Portions of this article are excerpted and adapted from the upcoming book Hope Against Hope, authored by Renascent’s Clinical Director Michael Lochran and consulting Psychotherapist Laura Cavanagh. Hope Against Hope’s anticipated release is in 2022.
A Brief History
For more than 40 years before Bill Wilson founded Alcoholics Anonymous (AA), alcoholism was considered to be untreatable. Individuals with alcohol use issues – Bill W. included – were imprisoned or consigned to “drunk tanks” or the foul wards of hospitals. Unable to remain sober for any length of time, Bill W. was convinced that his drinking would kill him. But a surprise visit from an old friend changed everything. His friend had stopped drinking – and had managed to stay stopped. His example gave Bill W. hope and provided a path for him to follow. Soon after, Bill W. quit drinking and remained sober until his death more than 35 years later.
Bill W. knew his encounter with his friend had changed his life forever. Out of a desire to help others in the same way that his friend had helped him, he established the fellowship of Alcoholics Anonymous (AA) in 1935. Since then, AA and its offshoots (such as Narcotics Anonymous (NA), Gamblers Anonymous (GA), Cocaine Anonymous (CA), and others) have grown to include more than two million members across the world.
The example set by the grassroots organization of AA inspired a new wave in medical and professional addiction treatment. AA members were living proof that t recovery was possible. Professional treatment facilities sought to pick up where these grassroots community groups left off, and to help those who needed more intensive help and support. One of the first treatment centres to open was the renowned Hazelden Betty Ford treatment facility. This centre opened its doors in 1949 and remains a leader in the treatment of addiction to this day.
Hazelden’s philosophy, informed by the success of AA, is known as a Twelve-Step Facilitation (TSF) approach. The centre’s professionalized approach was dubbed the Minnesota Model. It incorporated many of the best aspects of the 12-step community groups, including a focus on post-treatment planning for relapse prevention and peer models with lived experience in recovery from addictions as part of their staff. Many treatment centres today, including Renascent, follow versions of the Minnesota Model.
The Twelve-Step Facilitation Approach (TSF)
Twelve-Step Facilitation (TSF) refers to the way clients are introduced to the 12-step model. The Minnesota Model uses TSF along with other supports like cognitive behavioural therapy (CBT), dialectical behaviour therapy (DBT), and Motivational Enhancement Therapy to treat addictions. A goal of TSF is to introduce clients to 12-step programming and to encourage them to build a post-treatment recovery program that includes 12-step involvement in order to prevent relapse after graduation from intensive treatment.
TSF therapy is an effective, evidence-based treatment for addictive disorders, including alcohol-, stimulant-, and other substance-use disorders, as well as for behavioural addictions like gambling. TSF models are effective in both inpatient and outpatient treatment settings. Clients provided with TSF therapy show improved outcomes compared to those who receive generalized addictions counselling or CBT only. This advantage is particularly robust when these groups are compared over long-term follow-up periods.
Effective, evidence-based treatment
A considerable body of research has established TSF as an evidence-based practice for addictions treatment. Using the Centers for Disease Control (CDC)’s definition of strength of research evidence, the Substance Abuse and Mental Health Services Administration (SAMHSA) of the US Department of Health and Human Services summarizes the research-based evidence as follows:
“Well-supported scientific evidence demonstrates the effectiveness of 12-step mutual aid groups focused on alcohol and 12-step facilitation [TSF] interventions.”SAMHSA, Surgeon General’s Report, 2016
The TSF Advantage: A Lifelong Solution
A huge advantage of the TSF model is that relapse prevention and post-treatment engagement are central to programming and promoted throughout the intensive treatment period. Clients are coached in how to sustain recovery as a lifelong practice. Most people can stop drinking or using for a period of time. As Bill W. learned from his multiple stints in hospital wards, it is staying stopped that is the hard part.
Relapse prevention is critically important because addiction is a chronic, relapsing condition. Many individuals who get well in treatment do not stay well when they leave. Many people think of rehab as a cure. But we have to shift our understanding of addiction treatment to match the way we think about the treatment of other chronic conditions, like diabetes. People get well in rehab because they are participating in recovery-oriented activities. When they stop, they do not stay well. This does not mean that the treatment strategies did not work. It means that when we stop using them, they stop working.
The US Comprehensive Assessment and Treatment Outcome Research (CATOR) group is the largest independent research organization that evaluates substance use treatment programs. Independent evaluation is essential because treatment centres are not required by law to report standardized results. Even the earliest work of the CATOR group demonstrated the critical importance of post-treatment engagement, and the effects of intensity and duration of engagement in posttreatment activities. For example, one study found that about 75% of individuals who attended one or more AA meetings per week were abstinent at 6 months, compared to only 45% of those who attended meetings once per month. Only one-third of those who failed to attend any meetings posttreatment were still sober at 6 months. Follow up monitoring found that regular (weekly or more) attendance predicted continued sobriety at 12 and 24 months for (75% of participants). These results are particularly remarkable given that a staggering majority of people relapse within a year of rehab treatment – up to 85%. Indeed, many relapse within the first weeks of graduation from intensive treatment.
Relapse prevention training is clearly essential and it’s a key element of TSF. Participants are provided with concrete strategies around what to do to avoid relapse, and what to do in case of relapse. This is promoted through the concept of lifelong abstinence being achieved moment-by-moment. Participants are encouraged to focus only on a single moment of recovery at a time and invited to commit to not drinking or using for just one day; they always have the option to drink or use tomorrow. A lifetime of sobriety is achieved by stringing together one moment after another.
The Renascent Difference
Like Hazelden Betty Ford, Renascent’s approach integrates TSF with other evidence-based strategies, particularly CBT, DBT, and Motivational Enhancement Therapy. In the tradition of Hazelden’s Minnesota Model, we know the power of example: every one of our counsellors is not only a trained professional but also a living model of recovery from addictions. Our counsellors provide undeniable proof that a lifetime of recovery is not only possible but full of wonderful possibilities.
From the very first day of treatment, we are preparing our clients for life beyond treatment. With their lived experiences, our counselling team sets the example. We begin post-treatment planning from the very beginning. We encourage post-treatment engagement with a range of recovery-oriented and recovery-supporting activities, including involvement in 12-step community groups. Right from the start, we begin to shift the responsibility for a program of recovery onto the person who will be managing it for a lifetime: the client themselves. Through our example and our belief in their ability to get well and stay well, we help our clients to believe in themselves.
Renascent Can Help
At Renascent, we know that freedom from addiction is possible. Every one of our counsellors is living proof. Combining lived experience with evidence-based practice, we help you to get well, and give you the tools to stay well. We help our clients to see that not only is recovery possible, but to see the possibilities that will open to them when they start to put those moments of recovery together, one day at a time.