0
0

Chapter 26. Twelve-Step FacilitationAn Adaptation for Psychiatric Practitioners and Patients

Richard K. Ries, M.D.; Marc Galanter, M.D.; J. Scott Tonigan, Ph.D.
DOI: 10.1176/appi.books.9781585623440.353395

Sections

Excerpt

The goal of this chapter is to help clinicians better engage and support patients who have co-occurring or primary alcohol or drug problems through use of 12-step programs to enhance treatment outcomes and recovery. Twelve-step facilitation (TSF) is an evidence-based practice with a large research base, a therapy manual (Nowinski et al. 1995), and a Web-based training site (Sholomskas and Carroll 2006). It is a valuable technique easily available to the practicing psychiatrist and other mental health professionals. The research base of TSF is reviewed in other chapters of this book. This chapter is a condensed presentation of some of the key techniques and concepts of TSF, with some special adaptations for psychiatric practice. An important concept to recognize at the outset is that TSF is a therapist's technique to help patients engage in and maximize their response to 12-step meetings, such as Alcoholics Anonymous (AA). (TSF is not AA, nor is it, as far as we know, officially endorsed by AA or other 12-step programs.) TSF can also be applied to treat individuals who are dependent on substances other than alcohol, such as narcotics. Such individuals can be encouraged to go to Narcotics Anonymous (NA) meetings, where the 12 steps are applied as well.

Your session has timed out. Please sign back in to continue.
Sign In Your Session has timed out. Please sign back in to continue.
Sign In to Access Full Content
 
Username
Password
Sign in via Athens (What is this?)
Athens is a service for single sign-on which enables access to all of an institution's subscriptions on- or off-site.
Not a subscriber?

Subscribe Now/Learn More

PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.

Need more help? PsychiatryOnline Customer Service may be reached by emailing PsychiatryOnline@psych.org or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).

Table Reference Number
TABLE 26–1. The 12 Steps of Dual Recovery Anonymous
Table Reference Number
TABLE 26–2. Engaging those with Alcoholics Anonymous (AA) resistance
Table Reference Number
TABLE 26–3. Examples of working with patients
Table Reference Number

Co-occurring and substance-induced disorders are common in psychiatric patients, and mental health practitioners can enhance outcomes from both disorders by applying 12-step facilitation (TSF).

TSF is not Alcoholics Anonymous (AA) nor is it endorsed by AA. It is an evidence-based therapy performed by the clinician to help a patient begin to attend and benefit from 12-step meetings, including AA.

Co-occurring disorders (COD) TSF is a practical enhancement of TSF that includes typical psychiatric issues and treatment but has not been separately tested.

Twelve-step approaches and meetings are ubiquitous, inexpensive, and evidence based and provide long-term, recovery-based help with patients with substance use disorders.

Twelve-step approaches to acceptance and denial for the chronic and often relapsing illness of addiction are appropriate for and benefit most psychiatric disorders.

The official policy of AA is supportive to seeing psychiatrists and taking psychiatric medications for mental disorders. However, a good deal of variability exists with many 12-step communities having COD 12-step meetings and others being neutral or even hostile toward the idea.

Developing COD TSF skills is an effective way for the mental health practitioner to stay productively involved with his or her COD patient, provides a good model of integrated care, and provides a great deal of low-cost but high-frequency psychosocial support to the patient.

References

Alcoholics Anonymous: Alcoholics Anonymous. New York, Alocholics Anonymous World Services Inc., 1976
 
Alcoholics Anonymous: Twelve Steps and Twelve Traditions. New York, Alocholics Anonymous World Services Inc., 1984
 
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000
 
Bolton J, Cox B, Clara I, et al: Use of alcohol and drugs to self-medicate anxiety disorders in a nationally representative sample. J Nerv Ment Dis 194:818–825, 2006
[PubMed]
 
Carroll KM: Behavioral therapies for co-occurring substance use and mood disorders. Biol Psychiatry 56:778–784, 2004
[PubMed]
 
Center for Substance Abuse Treatment: Substance Abuse Treatment for Persons With Co-occurring Disorders. A Treatment Improvement Protocol TIP 42 (DHHS Publ No SMA-05-3992). Rockville, MD, Substance Abuse and Mental Health Services Administration, 2005
 
Comtois KA, Russo JE, Roy-Byrne P, et al: Clinicians' assessments of bipolar disorder and substance abuse as predictors of suicidal behavior in acutely hospitalized psychiatric inpatients. Biol Psychiatry 56:757–763, 2004
[PubMed]
 
Dual Recovery Anonymous: The twelve steps of Dual Recovery Anonymous. 1993–2004. Available at: http://www.draonline.org/dra_steps.html. Accessed January 20, 2008.
 
