Twelve Step Facilitation Therapy facilitates patients’ active participation in the fellowship of Alcoholics Anonymous.

TSF regards such active involvement as the primary factor responsible for sustained sobriety (recovery) and therefore as the desired outcome of participation in this treatment program.

This therapy is grounded in the concept of alcoholism as a spiritual and medical disease.

TSF consists of a brief, 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 behavioral, 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 is only used by specialist alcoholism therapists.
• BriefTSF is used by generalist healthcare workers.

See also;

• 12-Step Treatment More Effective than Alternative
• AA Offers Recovery Not Religion
• Brief-TSF can assist patients cease alcohol consumption.
• Subscribe to Twelve Step Facilitation by e-Mail

Alcohol dependence is a chronic, relapsing bio-behavioral disease mediated by various parts of the brain, including reward systems, memory circuits, and the prefrontal cortex.

It is characterized by loss of the ability to drink alcohol in moderation and continued drinking despite negative consequences.

The alcohol withdrawal syndrome is a common but not universal diagnostic feature of alcohol dependence.

Benzodiazepine assisted detoxification of the alcohol withdrawal syndrome prevents the development of withdrawal seizures and delirium tremens, and makes patients more comfortable, which promotes engagement in treatment.

Symptom-triggered dosing, based on a withdrawal rating scale such as the Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised, is optimal for minimizing the total benzodiazepine dosage.

Use of a long-acting benzodiazepine (eg, chlordiazepoxide) is preferred in uncomplicated patients.

Thiamine should be administered routinely before the administration of intravenous fluids to prevent the development of Wernicke’s encephalopathy and Wernicke-Korsakoff syndrome.

In combination with psychosocial treatment naltrexone, and acamprosate can reduce the frequency of relapse.

Naltrexone may be more effective for reduction of loss of control with the first drink and cue-related craving.

Acamprosate may be more effective for stabilizing the physiology of post-acute withdrawal.

Psychiatric co-morbidity, especially depression, is common and is best addressed concurrently, although definitive diagnosis may have to await a period of prolonged sobriety.

Prescription of addictive substances, including benzodiazepines beyond the period of acute detoxification, should be avoided, and if necessary should be closely monitored (eg, by frequent visits with small prescriptions or clinic administed, and/or urine or breath alcohol screenings).

Abstinence from alcohol is recommended for persons with alcohol dependence.

Psychosocial treatment and participation in Alcoholics Anonymous can help patients achieve and maintain abstinence.

Research report; The psychiatric management of patients with alcohol dependence. Curr Treat Options Neurol. 2007 Sep;9(5):381-92. Ritvo JI, Park C.

Brief-TSF training is designed to complement this model.

Mechanisms of behavior change in alcoholics anonymous: does Alcoholics Anonymous lead to better alcohol use outcomes by reducing depression symptoms?

Rationale  Indices of negative affect, such as depression, have been implicated in stress-induced pathways to alcohol relapse. Empirically supported continuing care resources, such as Alcoholics Anonymous (AA), emphasize reducing negative affect to reduce relapse risk, but little research has been conducted to examine putative affective mechanisms of AA’s effects.

Methods  Using lagged, controlled, hierarchical linear modelling and meditational analyses this study investigated whether AA participation mobilized changes in depression symptoms and whether such changes explained subsequent reductions in alcohol use. Alcohol-dependent adults (n = 1706), receiving treatment as part of a clinical trial, were assessed at intake, 3, 6, 9, 12 and 15 months.

Results  Findings revealed elevated levels of depression compared to the general population, which decreased during treatment and then remained stable over follow-up. Greater AA attendance was associated with better subsequent alcohol use outcomes and decreased depression. Greater depression was associated with heavier and more frequent drinking. Lagged mediation analyses revealed that the effects of AA on alcohol use was mediated partially by reductions in depression symptoms. However, this salutary effect on depression itself appeared to be explained by AA’s proximal effect on reducing concurrent drinking.

Conclusions  AA attendance was associated both concurrently and predictively with improved alcohol outcomes. Although AA attendance was associated additionally with subsequent improvements in depression, it did not predict such improvements over and above concurrent alcohol use. AA appears to lead both to improvements in alcohol use and psychological and emotional wellbeing which, in turn, may reinforce further abstinence and recovery-related change.

