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.
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.
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.
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;
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.
There is a long-recognized association between alcohol consumption and aggressive behavior. But does aggression and hostility continue into sobriety?
This study was designed to examine aggression in a group of socially well-adapted recovered alcoholics.
The question addressed was whether the treatment, together with long-term abstinence from alcohol, could reduce aggression and hostility in recovered alcoholics.
Sixty four male stable alcoholics with at least 3 years sobriety were compared with 69 non-alcoholics. Neither group had any other psychological problems.
Both groups were given a questionnaire on general characteristics as well as aggressive and hostility traits.
After a 3-year abstinence, men from the recovering alcoholics group displayed greater signs of hostility and covert aggression. They were different from non-alcoholics on measures for indirect aggression, irritability, negativism, suspicion, resentment, and guilt.
Research report; Ziherl S, Cebasek Travnik Z, Kores Plesnicar B, Tomori M, Zalar B. Trait aggression and hostility in recovered alcoholics. Eur Addict Res 2007; 13(2): 89-93.
While the war on drugs continues to attract world attention, it is often overlooked that alcoholism remains a major worldwide health concern. No matter what your expertise, the Handbook of Alcoholism can help you acquire the necessary skills to treat problem drinkers and alcohol-dependent patients. In three sections;
Patient Care,
Research, and
Useful Data and Definitions
this comprehensive handbook not only addresses the underlying psychological problems of alcoholism, but helps you to better diagnose and treat the non-psychiatric medical disorders caused by the disease.
Alcoholics and addicts can attest to their countless attempts to stop or cut back on their drinking or drugging. They learn but cannot really accept that they have no power over alcohol or drugs.
The following research of the 1970’s began to explore this phenomenon and in the process confirming a basic tenet of Alcoholics Anonymous.
We alcoholics are men and women who have lost the ability to control our drinking. We know that no real alcoholic ever recovers control. All of us felt at times that we were regaining control, but such intervals – usually brief – were inevitably followed by still less control, which led in time to pitiful and incomprehensible demoralization. We are convinced to a man that alcoholics of our type are in the grip of a progressive illness. Over any considerable period we get worse, never better. Alcoholics Anonymous, pp 30.
Abstract of research report; This study evaluates the ability of alcoholics to regulate their blood alcohol levels (BAL) within a designated range by relying primarily on interoceptive (internal) cues. Forty male alcoholics and 20 control subjects were exposed to an initial training session in which they received sufficient ethanol to maintain them within a designated BAL range over a 2 1/2-hour period.
They were then exposed to two experimental sessions, one providing "overfeedback" and one "underfeedback." During each session, subjects had ten drinking decisions to make with respect to regulation of their BAL.
The results indicated that alcoholics displayed greater "loss-of-control" than control subjects.
This finding supported the hypothesis that alcoholics may possess a neurophysiologic feedback dysfunction that contributes to their relative inability to regulate ethanol intake.
A. M. Ludwig, F. Bendfeldt, A. Wikler and R. B. Cain. Loss of control in alcoholics. Archives of General Psychiatry. Vol. 35 No. 3, March 1978.
Lifetime exposure to potentially traumatic events in a sample of alcoholic patients in Poland.
Recent studies show a high prevalence of traumatic events in samples of patients with a substance use disorder.
In the present study, the lifetime exposure to potentially traumatic events (PTE’s) was estimated in a sample of 458 patients recruited at 17 randomly chosen alcohol-dependence treatment units in the public healthcare sector in Poland.
Eighty percent of the patients reported a history of at least one potentially traumatic event.
Sixty percent of them reported experiencing more than one probable trauma.
However, only the patients who experienced physical assault reported worse clinical severity in posttraumatic stress (PTSD) and alcohol-use related symptomatology.
The findings confirm the importance of trauma assessment in alcohol-dependent patients and the inclusion of trauma-related issues in the treatment of alcohol dependence.
Research report; Lifetime exposure to potentially traumatic events in a sample of alcohol-dependent patients in Poland. Dragan M, Lis-Turlejska M. J Traum Stress 2007; 20(6): 1041-51.
Researchers say that men with clinical depression are more likely to kill themselves if they drink heavily or also suffer from a type of personality disorder known for aggressive and impulsive behavior, Reuters reported Dec. 23.
Researcher Gustavo Turecki and colleagues looked at a group of men with major depressive disorder, including 104 who committed suicide and 74 percent who are living. They found that those who were classified as alcohol abusers or dependent were four times more likely to kill themselves, while those with “Cluster B” personality disorders were 17 times more likely to commit suicide.
“Why some patients with major depressive disorder die by suicide while others with seemingly the same disorder do not, is a question of enormous clinical relevance,” the researchers noted. “…[H]igher levels of impulsive and aggressive behaviors, combined with behavioral disinhibition facilitated by substance use, may mediate suicide in major depressive disorder.”
Drinking and personality disorders were especially dangerous for younger men with depression. “If a clinician has a patient that has major depression and comorbidity with substance-related problems and the presence of cluster B personality trait and is younger, these are patients you want to make sure you pay close attention to,” said Turecki.
The study appears in the November 2005 issue of the American Journal of Psychiatry. Reference; Dumais, A., et al. (2005) Risk Factors for Suicide Completion in Major Depression: A Case-Control Study of Impulsive and Aggressive Behaviors in Men. Am J Psychiatry 162: 2116-2124. From; Join Together
The Practical Art of Suicide Assessment: A Guide for Mental Health Professionals and Substance Abuse Counselors by Shawn Christopher Shea
Twelve Step Facilitation Therapy facilitates patients’ active participation in the fellowship of Alcoholics Anonymous.
I’ll Quit Tomorrow: A Practical Guide to Alcoholism Treatment
