TSF can be utilized in three situations as adjunctive to your normal program of practice:

• As a ‘discrete’ structured intervention.
• As an ‘opportunistic intervention’ or relapse prevention, where you can utilize elements as necessary.
• As a ‘knowledge base’ – You will have an awareness and understanding of Brief-TSF theory and methods, and AA practices and culture; you will be able to respect and support a patients choice of treatment while addressing other issues in your special area of practice.

Professional Intervention Program

BriefTSF is suitable for use by generalist healthcare workers; including doctors, nurses, psychologists, social workers, faith based workers and counselors.

Universality of BriefTSF

The basic Brief-TSF principles can be adapted and applied to drug addiction, excessive gambling, eating disorders and emotional problems that have psychological, emotional, physical, spiritual and mental aspects.

Related Reading:

AA is often recommended as adjunctive to formal alcoholism treatment

The following are some governments and significant organizations who recommend Alcoholics Anonymous and craving reduction medication as an adjunctive components of professional alcoholism treatment. Some examples are -

Australia ;

• McCabe D., and Holmwood C. (2003), Co morbidity of mental disorders and substance use in General Practice. Commonwealth of Australia, Department of Health and Ageing.
• Shand F, Gates J, Fawcett J, and Mattick R. (2003), Guidelines for the Treatment of Alcohol Problems, Australian National Drug and Alcohol Research Centre (NDARC).
• Dale A. , and Marsh A. (2000), Evidence Based Practice Indicators for Alcohol and Other Drug Interventions; Literature Review, Best Practice in Alcohol and Other Drug Interventions Working Group. Western Australian Government.

Britain ;

• Strang J., (Chair) , (1999), Drug Misuse and Dependence – Guidelines on Clinical Management. Department of Health, England, Scotland, Wales and Northern Ireland.
• Slattery J, Chick J, Cochrane M, Craig J, Godfrey C, MacPherson K, Parrott S. (2002), Health Technology Assessment of Prevention of Relapse in Alcohol Dependence. Health Technology Board for Scotland. National Health Service.

Canada ;

• Roberts G & Roberts A., (1999), Best Practices in Substance Abuse Treatment and Rehabilitation. Office of Alcohol, Drugs and Dependency Issues, Health Canada.

New Zealand;

• Bushnell J., (1999). Guidelines for Recognizing, Assessing and Treating Alcohol and Cannabis Abuse in Primary Care. New Zealand National Health Committee. July 1999.

United States;

• The National Institute on Drug Abuse (NIDA), (July 2002), Principles of Drug Addiction Treatment; A Research Based Guide. National Institute Health Publication No. 00-4180.
• American Society of Addiction Medicine (ASAM).
• USA – National Institute on Alcohol Abuse and Alcoholism (NIAAA)

Related Reading:

Alcohol Consumption, Alcoholics Anonymous Membership, and Homicide Mortality Rates in Ontario 1968 to 1991.

BACKGROUND: Research has shown a strong link between alcohol use and a variety of problems, including violence.

Parker and colleagues have presented a selective disinhibition theory for the link between alcohol use and homicide (and other violence) that posits a causal relationship that is also influenced by other situational and contextual factors.

This model is particularly well suited for aggregate-level investigations.

In this study, we examine the impact of alcohol factors, including consumption measures and Alcoholics Anonymous (AA) membership rates, on homicide mortality rates in Ontario, and test predictions derived from the selective disinhibition model.

METHODS: Time series analyses with ARIMA modeling were applied to total, male, and female homicide rates in Ontario between 1968 and 1991.

The analyses performed included total alcohol consumption, spirits consumption, beer consumption, and wine consumption.

Missing AA membership data were interpolated with cubic splines.

RESULTS: For the total population and males, homicide rates were significantly and positively related to total alcohol consumption and to the consumption of beer and spirits.

They were also negatively related to AA membership rates in the analyses involving spirits and wine and positively related to unemployment rates in the analyses involving beer, wine, and total alcohol.

Among females, none of the measures were significant predictors of homicide mortality rates.

CONCLUSIONS: These data provide important support for the selective disinhibition model and confirm important relationships between per capita consumption measures and homicide mortality rates, especially among males, seen in other studies.

Additionally, the results for AA membership rates are consistent with the hypothesis that AA membership and treatment for misuse of alcohol can exert beneficial effects observable at the population level.

Mann RE, Zalcman RF, Smart RG, Rush BR, Suurvali H. Alcohol consumption, alcoholics anonymous membership, and homicide mortality rates in Ontario 1968 to 1991. Alcohol Clin Exp Res. 2006 Oct;30(10):1743-51.

Related Reading:

Rates and correlates of relapse among individuals in remission from DSM-IV alcohol dependence: a 3-year follow-up.

< The Drinker by Cezanne

BACKGROUND: There is little information on the stability of abstinent and non-abstinent remission from alcohol dependence in the general U.S. population. The aim of this study was to examine longitudinal changes in recovery status among individuals in remission from DSM-IV alcohol dependence, including rates and correlates of relapse, over a 3-year period.

METHODS: This analysis is based on data from Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative sample of U.S. adults aged 18 years and older originally interviewed in 2001 to 2002 and re-interviewed in 2004 to 2005. The Wave 1 NESARC identified 2,109 individuals who met the DSM-IV criteria for full remission from alcohol dependence. Of these, 1,772 were re-interviewed at Wave 2, comprising the analytic sample for this study. Recovery status at Wave 2 was examined as a function of type of remission at Wave 1, with a focus on rates of relapse, alternately defined as recurrence of any alcohol use disorder (AUD) symptoms and recurrence of DSM-IV alcohol dependence. Logistic regression models were used to estimate the odds of relapse among asymptomatic risk drinkers and low-risk drinkers relative to abstainers, adjusted for a wide range of potential confounders.

