• AA Can Help Most Alcoholics
• Al-Anon offers new life
• Alcohol and Anxiety
• Alcoholic Defense Mechanisms
• Alcoholics Anonymous and Nursing
• An Introduction to Medication for Alcoholism
• Anti-craving Drugs
• Binge Drinking & Brain Damage
• Brief Intervention in Emergency Room is Effective
• Brief-TSF Description
• Brief-TSF holistic treatment
• Characteristics of Children of Alcoholic
• Common Problems in Recovery
• Counseling and the 12 Steps of AA
• COUNSELOR CHARACTERISTICS
• God As We Understood Him
• Helping Alcoholics
• Nutritional Therapy in Alcoholic Liver Disease
• Painkiller abuse
• Readiness to Change Profiles
• Recovering Alcoholics Effective in Helping others
• Recovery through the Twelve Steps
• Research Evidence for TSF
• Risky Partners and Domestic Violence
• Spiritual assessment
• Stages of an Eating Disorder
• The 12-Steps Promote Acceptance of Addiction
• Treating Alcoholism as a Chronic Disease
• TSF Description
• What about partners of alcoholics?
• What About This Spiritual Awakening Thing
• Women and the Twelve Steps of AA
• World view change in Adult Children of Alcoholics

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Strategies for Dealing With Crises

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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Brief-TSF 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.

This is truly adjunctive therapy.

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TSF & 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-centeredness 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.

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Brief-TSF ASSESSMENT

The assessment session in BriefTSF runs for up to 1 hour. The goals are to:

• Establish client-facilitator rapport.
• Conduct a collaborative assessment of alcohol (history).
• Discuss the client’s prior efforts to stop or control use.
• Discuss negative consequences associated with use.
• Share a diagnosis with the client and attempt to have it be a collaborative decision.
• Attempt to get a commitment from the client to sample several AA meetings and to try and to keep an open mind.
• Introduce an AA Peer Sponsor by phoning immediately the person indicates a commitment.

Assessment within the TSF model has both an informational and a motivational goal.

Consistent with 12 step philosophy, no client is excluded from treatment as a consequence of drinking, although with some clients it may become appropriate to discuss inpatient treatment.

Sessions with clients who are found to be (or who admit to being) drunk or under the influence of other psychotropic drugs are terminated, and arrangements are made to get the client home safely.

Further appointments are made as appropriate.

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TARGET POPULATIONS

Clients Best Suited for This Approach

Twelve Step Facilitation has been utilized in controlled outcome studies with alcohol abusers and alcoholics and with persons who have concurrent alcohol-cocaine abuse and dependency. It has been used with clients of diverse socioeconomic, educational, and cultural backgrounds and a range of maladjustment.

Clients Poorly Suited for This Approach

Individuals who have severe symptoms of addiction to cocaine or opiates. That is not to say that alternative treatments have proven effective with that group of individuals.

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Brief-TSF COUNSELOR CHARACTERISTICS AND TRAINING

Educational Requirements

Brief-TSF requires considerable clinical skill to implement properly. Issues in implementation include the ability to stay focused, maintain structure within each session, and engage in constructive confrontation. Accordingly, it is recommended that prospective facilitators have counseling experience and/or training.

Counselor’s Recovery Status

Brief-TSF facilitators need not be in recovery personally. Any serious Brief-TSF facilitator, however, should have read all relevant AA literature that clients will be asked to read and should be familiar with at least AA and Al-Anon meetings from personal experience. In addition, it is not recommended that a facilitator whose own views are unsympathetic to the primary goals of Brief-TSF (e.g., abstinence, active involvement in 12 step fellowships) seek to implement this model, for obvious reasons.

Balance

Ideal Personal Characteristics of Counselor

The best Brief-TSF facilitators have a good working grasp of basic Rogerian non-specific, client-centered therapeutic skills, including unconditional positive regard and good active listening skills, combined with a good-working knowledge of 12 step philosophy and the practicalities of getting active in 12 step fellowships. The ideal Brief-TSF facilitator is able to maintain session focus without excessive drift while also maintaining rapport. The Brief-TSF facilitator establishes a collaborative relationship with the client and utilises confrontation in a constructive, non-punitive manner.

Counselor’s Behaviours Prescribed

The Brief-TSF facilitator will help the client:

• Assess his or her alcohol and advocate abstinence.
• Explain basic 12 step concepts (e.g., surrender, acceptance & action).
• Advocate and actively support and facilitate initial involvement in AA.
• Facilitate introduction to an AA Peer Sponsor.
• Facilitate ongoing participation in AA.
• Suggest and discuss specific readings from AA literature.
• Help the client learn to use AA members as resources in times of crisis and to support and celebrate sobriety.
• Conduct sessions that helps the client assess critically his or her progress in the program.

