Twelve Step Facilitation (TSF)

Twelve-Step Facilitation (TSF) consists of a structured, and manual-driven approach to facilitating early recovery from alcohol abuse/alcoholism and other drug abuse/addiction. It is intended to be implemented on an individual basis in 12 to 15 sessions and is based in behavioural, spiritual, and cognitive principles that form the core of 12-step fellowships such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA). It is suitable for problem drinkers and other drug users and for those who are alcohol or other drug dependent.

TSF seeks to facilitate two general goals in individuals with alcohol or other drug problems: acceptance (of the need for abstinence from alcohol or other drug use) and surrender, or the willingness to participate actively in 12-step fellowships as a means of sustaining sobriety. These goals are in turn broken down into a series of cognitive, emotional, relationship, behavioural, social, and spiritual objectives.

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-contredanses must be replaced by surrender to the group 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 as the locus of change in one’s life.

The facilitator in the TSF treatment model is more truly a facilitator of change than an agent of change. The true agent of change (i.e., sustained sobriety) lies in active participation in 12-step fellowships like AA and NA along with the principles set forth in the 12 steps and 12 traditions that guide these fellowships.

Alcoholism and other drug addiction are considered illnesses that affect individuals both mentally and physically in such a way that they are unable to control their use of alcohol or other drugs. Viewed from this perspective, the concept of controlled use of alcohol or other drugs amounts to denial of the primary problem, that is, loss of control. Specific causative factors 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.

After Nowinski J. NIDA, 2000.

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  Research Summary; Unsafe sex by people infected with HIV poses a grave public health risk. To examine whether alcohol use increases the likelihood of unsafe sex in people with HIV, investigators interviewed 262 patients from 2 HIV clinics. Alcohol consumption measures assessed use in the past 6 months and included drinking days, drinks per drinking day, binge drinking,* and hazardous drinking.**

In the past 6 months, 63 percent of patients had been sexually active,

• 38 percent had unprotected sex (i.e., no condom), and
• 21 percent had multiple sex partners.

All alcohol consumption measures were significantly associated with the likelihood of having any sex (odds ratios ranging from 1.5 to 2.9) and of having unprotected sex (odds ratios ranging from 1.4 to 2.7).

One-third of hazardous drinkers — compared with 9 percent of nonhazardous drinkers — were having both unprotected sex and sex with multiple partners.

Heroin and cocaine use did not significantly affect the likelihood of having any or unprotected sex.

Comments by Jeffrey Samet, MD, MA, MPH:

This study demonstrates a clear association between alcohol use and unsafe sex in patients infected with HIV. As the authors note, determining the basis of this association (e.g., risk-taking personality, lowered sexual inhibitions due to alcohol) requires studies that demonstrate the relationship between the two behaviors. Nevertheless, these findings support the case for assessing alcohol use among all patients with HIV.

• * 5 or more drinks per day for men, 3 or more drinks per day for women
  ** at least 1 binge episode, or greater than 14 drinks per week for men and greater than 7 drinks per week for women
• Reference: Stein M, Herman DS, Trisvan E, et al. Alcohol use and sexual risk behavior among human immunodeficiency virus-positive persons. Alcohol Clin Exp Res. 2005; 29(5): 837-843.

From; Join Together Online

See also;

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

Counseling Clients with HIV Disease: Assessment, Intervention, and Prevention by Mary Ann Hoffman Read more about this title…

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Online Videos Train Clinicians to Help Patients Who Drink Too Much

A new, interactive video training program from the National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the National Institutes of Health (NIH), demonstrates quick and effective strategies for screening patients for heavy drinking and helping them to cut down or quit.

“The video scenarios demonstrate evidence-based techniques for assessing and managing at-risk drinking and alcohol use disorders,” says NIAAA Director Ting-Kai Li, M.D. “We want to make these techniques widely available to clinicians so that more people with alcohol use problems will get the help they need.”

Called “Video Cases: Helping Patients Who Drink Too Much,” the program is available online at www.niaaa.nih.gov/guide.

Based on the NIAAA Clinician’s Guide, the online program features four 10-minute video case scenarios, each led by an expert clinician who offers insights and engages viewers in considering different strategies for treatment and follow-up.

Continuing education credit for physicians and nurses who use the training program will be provided through Medscape.com.

“The videos model clinicians interacting with patients with different levels of alcohol involvement and who are in different stages of readiness to change,” noted Mark Willenbring, M.D., director of NIAAA’s Division of Treatment and Recovery Research. “The video scenarios take place in several different settings to show that clinicians in primary care, mental health, and other specialties are all in a prime position to make a difference.”

In addition to the video case studies, the program includes a 15- to 20-minute tutorial on the NIAAA Clinicians Guide. With video narration and animated graphics, this section teaches clinicians how to:

• Ask patients about alcohol use
• Assess heavy drinkers for alcohol use disorders
• Help at-risk drinkers to cut back to safer drinking levels
• Help patients with alcohol use disorders to quit, including treating them with newer, effective medications for dependence when indicated

The tutorial and case studies require about an hour to complete.

“As physicians, we see the serious impact that excessive alcohol use can have on patients, their families and public safety,” said Ronald M. Davis, M.D., president of the American Medical Association. “Scientific evidence shows if we can prevent alcohol consumption from becoming a problem, we can help stop thousands, even millions, of alcohol-related diseases and injuries. The AMA encourages physicians to learn how to conduct screening and brief interventions for at-risk drinking behavior and how to identify and treat alcoholism.” 

See also;

• Twelve-Step Programs as an Adjunct to Psychotherapy and Psychopharmacology
• Subscribe to Twelve Step Facilitation by e-Mail

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Does early onset of non-medical use of prescription drugs predict subsequent prescription drug abuse and dependence? Results from a national study.