RESULTS: By Wave 2,

• 51.0% of the Wave 1 asymptomatic risk drinkers had experienced the recurrence of AUD symptoms, compared with
• 27.2% of low-risk drinkers and
• 7.3% of abstainers.

Across all ages combined, the adjusted odds of recurrence of AUD symptoms relative to abstainers were

• 14.6 times as great for asymptomatic risk drinkers and
• 5.8 times as great for low-risk drinkers.

The proportions of individuals who had experienced the recurrence of dependence were 10.2, 4.0, and 2.9%, respectively, and the adjusted odds ratios relative to abstainers were 7.0 for asymptomatic risk drinkers and 3.0 for low-risk drinkers.

Age significantly modified the association between type of remission and relapse.

Differences by type of remission were not significant for younger alcoholics, who had the highest rates of relapse.

Abstinence represents the most stable form of remission for most recovering alcoholics

CONCLUSIONS: Abstinence represents the most stable form of remission for most recovering alcoholics. Study findings highlight the need for better approaches to maintaining recovery among young adults in remission from alcohol dependence, who are at particularly high risk of relapse.

Research; Dawson DA, Goldstein RB, Grant BF. Alcohol Clin Exp Res. 2007 Dec;31(12):2036-45. Rates and correlates of relapse among individuals in remission from DSM-IV alcohol dependence: a 3-year follow-up.

Motivational Enhancement Therapy Manual: A Clinical Research Guide for Therapists Treating Individuals With Alcohol Abuse and Dependence by William R. Miller Read more about this title…

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Partner Brief-TSF

Brief-TSF includes intervention with significant others in an alcohol dependents life. Significant others may be family members such as partners of alcoholics, children of alcoholics, adult children of alcoholics, parents of alcoholics, grand parents of alcoholics and work colleagues. These are sometimes known as co-dependents of alcoholism.

Partner Brief-TSF has similar goals and methods to Brief-TSF. The overall goal is referral of the significant other to Al-anon or Alateen. This is achieved by disturbing the denial of enabling behaviors, promotion of selfhood and making contact with an Al-anon peer sponsor.

Related Reading:

In a new target population researchers have found that alcoholics who have a particular variant of an opioid-receptor gene appear to respond better to naltrexone, an opioid antagonist that is used to reduce alcohol craving and relapse.

National Institute on Alcohol Abuse and Alcoholism (NIAAA) researchers who reviewed data from the 2001-2004 COMBINE (Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence) study found that 87 percent of patients with the OPRM1 gene variant reported good outcomes with naltrexone treatment, compared to 49 percent of those receiving placebos and 55 percent of individuals lacking the gene variant who received either a placebo or naltrexone.

The study defined good outcomes as abstinence or moderate alcohol consumption without attendant problems.

“Analysis of the large COMBINE patient population increases confidence that the OPRM1 variant is in part responsible for positive responses to naltrexone,” said Ting-Kai Li, director of NIAAA. “This study points to the promise of research on gene-medication interactions to refine treatment selection, improve clinical results, and inform ongoing medications development.”

The research was published in the Feb. 4, 2008 issue of the Archives of General Psychiatry.

See also;

• Brief-TSF can assist patients cease alcohol consumption.
• Anti-craving Naltrexone Injection Reduces Drinking

Related Reading:

The 8-year course of alcohol abuse: Gender differences in social context and coping.
Women and men with alcohol use disorders were compared in terms of social context and coping methods and in terms of changes in these indexes associated with participation in professional treatment and Alcoholics Anonymous (AA).

The participants, initially untreated problem drinkers (230 women and 236 men), were followed for 8 years.

Women and men did not differ in the type of help received, but women had longer professional treatment.

At baseline, women had more stressors and fewer resources from family and relied more on avoidance coping and drinking to cope.

During the next 8 years, women, more than men, increased approach coping and reduced their use of avoidance coping and drinking to cope.

With control for baseline status, women had better social resource, coping, and drinking outcomes than men did at 1 year and 8 years.

Among men, but not among women, longer duration of professional treatment during year 1 was associated with improved approach coping.

A longer duration of AA attendance during year 1 and the full 8 years was associated with more resources from friends, more use of approach coping, and less drinking to cope.

In turn, more friends resources and approach coping and less drinking to cope were associated with better drinking outcomes.

Decreases in avoidance coping and drinking to cope were more strongly associated with better drinking outcomes among men than among women.

Thus it may be important to target men for formal services or self-help to increase their use of approach coping in efforts to maintain abstinence. Women’s strategies for improving their social context need further investigation for adaptation to male problem drinkers.

Timko, Christine; Finney, John W.; and Moos, Rudolf H.  The 8-year course of alcohol abuse: Gender differences in social context and coping.  Alcoholism: Clinical & Experimental Research 29(4):612-621, April 2005.

Related Reading:

Alcoholism and Brief-TSF

Have you ever been frustrated by a patients heavy drinking?

Or, is there poor treatment compliance with alcoholism?

Health, work or relationships decline while drinking continues?

You want to help, and have tried, but are at your wits end.

Do you have time to train as an alcohol specialist? If not,

Brief Twelve Step Facilitation can help, allowing you to get on with your primary role.

BriefTSF is an adjunctive alcoholism intervention

The primary aim of Brief Twelve Step Facilitation (Brief-TSF) is to introduce patients to the Twelve Step Fellowship – Alcoholics Anonymous. Then, in a support role, encourage maintenance of AA membership to enable sustained sobriety and rehabilitation.

Related Reading: