Compatibility With Other Treatments

Brief-TSF may be utilised in combination with supportive pharmacotherapy; for example, craving reduction medications.

While recognising the existence of multiple problems of adjustment in most problem drinkers (e.g., marital conflict, family dysfunction), Brief-TSF advocates pursuing the goal of early recovery as primary, delaying most other therapies if necessary, until the client has achieved approximately 6 months of sobriety.

The primary exceptions to this recommendation would be emergency or incapacitating medical treatment, debilitating depression or other major affective disorder, or a psychotic disorder, which would take precedence over Brief-TSF.

Brief-TSF is not compatible with treatments based on notions of controlled use.

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Brief detection and co-occurrence of violence, depression and alcohol risk in prenatal care settings.

The purpose of the study was to examine the rates and inter-relationships among violence receipt, alcohol use problems, and depression in women seeking prenatal care.

While waiting for their prenatal care appointment, women (n = 1054) completed measures of past year partner and non-partner violence receipt, alcohol misuse (using the TWEAK and quantity and frequency of alcohol use in past year), and depression (using the Center for Epidemiological Studies Depression Scale – CESD and prior history of depression).

Over 30% of women reported either violence receipt, alcohol use problems or depression risk.

Significant inter-relationships among all measured risk variables were found.

Violence receipt was significantly related to

• alcohol misuse,
• cigarette use,
• less education, and
• scoring above the cutoff on the CESD (? 16).

Practitioners can be well-equipped to provide assessment, interventions, or referrals as needed to the high numbers of women encountered in prenatal care settings experiencing psychosocial and behavioral problems that may affect their pregnancy.

Research; H. A. Flynn, M. A. Walton, S. T. Chermack, R. M. Cunningham and S. M. Marcus. Brief detection and co-occurrence of violence, depression and alcohol risk in prenatal care settings. Archives of Women’s Mental Health, 1434-1816 (Print) 1435-1102 (Online), Volume 10, Number 4 / August, 2007

Brief-TSF provides guidelines and strategies for using the TWEAK.

Alcoholics Anonymous and Nursing; Lessons in Holism and Spiritual Care.

Alcoholic Anonymous (AA) is a worldwide, 2 million-member organization that has assisted countless alcoholics to achieve sobriety through a spiritual program of recovery from alcoholism.

Based on spiritual principles known as the “Twelve Steps” and “Twelve Traditions,” AA has provided a model for other recovery programs such as

• Narcotics Anonymous (NA),
• Gamblers Anonymous (GA), and
• Sex and Love Addicts Anonymous (SLAA).
• Al-anon
• Adult Children of Alcoholics

Recovery in AA appears to involve a process of self-transcendence.

In recent years, nursing scholars have increasingly explored the concepts of self-transcendence and spirituality as they apply to nursing theory and practice.

This article explores the roots and spiritual dimensions of 12-step recovery programs. It further explores the ways in which theoretical and clinical knowledge about the delivery of spiritual care interventions may be gained from an understanding of AA’s spiritual approach to recovery.

Alcoholics Anonymous and Nursing; Lessons in Holism and Spiritual Care. Eileen M. McGee, J Holist Nurs 2000; 18; 11.

Brief-TSF can assist patients cease alcohol consumption.

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.

A comparative evaluation of substance abuse treatment

This article first explains the conceptual framework and plan of a naturalistic, multisite evaluation of Department of Veterans Affairs (VA) substance abuse treatment programs. It then examines the effectiveness of an index episode of inpatient treatment and the effectiveness of continuing outpatient care and participation in self-help groups.

The study was conducted among 3018 patients from 15 VA programs that emphasized 12-Step, cognitive-behavioral (CB), or eclectic treatment.

Casemix-adjusted 1-year outcomes showed that patients in 12-Step programs were the most likely to be abstinent, free of substance abuse problems, and employed at the 1-year follow-up.

Patients who obtained more regular and more intensive outpatient mental health care, and those who participated more in 12-Step self-help groups, were more likely to be abstinent and free of substance use problems at the 1-year follow-up.

These findings support the effectiveness of 12-Step treatment and show that patients with substance use disorders who become more involved in outpatient care and self-help groups tend to experience better short-term substance use outcomes.

Moos RH, Finney JW, Ouimette PC, Suchinsky RT. A comparative evaluation of substance abuse treatment. Alcohol Clin Exp Res. 1999 Mar;23(3):529-36.

Screening for Alcohol Problems in Primary Care;

A Systematic Review

Background; Primary care physicians can play a unique role in recognizing and treating patients with alcohol problems.

Objective; To evaluate the accuracy of screening methods for alcohol problems in primary care.

Methods; We performed a search of MEDLINE for years 1966 through 1998. We included studies that were in English, were performed in primary care, and reported the performance characteristics of screening methods for alcohol problems against a criterion standard. Two reviewers appraised all articles for methodological content and results.

Results; Thirty-eight studies were identified. Eleven screened for at-risk, hazardous, or harmful drinking; 27 screened for alcohol abuse and dependence. A variety of screening methods were evaluated.

The Alcohol Use Disorders Identification Test (AUDIT) was most effective in identifying subjects with at-risk, hazardous, or harmful drinking (sensitivity, 51%-97%; specificity, 78%-96%).

The CAGE questions proved superior for detecting alcohol abuse and dependence (sensitivity, 43%-94%; specificity, 70%-97%).

These 2 formal screening instruments consistently performed better than other methods, including quantity-frequency questions.

The studies inconsistently adhered to methodological standards for diagnostic test research: 3 provided a full description of patient spectrum (demographics and comorbidity), 30 avoided workup bias, 12 avoided review bias, and 21 performed an analysis in pertinent clinical subgroups.

Conclusions; Despite methodological limitations, the literature supports the use of formal screening instruments over other clinical measures to increase the recognition of alcohol problems in primary care.

Research; David A. Fiellin, M. Carrington Reid, Patrick G. O’Connor. Screening for Alcohol Problems in Primary Care; A Systematic Review. Arch Intern Med. 2000;160:1977-1989.

Brief-TSF includes both the AUDIT and CAGE questionnaires.

• Early detection, including screening and brief interventions (for nondependent problem drinkers)
• Comprehensive assessment and individualized treatment plan
• Care management
• Individually delivered, proven professional interventions
• Contracting with patients
• Social skills training
• Medications
• Specialized services for medical, psychiatric, employment or family problems
• Continuing care
• Strong bond with therapist or counselor
• Longer duration (for alcohol dependent persons)
• Participation in support groups
• Strong patient motivation

Research Sources: McLellan, T.A. 2002; Miller,W.R. 2002; National Institute on Drug Abuse. 1999; Project MATCH Research Group. 1997.

Active participation in a support group can contribute to long-term recovery.

Project MATCH and other studies in the 1990s definitively proved that AA can be an active ingredient of treatment both during a professional intervention and afterward, depending on the patient’s type of therapy.

Patients who joined the AA fellowship or who had an AA sponsor after receiving twelve step facilitation therapy had better abstinence records than those who received an intervention but did not continue their AA participation upon completion.

Other research indicates AA participation may be less effective for patients who receive cognitive behavior therapy because the programs have different goals that may confuse patients.

What researchers still don’t understand, however, are the precise mechanisms of AA participation.

While AA affiliation is associated with self-efficacy, motivation and coping efforts, all significant predictors of good outcome following a professional intervention, some studies have shown that patients who adopt more of the fellowship’s basic tenets – such as acknowledging that alcoholism is a disease, admission of their powerlessness over alcohol and working the twelve steps of the program – relapse at the same rates as patients who adopt very few.

This suggests that the active ingredient may be less about AA per se than continuing participation in support groups that promote a lifestyle inconsistent with the problematic use of alcohol and other drugs.

From; www.ensuringsolutions.org

Brief-TSF is designed to support active participation in Alcoholics Anonymous.

A new report shows that people in recovery can help hospitalized alcoholics by encouraging them to quit drinking and enter counseling, Reuters reported June 11.

“A recovering alcoholic can help alcoholics who are still suffering from the disease, because the patients relate to them,” said Dr. Richard D. Blondell, an addiction-medicine specialist at the University of Louisville School of Medicine in Kentucky. “The patients credit the visitor as the main thing that motivated them.”

The study included 140 patients who were hospitalized for alcohol-related incidents. One group received standard medical care, a second group received medical care plus a 15-minute intervention by a trained addiction specialist, and the third group received medical care, intervention, and an in-depth talk with a recovering alcoholic.

Researchers found that 59 percent of those who met with recovering alcoholics abstained from drinking for six months after the incident, compared to 44 percent of those who received addiction counseling alone, and one-third of those who only received medical care.

In addition, half the patients who met with recovering alcoholics had entered some form of treatment, compared with only 15 percent of those who received medical treatment and counseling by an addiction specialist.

The study is published in the May issue of the Journal of Family Practice.

From; Jointogether

Brief-TSF is based on these principles.

A pilot study of the role of AA sponsors

An AA sponsor is a close 1-on-1 collaboration between an older sober member and a relative newcomer to sobriety. Its a two way helping relationship – the sponsor affirms their own sobriety and the sponsee gains new insights.

AIMS: The aim of this study was to explore the roles of Alcoholics Anonymous (AA) sponsors and to describe the characteristics of a sample of sponsors.

METHODS: Twenty-eight AA sponsors, recruited using a purposive sampling method, were administered an unstructured qualitative interview and standardized questionnaires. The measurements included: a content analysis of sponsors’ responses; Severity of Alcohol Dependence Questionnaire-Community version (SADQ-C) and Alcoholics Anonymous Affiliation Scale (AAAS).

RESULTS: Sample characteristics were as follows:

• the median length of AA attendance was 9.5 years (range 5-28);
• the median length of sobriety was 11 years (range 4.5-28);
• the median number of sponsees per sponsor was 1 but there was a wide range (0-17, interquartile range 3.75); and
• the sponsors were highly affiliated to AA (median AAAS score 8.75, range 5.5-8.75, maximum possible score 9).

Past alcohol dependence scores were surprisingly low:

• 5 (18%) sponsors had mild,
• 14 (50%) moderate and
• 9 (32%) severe dependence according to the SADQ-C (median 26.5, range 11-56).

Sponsorship roles were as follows: 16 roles were identified through the initial content analysis. These were distilled into three super-ordinate roles through a thematic analysis:

1. encouraging sponsees to work the programme of AA (doing the 12 steps and engaging in AA activity);
2. support (regular contact, emotional support and practical support); and
3. carrying the message of AA (sharing sponsor’s personal experience of recovery with sponsees).

CONCLUSIONS: The roles identified broadly corresponded with the AA literature delineating the duties of a sponsor. This non-random sample of sponsors was highly engaged in AA activity but only had a past history of moderate alcohol dependence.

Research; The role of AA sponsors: a pilot study. Whelan PJ, Marshall EJ, Ball DM, Humphreys K. Alcohol Alcohol. 2009 Jul-Aug;44(4):416-22. Epub 2009 Mar 18.

• See also;
• 12 Step Sponsor

The Twelve-Step Facilitation Handbook: A Systematic Approach to Early Recovery from Alcoholism and Addiction by Joseph Nowinski

The Twelve Steps Of Alcoholics Anonymous: Interpreted By The Hazelden Foundation by Hazelden Foundation

 

Delivery of a brief motivational intervention to patients with alcohol-related facial injuries: role for a specialist nurse.

In this paper we focus on providing an alcohol screening and intervention service within maxillofacial surgery.

Two trained nurses screened patients with alcohol-related facial injuries who attended maxillofacial outpatient clinics, and gave brief motivational interventions to those who had been drinking to a hazardous level.

Patients were followed up at 3 and 12 months after the intervention. 195/249 patients (78%) drank to a hazardous level.

One hundred and ninety-five patients received an intervention. Duration of intervention was between 5 and 65 minutes. Reasons for refusal to participate included lack of interest or time, and the main reason for exclusion was length of time since injury.

The follow up rate was 103 (53%) at 3 months and 134 (69%) at 12 months.

CONCLUSIONS: The high level of hazardous drinking among people with facial trauma suggests a clear need for alcohol screening and intervention. It is feasible for nursing staff to deliver brief interventions in a busy maxillofacial trauma clinic.

Oakey F, Ayoub AF, Goodall CA, Crawford A, Smith I, Russell A, Holland IS. Delivery of a brief motivational intervention to patients with alcohol-related facial injuries: role for a specialist nurse. Br J Oral Maxillofac Surg. 2008 Mar;46(2):102-6. Epub 2007 Dec 21.

See also;

• Brief-TSF is designed to address these issues.