Counselor’s Behaviours Proscribed

The Brief-TSF facilitator does not:

• Conduct sessions with an intoxicated client.
• Attend AA meetings with the client.
• Act as an AA sponsor.
• Threaten reprisals for non-compliance.
• Advocate controlled drinking or other drug use.
• Allow therapy to drift excessively onto collateral issues, such as marital or job conflict.

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What About This Spiritual Awakening Thing?

The phrase ‘spiritual awakening‘, found in the Twelfth Step and throughout A.A. literature, remains daunting to many beginners. For some, it conjures up a dramatic conversion experience – not an appealing idea to an alcoholic just coming off a drunk. To others, beaten down by years of steady drinking, it seems completely out of reach. But for those who persevere, ongoing sobriety almost invariably brings the realization that – in some wonderful and unexpected way – they have indeed experienced a spiritual change.

Spirituality, A.A. style, is the result of action. Step Twelve begins, Having had a spiritual awakening as the result of these Steps. . . (italics added), and in the book Twelve Steps and Twelve Traditions (page 106), Bill W. describes what happens: ‘Maybe there are as many definitions of spiritual awakening as there are people who have had them. But certainly each genuine one has something in common with all the others. . . .

When a man or woman has a spiritual awakening, the most important meaning of it is that he has now become able to do, feel, and believe that which he could not do before on his unaided strength and resources alone. He has been granted a gift which amounts to a new state of consciousness and being. He has been set on a path which tells him he is really going somewhere, that life is not a dead end, not something to be endured or mastered. In a very real sense he has been transformed, because he has laid hold of a source of strength which, in one way or another, he had hitherto denied himself.’

AA – A Newsletter for Professionals, Fall 2003

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Major Goals of 12-Step Facilitation Therapy (TSF) in Project MATCH

Acceptance

• Acceptance by patients that they suffer from the chronic and progressive illness of alcoholism
• Acceptance by patients that they have lost the ability to control their drinking
• Acceptance by patients that because there is no effective cure for alcoholism, the only viable alternative is complete abstinence from the use of alcohol

Surrender

• Acknowledgment on the part of the patient that hope for recovery (i.e., sustained sobriety) exists, but only by accepting the reality of loss of control and by having faith that some higher power can help the patient, whose own willpower has been defeated by alcoholism
• Acknowledgment by the patient that the fellowship of Alcoholics Anonymous (AA) has helped millions of alcoholics sustain their sobriety and that the patient’s best chances for success are to follow the AA path.

Brief-TSF follows these goals

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‘God As We Understood Him’

The basic principles of Alcoholics Anonymous were worked out in the late 1930s and early ’40s, during what co-founder Bill W. often referred to as the Fellowship’s period of “trial and error.”

The founding members had been using six steps borrowed from the Oxford Groups, where many of them started out. Bill felt that more specific instructions would be better, and in the course of writing A.A.’s basic text, ‘Alcoholics Anonymous’, he expanded them to twelve.

But he was dealing with a group of newly sober drunks, and not surprisingly his new version met with spirited opposition. Even though the founding members were in many ways a homogeneous bunch (white, middle-class, almost exclusively male, and primarily Christian in background), they represented the full spectrum of opinion and belief. Bill tells us in ‘Alcoholic Anonymous Comes of Age’, a history of the Fellowship’s early years, that “the hot debate about the Twelve Steps and the book’s content was doubled, doubled and redoubled.

There were conservative, liberal, and radical viewpoints.” (page 162) Some thought the book ought to be Christian; others could accept the word “God” but were opposed to any other theological proposition. And the atheists and agnostics wanted to delete all references to God and take a psychological approach.

Bill concludes: “We finally began to talk about the possibility of compromise. . . . In Step Two we decided to describe God as a ‘Power greater than ourselves.’ In Steps Three and Eleven we inserted the words ‘God as we understood Him.’ From Step Seven he deleted the words ‘on our knees.’

And, as a lead-in sentence to all the steps we wrote these words: ‘Here are the steps we took, which are suggested as a program of recovery.’ A.A.’s Twelve Steps were to be suggestions only.” (ibid., page 167)

More than sixty years later, those crucial compromises, articulated after weeks of heated controversy, have made it possible for alcoholics of all faiths, or no faith at all, to embrace the A.A. program of recovery and find lasting sobriety.

AA – A Newsletter for Professionals Fall 2003

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