Aims; The present study examined the associations between early onset of non-medical use of prescription drugs (NMUPD) (i.e. sedatives, tranquilizers, opioids, stimulants) and the development of prescription drug abuse and dependence in the United States.

Design; Data were collected from structured diagnostic interviews using the National Institute on Alcohol Abuse and Alcoholism (NIAAA) Alcohol Use Disorder and Associated Disabilities Interview Schedule: Diagnostic and Statistical Manual version IV (DSM-IV).

Setting; National USA prevalence estimates were derived from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC, n = 43 093).

Participants; A nationally representative cross-sectional sample of civilian non-institutionalized adults aged 18 years or older in the United States, of whom 52% were women, 71% white, 12% Hispanic, 11% African American, 4% Asian and 2% Native American or of other racial background.

Findings; A higher percentage of individuals who began using prescription drugs non-medically at or before 13 years of age were found to have developed prescription drug abuse and dependence versus those individuals who began using at or after 21 years of age.

Multivariate logistic regression analyses indicated that the odds of developing any life-time prescription drug abuse among non-medical users was reduced by approximately 5% with each year non-medical use was delayed [adjusted odds ratio (AOR) = 0.95, 95% CI = 0.94, 0.97], and that the odds of developing any life-time prescription drug dependence were reduced by about 2% with each year onset was delayed (AOR = 0.98, 95% CI = 0.96, 1.00) when controlling for relevant covariates.

Conclusions; The results of this study indicate that early onset of NMUPD was a significant predictor of prescription drug abuse and dependence.

These findings reinforce the importance of developing prevention efforts to reduce NMUPD and diversion of prescription drugs among children and adolescents.

McCabe SE, West BT, Morales M, Cranford JA, Boyd CJ. Does early onset of non-medical use of prescription drugs predict subsequent prescription drug abuse and dependence? Results from a national study. Addiction. 2007 Oct 4;

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Drinking and Biting

It’s a problem Mike Tyson knows well: fights that escalate into men biting other men. And researchers say that most human-bite cases involve males who have been drinking, the CanWest News Service reported June 20.

Irish researchers say that 86 percent of human-bite cases involve alcohol, and that men are bitten 12 times more often than women. Most bites occur on the face — particularly the ears, nose and cheek — as well as the fingers and forearm. Sixty-five percent of all bites involve the ear.

"I think a lot of people wouldn’t know this happens, or to the extent that it happens," said study co-author Patricia Eadie, a plastic surgeon at St. James’s Hospital in Dublin. "There’s a lot of person-on-person violence that can be due to alcohol and drugs." Many such incidents go unreported because victims don’t seek medical attention, she added.

The study was published in the July 2007 issue of the Emergency Medicine Journal.

Research Reference: Henry, F.P., Purcell, E.M., Eadie, P.A. (2007) The human bite injury: a clinical audit and discussion regarding the management of this alcohol fuelled phenomenon. Emergency Medicine Journal, 24: 455-458.

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Reduction in heavy drinking as a treatment outcome in alcohol dependence.

This article, published in a prestigious journal, suggests that controlled drinking should return to the public health arena. This, even though this policy has been dismissed, about 2 decades ago, as being unworkable and dangerous to the individuals, their families and society as a whole.

Alcoholics who have tried controlled drinking will attest to the futility of such a policy and goal.

Reduction in heavy drinking for ‘problem drinkers’ is a viable goal but not for alcoholics.

The only valuable suggestion made in the article is the final one

“outcomes be individualized to patients’ goals”.

There is no clinical benefit in trying to get an alcoholic to control their drinking.

Abstract; In the field of clinical alcohol disorders treatment in North America, abstinence continues to be largely viewed as the optimal treatment goal; however, there is a growing awareness of limitations when abstinence is considered the only successful outcome.

Although this issue has been discussed in research settings, new studies on the public health significance of heavy drinking (defined as five or more standard drinks per drinking day in men, and four or more standard drinks per drinking day in women) in the past 10 years suggest that clinical providers should consider the value of alternative outcomes besides abstinence.

A focus on abstinence as the primary outcome fails to capture the impact of treatment on reduction in the pattern and in the frequency of alcohol consumption.

In addition, evaluating reduction in drinking as “positive” has value for patients as an indicator of clinical progress. Measurement of continuous variables, such as the quantity and the frequency of alcohol consumption, has provided a clearer understanding of the scope of alcohol-related morbidity and mortality at the societal level, and of the relationship between individual patient characteristics and the naturalistic course of alcohol use, abuse, and dependence.

A review of these characteristics suggests that there are clinical benefits associated with reducing heavy drinking in alcohol-dependent patients.

Given the significant public health consequences associated with heavy drinking and the benefits associated with its reduction, it is proposed that researchers, public health professionals, and clinicians consider using reduction in heavy drinking as a meaningful clinical indicator of treatment response, and that outcomes be individualized to patients’ goals and readiness to change.

Research report; David R. Gastfriend, James C. Garbutt, Helen M. Pettinati and Robert F. Forman. Reduction in heavy drinking as a treatment outcome in alcohol dependence. Journal of Substance Abuse Treatment. Volume 33, Issue 1, July 2007, Pages 71-80

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After just 4 months of operation my blogs have hit the 20,000 visitor mark. To me this is astounding. Thank you.

The statistics for September are;

Visitors – 20,002

Pages viewed – 49,968

Posts – 95

Comments – 90. Well, we can push this up next month.

My blogs are;

www.BriefTSF.com

www.Recoveryissexy.com

www.TwelveStepFacilitation.com

www.AlcoholSelfHelpNews.wordpress.com

Blogging For Dummies (For Dummies (Computer/Tech)) by Brad Hill Read more about this title…

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