Introducing a Multidimensional Measurement Model for Addiction Recovery
The sun was thought to revolve around the earth for 1500 years. It was not until a European astronomer named – Nicolaus Copernicus first formulated a modern heliocentric theory of the solar system that we began to change our thinking. This insight eventually ushered in a major paradigm shift in astronomy and physics. Any model or viewpoint of improvement maintains the integrity and meaning of its own position, often with the exception of other explanations. For example, there are models of recovery and theories for: biological, psychological, social, cultural and spiritual views, all of which can explain human behavior. Unfortunately, these views can thus & # 147; blind & # 148; their adherents to alternative interpretations until some new insight is obtained that solves the unresolved issues. It is my hope that 7 & # 150; Dimension model for measuring dependency dependency is a step towards a & # 147; Copernicus & # 148; type of paradigm shift.
Because human behavior is so complex, an attempt to understand the reasons why individuals continue to use and / or abuse themselves with drugs and / or ill-adjusted behavioral addiction to the point of developing self-defeating behavior patterns and / or other lifestyle dysfunctions or self-harm is extremely difficult to achieve. Many researchers, therefore, prefer to talk about risk factors that may contribute but may not be sufficient to cause addiction. They point to an eclectic biopsychosocial approach that involves multidimensional interactions between genetics, biochemistry, psychology, sociocultural and spiritual influences.
Risk factors / contributing causes / influences:
1. Genetics (Family History) & # 150; is known to play a role in causing sensitivity through such biological pathways as metabolic rates and sensitivity to alcohol and / or other medications or addictive behaviors.
2. Biochemistry & # 150; the discovery of morphine-like substances called endorphins (runners high, etc.) and the so-called & # 147; pleasure track & # 148; & # 150; the mesocorticolimbic dopamine pathway (MCLP). This is the brain center or possible anatomical sites underlying addiction where alcohol and other substances stimulate to produce euphoria & # 150; which then becomes the desired goal (tolerance & # 150; loss of control & # 150; withdrawal).
3. Psychological factors & # 150; developmental personality traits, vulnerability to stress, and the desire for tension and symptom reduction from various mental health issues and traumatic life experiences.
Our current healthcare system is geared to focus on acute care rather than chronic illnesses. It focuses on a Unitary Syndrome model where the only marker of treatment response or success is specific symptom reduction. Health care consumers are increasingly advocating for a multidimensional model that takes into account a number of life-functioning domains that influence patient progress in treatment. Evidence-based meta-analysis studies also claim the prognostic power of life-function variables to predict outcomes, as well as their significance for treatment planning versus a unit model that has had little empirical support. Precise diagnosis also relies on a thorough multidimensional assessment process, along with possible assistance from a multidisciplinary treatment team approach. Behavioral practitioners are aware that although a disorder can be primarily physical or primarily psychological, it is always a disorder for the whole person & # 150; not just of the body or mind.
American Society of Addiction Medicine (ASAM)
The American Society of Addiction Medicine & # 146; s (2003) & # 147; Patient Positioning Criteria for the Treatment of Substance-Related Disorders, 3rd Edition & # 148 ;, has set the standard in addiction treatment for recognition of a multi-dimensional, biopsychosocial assessment process. ASAM developed the following six dimensions specifically for the dependency area with the aim of providing clinicians with decision guidelines for patients’ care space:
1. Potential acute intoxication and / or withdrawal
2. Biomedical conditions and complications
3. Emotional / behavioral conditions and complications
4. Acceptance of treatment / resistance
5. Potential for relapse / continued use
6. Recovery environment
ASAM dimensional boundaries were developed to assess the severity of illness (alcoholism / substance abuse). Then, the severity of the disease level is used to determine the match to the type and intensity of the treatment to help guide placement in one of four care levels. The dimensional assessments involve asking whether the patient’s daily living activities were significantly impaired in order to disrupt or distract goals and abstinence, restitution and / or stability therapy.