Galanter M: Spirituality and recovery in twelve-step programs: an empirical model. J Subst Abuse Treat 33:265–272, 2007
[PubMed]
 
Humphreys K, Moos RH: Encouraging posttreatment self-help group involvement to reduce demand for continuing care services: two-year clinical and utilization outcomes. Alcohol Clin Exp Res 31:64–68, 2007
[PubMed]
 
Kaskutas LA, Bond J, Humphreys K: Social networks as mediators of the effect of Alcoholics Anonymous. Addiction 97:891–900, 2002
[PubMed]
 
Kessler RC, Chiu WT, Demler O, et al: Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 62:617–627, 2005
[PubMed]
 
Linehan MM: Cognitive Behavioral Treatment of Borderline Personality Disorder. New York, Guilford, 1993
 
Mankowski ES, Humphreys K, Moos RH: Individual and contextual predictors of involvement in twelve-step self-help groups after substance abuse treatment. Am J Community Psychol 29:537–563, 2001
[PubMed]
 
Marlatt GA, Gordon JR (eds): Relapse Prevention: Maintenance Strategies in the Treatment of Addictive Behaviors. New York, Guilford, 1985
 
Mattson ME, Del Boca FK, Carroll KM, et al: Compliance with treatment and follow-up protocols in Project MATCH: predictors and relationship to outcome. Alcohol Clin Exp Res 22:1328–1339, 1998
[PubMed]
 
McLellan AT, Kushner H, Metzger D, et al: The Fifth Edition of the Addiction Severity Index. J Subst Abuse Treat 9:199–213, 1992
[PubMed]
 
Minkoff K: An integrated treatment model for dual diagnosis of psychosis and addiction. Hosp Community Psychiatry 40:1031–1036, 1989
[PubMed]
 
Morgenstern J: Pathogenesis and Treatment of Alcoholism. PsycCRITIQUES. Washington, DC, American Psychological Association, 2004
 
Norcross JC: Personal integration: an N of 1 study. Journal of Psychotherapy Integration 16:59–72, 2006
 
Nowinski J, Baker S, Carroll K: Twelve Step Facilitation Therapy Manual. Rockville, MD, National Institute on Alcohol Abuse and Alcoholism, 1995
 
Puchalski CM, Dorff RE, Hendi IY: Spirituality, religion, and healing in palliative care. Clin Geriatr Med 20:689–714, vi–vii, 2004
 
Sholomskas DE, Carroll KM: One small step for manuals: computer-assisted training in twelve-step facilitation. J Stud Alcohol 67:939–945, 2006
[PubMed]
 
Tonigan JS, Bogenschutz MP, Miller WR: Is alcoholism typology a predictor of both Alcoholics Anonymous affiliation and disaffiliation after treatment? J Subst Abuse Treat 30:323–330, 2006
[PubMed]
 
Weiss RD: Treating patients with bipolar disorder and substance dependence: lessons learned. J Subst Abuse Treat 27:307–312, 2004
[PubMed]
 
Weiss RD, Ostacher MJ, Otto MW, et al: Does recovery from substance use disorder matter in patients with bipolar disorder? J Clin Psychiatry 66:730–735, 2005
[PubMed]
 
+

CME Activity

Add a subscription to complete this activity and earn CME credit.
Sample questions:
1.
Twelve-step facilitation (TSF), when integrated with usual therapy and medications for substance dependence, has several advantages. Which of the following is not one of these advantages?
2.
The first of Dual Recovery Anonymous' (DRA) 12 steps is "we admitted we were powerless over our dual illness of chemical dependency and emotional or psychiatric illness—that our lives had become unmanageable." This means that persons with both psychiatric and addiction disorders are. . .
3.
HALT is an Alcoholics Anonymous (AA) mnemonic and slogan that captures common emotional relapse states. Which of the following words is represented in the mnemonic?
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Related Content
Articles
Books
The American Psychiatric Publishing Textbook of Substance Abuse Treatment, 4th Edition > Chapter 34.  >
The American Psychiatric Publishing Textbook of Substance Abuse Treatment, 4th Edition > Chapter 35.  >
APA Practice Guidelines > Chapter 14.  >
APA Practice Guidelines > Chapter 0.  >
Topic Collections
Psychiatric News
 
  • Print
  • PDF
  • E-mail
  • Chapter Alerts
  • Get Citation