Research; John F. Kelly, Robert L. Stout, Molly Magill, J. Scott Tonigan & Maria E. Pagano, Addiction, Volume 105 Issue 4, Pages 626 – 636

• See also
• Disturbing Denial
• Strategies for Dealing With Denial
• Addiction & Recovery Books
• The Dual Disorders Recovery Book
• Acceptance and Surrender

AA and 12 step alcoholism treatment programs

The author of this report notes that AA self-help groups are the most commonly accessed component of treatment for alcoholism and alcohol-related problems. Additionally, the concepts and approaches of AA have significantly influenced other twelve-step programs in professional treatment.

Research has indicated that participation in AA or other 12-step programs results in reductions in substance abuse and also in psychiatric problems, reducing health care costs over time.

Section headings in this book chapter include:

1. nature and prevalence of AA;
2. nature and prevalence of 12-step treatment programs;
3. evaluations of community-based AA groups;
4. evaluation research on 12-step oriented professional treatment programs
5. potential future research directions.

Research report; Humphreys, K. Alcoholics Anonymous and 12-step alcoholism treatment programs. In: M. Galanter, Ed., Recent Developments in Alcoholism: Volume 16. Research on Alcoholism Treatment, New York, NY: Kluwer Academic/Plenum Publishers, 2003. (pp. 149-164)

We evaluates the gender matching hypothesis in Project MATCH, which states that women will benefit more from Cognitive-Behavioral Coping Skills Therapy (CBT) than from Twelve Step Facilitation (TSF).

CBT was expected to address the ancillary problems (e.g., external stressors, negative mood) that are more prevalent among female alcoholics; at the same time, TSF, which would encourage women to attend Alcoholics Anonymous (AA) meetings, was expected to increase guilt and undermine self-esteem and assertion.

Tests of the matching contrasts failed to provide support for the hypothesis in either arm of the trial.

Gender did produce significant prognostic effects in analyses of the aftercare arm, with women reporting a higher proportion of abstinent days and fewer drinks per occasion than men did.

Causal chain analyses produced mixed results. Male and female clients were shown to differ in terms of their initial treatment needs, and follow-up status with respect to these needs was related to drinking outcomes.

Contrary to prediction, however, CBT sessions for women, as compared to those for men, were not appreciably more likely to teach general problem-solving or mood-management skills.

Further, women did not avoid AA meetings.

• Attendance at self-help meetings was comparable for the sexes in the outpatient arm;
• in the aftercare study, women attended significantly more meetings and reported a higher degree of AA involvement.

Gender matching hypothesis 28. Del Boca, F.K.; Mattson, M.E. Gender matching hypothesis. In R. Longabaugh and P.W. Wirtz, Eds., Project MATCH Hypotheses: Results and Causal Chain Analysis, Bethesda, MD:NIAAA, 2001. 330p. (pp. 186-203)

Helping Helps the Helper

Aims; The helper therapy principle suggests that, within mutual-help groups, those who help others help themselves. The current study examines whether clients in treatment for alcohol and drug problems benefit from helping others, and how helping relates to 12-step involvement. Design Longitudinal treatment outcome.

Participants; An ethnically diverse community sample of 279 alcohol- and/or drug-dependent individuals (162 males, 117 females) was recruited through advertisement and treatment referral from Northern California Bay Area communities. Participants were treated at one of four day-treatment programs.

Measurements; A helping checklist measured the amount of time participants spent, during treatment, helping others by sharing experiences, explaining how to get help and giving advice on housing and employment. Measures of 12-step involvement and substance use outcomes were administered at baseline and a 6 month follow-up.

Findings; Helping and 12-step involvement emerged as important and related predictors of treatment outcomes. In the general sample, total abstinence at follow-up was strongly and positively predicted by 12-step involvement at followup, but not by helping during treatment; still, helping positively predicted subsequent 12-step involvement. Among individuals still drinking at follow-up, helping during treatment predicted a lower probability of binge drinking, whereas effects for 12-step involvement proved inconsistent.

