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

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)

 

Mutual Support: For Professionals

This article at Faces and Voices of Recovery details some of the issues in working with mutual and self-help fellowships for recovery from various substance abuse issues.

Subjects include;

A. Problems and Pitfalls in Working With Mutual Support Groups

• Taking Over the Peer Helper Role
• Over identification with Resistance
• Problems with Religion
• Gender Issues
• Discomfort in groups
• Lack of transportation and other logistical barriers
• Working at Cross Purposes With the Group

B. Indicators of Mutual Support Involvement

C. Aids to Working With Mutual Support Groups

• General
• American Self Help Clearinghouse Self help Sourcebook online
• National Mental Health Consumers’ Self Help Clearinghouse
• Chemical Dependency
• Mental Illness

D. Professional Responsibilties

E. Readings & References

Note: A PDF version of this guide for professionals is also available.

More at; Faces and Voices of Recovery

See also;

• “I’m a doctor and an addict” What happens next?
•  COUNSELOR CHARACTERISTICS

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

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.

The impact of Alcoholics Anonymous (AA) on non-professional substance abuse recovery programs and sober living houses.

In addition to being a widely used and effective approach for alcohol problems, AA has been central to the development of several types of nonprofessional recovery programs.

Known as “social model recovery,” these programs were staffed by individuals in recovery and they encouraged program participants to become involved in AA as a way to address their drinking problems. In addition, they relied on the traditions, beliefs, and recovery practices of AA as a guide for managing and operating programs (e.g., democratic group processes, shared and rotated leadership, and experiential knowledge).

This chapter reviews the philosophy, history, and recent changes in several types of these programs, along with a depiction of AA’s influence on them.

Programs examined include neighborhood recovery centers, residential social model recovery programs, and two types of sober living houses: California Sober Living Houses and Oxford Houses. Recent outcome evaluations on both types of sober living houses are presented.

Polcin DL, Borkman T. The impact of Alcoholics Anonymous (AA) on non-professional substance abuse recovery programs and sober living houses. Recent Dev Alcohol. 2008;18:91-108.

See also;

• Brief-TSF ASSESSMENT
• AA and Treatment Work Better Together
• If you have healthcare training this manual may help.
• The Most Effective Form of Harm Reduction

Group Treatment for Substance Abuse: A Stages-of-Change Therapy Manual

The author of this article describes a psychological model, based on studies he and his colleagues have conducted, to clarify the operation of Alcoholics Anonymous (AA) and other movements that operate through social and ideologically grounded support and can be characterized as “spiritual recovery movements.”

Taken together, the findings from the cited studies make evident that peer-led ideologically oriented self-help programs illustrate the value of combining intense mutual support with the psychology of commitment to a health-related ideology.

Although peer-led self-help programs are not among the approaches employed by traditional psychiatrically grounded providers of care, their success underlines their potential value to mental health professionals who can make use of these programs to complement conventional treatment.

This would require the introduction of certain elements in professional curriculums, such as;

• an understanding of the psychology underlying these programs,
• an openness to the contribution of such programs to recovery from illness, and
• competency in referral to and even collaboration with these programs.

The current practice of psychiatrists and general medical caregivers does not reflect acceptance of these programs, however.

The author recommends that physicians in psychiatric residency programs should, as part of their standard curriculum, attend AA meetings, visit drug-free therapeutic community programs, and serve as co-leaders of peer-led therapy groups on ambulatory services.

Research report; Galanter, M. Alcohol and drug abuse: Healing through social and spiritual affiliation. Psychiatric Services, 53(9):1072-1074, 2002.

Brief-TSF is designed to address these issues.

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