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

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

The Role of Uncontrollable Trauma in the Development of PTSD and Alcohol Addiction

By Joseph Volpicelli, M.D., Ph.D.; Geetha Balaraman; Julie Hahn; Heather Wallace, M.A.; and Donald Bux, Ph.D.

After a traumatic event, people often report using alcohol to relieve their symptoms of anxiety, irritability, and depression.

Alcohol may relieve these symptoms because drinking compensates for deficiencies in endorphin activity following a traumatic experience. Within minutes of exposure to a traumatic event there is an increase in the level of endorphins in the brain.

During the time of the trauma, endorphin levels remain elevated and help numb the emotional and physical pain of the trauma.

However, after the trauma is over, endorphin levels gradually decrease and this may lead to a period of endorphin withdrawal that can last from hours to days. This period of endorphin withdrawal may produce emotional distress and contribute to other symptoms of posttraumatic stress disorder (PTSD).

Because alcohol use increases endorphin activity, drinking following trauma may be used to compensate this endorphin withdrawal and thus avoid the associated emotional distress. This model has important implications for the treatment of PTSD and alcoholism.

Alcohol Research & Health, Vol. 23, No. 4, 1999

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.

Alcoholics Anonymous and long term matching effects.

AIMS: (1) To examine the matching hypothesis that Twelve Step Facilitation Therapy (TSF) is more effective than Motivational Enhancement Therapy (MET) for alcohol-dependent clients with networks highly supportive of drinking 3 years following treatment; (2) to test a causal chain providing the rationale for this effect. DESIGN: Outpatients were re-interviewed 3 years following treatment. ANCOVAs tested the matching hypothesis. SETTING: Outpatients from five clinical research units distributed across the United States. Participants: Eight hundred and six alcohol-dependent clients. INTERVENTION: Clients were randomly assigned to one of three 12-week, manually-guided, individual treatments: TSF, MET or Cognitive Behavioral Coping Skills Therapy (CBT). MEASUREMENTS: Network support for drinking prior to treatment, Alcoholics Anonymous (AA) involvement during and following treatment, percentage of days abstinent and drinks per drinking day during months 37-39.

FINDINGS:

• The a priori matching hypothesis that TSF is more effective than MET for clients with networks supportive of drinking was supported at the 3 year follow-up;
• AA involvement was a partial mediator of this effect; clients with networks supportive of drinking assigned to TSF were more likely to be involved in AA;
• AA involvement was associated with better 3-year drinking outcomes for such clients.

CONCLUSIONS:

• in the long-term TSF may be the treatment of choice for alcohol-dependent clients with networks supportive of drinking;
• involvement in AA should be given special consideration for clients with networks supportive of drinking, irrespective of the therapy they will receive.

Research; Longabaugh R, Wirtz PW, Zweben A, Stout RL. Network support for drinking, Alcoholics Anonymous and long-term matching effects.Addiction. 1998 Sep;93(9):1313-33.

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)

Biomarkers in Alcohol Misuse: Their Role in the Prevention and Detection of Thiamine Deficiency

In Western countries alcohol misuse is the most frequent cause of thiamine (vitamin B1) deficiency (TD) and consequent neuro-impairment.

Studies have demonstrated that between 30 and 80% of alcoholics are thiamine deficient, and this puts them at risk of developing the Wernicke–Korsakoff (WK) syndrome.

The relative roles of alcohol and TD in causing brain damage remain controversial and it is important to try to determine the role played by each factor.

Animal studies support an additive effect of alcohol exposure and TD, and indicate the potential for interaction between alcohol and TD in human alcohol-related brain damage.

Early diagnosis of alcohol-related TD is therefore an important aspect of effective intervention and treatment.

Alcohol biomarkers provide a direct and indirect way of estimating the amount of alcohol being consumed, the duration of ingestion and the harmful effects that long-term alcohol use has on body functions.

Appropriate use of these markers is very helpful when considering a diagnosis of alcohol-related TD.

Research report; Rosanna Mancinelli, and Mauro Ceccanti. Biomarkers in Alcohol Misuse: Their Role in the Prevention and Detection of Thiamine Deficiency. Alcohol and Alcoholism 2009 44(2):177-182;

See also;

• 12-Step Treatment More Effective than Alternative
• AA Offers Recovery Not Religion
• AA and Treatment Work Better Together

I’ll Quit Tomorrow: A Practical Guide to Alcoholism Treatment

The Alcohol Use Disorders Identification Test (AUDIT) as screening instrument for adolescents.

BACKGROUND: The Alcohol Use Disorders Identification Test (AUDIT) is an international screening instrument extensively employed in adult target groups. However, there is scarce information on screening with the AUDIT in adolescent populations.

The purpose of this study was to determine the cut-off point for hazardous, harmful, and dependent alcohol use through the validation of the AUDIT in a Chilean adolescent sample.

METHODS: The original English version of the AUDIT was translated into Spanish, using the procedure recommended by the World Health Organization. The text was then back-translated and sent to one of the original authors (Thomas Babor), who approved the translation. Students attending public schools in Santiago, Chile, self-administered the AUDIT, and those older than 15 years completed the

Composite International Diagnostic Interview-Substance Abuse Module (CIDI-SAM), which served as a gold standard. Between 1 and 4 weeks after the CIDI-SAM, participants answered a second AUDIT.

RESULTS:

• A total of 42 female and 53 male adolescents (mean age: 15.9 [SD=1.2]) completed the AUDIT, with a mean score of 4.3.
• Reliability according to Cronbach’s alpha was 0.83.
• Test-retest correlation was also satisfactory (intra-class correlation 0.81 [95% CI 0.73-0.87]).
• Analysis of the receiver operating characteristic (ROC) curve yielded cut-off points for hazardous, harmful, and dependent alcohol use of 3, 5, and 7 points, respectively.

CONCLUSIONS: The Chilean version of the AUDIT is a valid and reliable tool for identifying adolescents with hazardous, harmful, and dependent alcohol use. The suggested cut-off points make screening with the AUDIT more accurate for adolescent populations.

Research; Drug Alcohol Depend. 2009 Aug 1;103(3):155-8. Epub 2009 May 6. The Alcohol Use Disorders Identification Test (AUDIT) as a screening instrument for adolescents. Santis R, Garmendia ML, Acuña G, Alvarado ME, Arteaga O.

• See also;
• 12-Step Treatment More Effective than Alternative
• Brief-TSF ASSESSMENT
• Brief-TSF can assist patients cease alcohol consumption.
• Learn about the disease

Youth With Alcohol and Drug Addiction: Escape from Bondage (Helping Youth With Mental, Physical, and Social Challenges) by Kenneth McIntosh

Different Like Me: A Book for Teens Who Worry About Their Parent’s Use of Alcohol/Drugs by Evelyn Leite

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