Conclusions; Findings support the helper therapy principle and clarify the process of 12-step affiliation.

Research report; Sarah E. Zemore, Lee Ann Kaskutas & Lyndsay N. Ammon, In 12-step groups, helping helps the helper. Addiction; March 2004

Peer Support in Action: From Bystanding to Standing By

A closer look at the role of a spiritual approach in addictions treatment.

Twelve Step Programs such as AA play a major role in addictions treatment, and their members are increasingly accepting of psychotherapy and medication.

However, many clinicians question the role of an approach defined by these Programs as spiritual.

This paper explores the nature, indications, and limitations of a spiritual approach to addiction and the implications for collaboration with mental health professionals.

It suggests that Twelve Step Programs not only provide accessible group support and a clear ideology regarding addiction but address individuals’ needs for identity, integrity, an inner life and interdependence within a larger social and moral, or spiritual context.

It examines the ways in which the religious connotations of the Program remain an obstacle for many patients and clinicians.

Clarification of the different needs met by modalities such as AA can improve the specificity and the comprehensiveness of treatment for patients with substance use disorders.

Peteet JR. A closer look at the role of a spiritual approach in addictions treatment. J Subst Abuse Treat. 1993 May-Jun;10(3):263-7.

The Measure of a Man: A Spiritual Autobiography (Oprah’s Book Club) by Sidney Poitier Read more about this title…

The 1956 General Service Conference of A.A. adopted unanimously the following statement of “A.A.’s Public Information

Policy”: In all public relationships, A.A.’s sole objective is to help the still suffering alcoholic. Always mindful of the importance of personal anonymity, we believe this can be done by making known to him, and to those who may be interested in his problem, our own experience as individuals and as a fellowship in learning to live without alcohol. We believe that our experience should be made available freely to all who express sincere interest.

We believe further that all our efforts in this field should always reflect our gratitude for the gift of sobriety and our awareness that many outside A.A. are equally concerned with the serious problem of alcoholism.

This statement reflects a longstanding A.A. tradition of not seeking publicity for promotional purposes, but of always being willing to cooperate with representatives of all media who seek information about the recovery program or about the structure of the Fellowship. Thousands of inquiries of this type are handled each year at the General Service Office (475 Riverside Drive, New York, NY 10115; mail address: Box 459, Grand Central Station, New York, NY 10163; telephone: 2128703400; www.aa.org). Many countries have local website’s that can be accessed from this main site.

Information and public relations matters affecting the Fellowship of A.A. as a whole are the concern of the Public Information Committee and the Committee on Cooperation with the Professional Community/Treatment Facilities of the General Service Board of Alcoholics Anonymous.

Reporters are welcome at A.A. open meetings, dinners, regional gettogethers, or similar gatherings of recovered alcoholics.

The only restriction is a request not to disclose the name of any A.A. member. (For obvious reasons, photographs cannot be taken at A.A. meetings.)

Note: In many areas, A.A. members have established committees on public information and cooperation with the professional community, to assist local media in obtaining accurate information about the Fellowship. Background material on A.A. may also be obtained upon request from these groups.

A.A. FACT FILE; PREPARED BY GENERAL SERVICE OFFICE OF ALCOHOLICS ANONYMOUS

TSF for Dual Diagnosis

The role of 12-step programs and 12-step-oriented treatments for dually diagnosed individuals (DDI) remains unclear. Here are presented the results of a pilot study in a target population of 10 seriously mentally ill patients received an adjunctive modified 12-step facilitation (TSF) therapy emphasizing engagement of DDI in a specialized 12-step program for DDI.

Participants significantly increased their 12-step attendance and decreased their substance use during the 12 weeks of treatment.

Larger and longer-term studies are needed to assess the efficacy of modified TSF for DDI relative to other treatments, and to determine what forms of TSF are most effective in this population.

Research; Bogenschutz MP. Tucker NE Specialized 12-step programs and 12-step facilitation for the dually diagnosed. Community Ment Health J. 2005 Feb;41(1):7-20.

Brief-TSF can be adapted to serve these people.

Spirituality/religiosity promotes acceptance-based responding and 12-step involvement.

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. Epub 2007 Jan 16.

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