Seven Dimensions Model
In 2004, the Dependency Dependency Improvement System (ARMS) was published & # 150; describing the following seven life-functional therapeutic activity dimensions for measuring progress. As can be seen below, ASAM (Severity of Illness) dimensions do not compete with the seven & # 147; Life Functional & # 148; dimensions, but rather add depth in the description of abstinence / relapse & # 150; 7th dimension. Each of the seven dimensions has individualized assessment criteria:
1. Social / cultural & # 150; dimension
2. Medical / physical – dimension
3. Mental / emotional – dimension
4. Educational / occupational dimension
5. Spiritual / religious dimension
6. Legal / financial dimension
7. Abstinence / relapse – dimension
a. Acute intoxication and / or potential for withdrawal
b. Biomedical conditions and complications
c. Emotional / behavioral conditions and complications
d. Treatment acceptance / resistance
e. Relapse / continued use potential
f. Recovery environment
Note: These seven dimensions are delineated in the book entitled Poly-behavioral Addiction and the Addiction Recovery measurement (Slobodzien, 2005).
The 7 & # 150; Dimension recovery model is not based on an extended version of ASAM dimensions. As noted above, it was originally designed to measure patient progress by assessing therapeutic life functioning activities. Investigators can prove to be effective as a general model for recovery from all pathological diseases, disorders and disabilities. It & # 146; s multidimensional assessment / treatment process includes the interconnection of multiple dimensions from biomedical to spiritual – taking into account the effects of feedback and the existence of each dimension mutually affecting each other. Due to human nature being complex, treatment progress must initially be adapted and guided by an individualized treatment plan based on a comprehensive biopsychosocial assessment that identifies specific problems, goals, objectives, methods and schedules for achieving the goals and treatment.
Lifestyle dependency can affect many domains in the individual’s functioning and often requires multimodal treatment. Targets for treatment include reduction in drug use and effects or attainment of abstinence, reduction in frequency and severity of relapse, and improvement of psychological and social functioning. Real progress requires time, dedication, and discipline in thinking about it, planning for it, working the plan, and monitoring the successes that have been made to prevent relapse. It also requires appropriate interventions and motivational strategies for each area of progress in a single life.
7 – Dimensions is a non-linear, dynamic, non-hierarchical model that focuses on interactions between multiple risk factors and situational determinants similar to disaster and chaos theories by predicting and explaining addictive behaviors and relapses. Multiple influences trigger and operate in high-risk situations and affect the individual’s global multidimensional function. The relapse process incorporates the interplay of background factors (e.g., family history, social support, years of possible addiction, and co-morbid psychopathology), physiological states (e.g., physical withdrawal), cognitive processes (e.g., self-efficacy, craving, motivation, the effect of withdrawal violations, expected outcomes) and coping skills (Brownell et al., 1986; Marlatt & Gordon, 1985). To put it simply, small changes in individual behavior can result in large qualitative changes at the global level and patterns at the global level in a system arise solely from innumerable small interactions. The clinical utility of 7 & # 150; The dimension restoration model is in its ability to help healthcare providers quickly gather detailed information about a person’s personality, background, substance use history, affective state, self-efficacy and coping skills for prognosis, diagnosis, treatment planning, and outcome goals.
The 7-dimension hypothesis is that there is a multidimensional synergistic negative resistance that individuals develop into any kind of treatment for a single dimension of their lives because the effects of an individual dependence have interacted multi-dimensionally. Having the primary focus on one dimension is inadequate. Traditionally, addiction treatment programs have failed to address the multidimensional synergistically negative effects of an individual who has multiple addictions (eg nicotine, alcohol and obesity, etc.). Behavioral addictions interact negatively with each other and with strategies to improve overall functioning. They tend to encourage the use of tobacco, alcohol and other drugs, help increase violence, reduce functional capacity and promote social isolation. Most treatment theories today involve assessing other dimensions to identify dual diagnosis or co-morbidity diagnoses or to assess contributing factors that may play a role in the individual’s primary dependence. The 7 dimensions & # 146; Theory is that a multi-dimensional treatment plan must be prepared that addresses the possible multiple dependencies identified for each individual life dimension in addition to developing specific goals and objectives for each dimension.
The 7 – Dimensions & # 146; theory promotes a synergistic positive effect that can ignite and release the human spirit when a person’s & # 146; s life-functional dimensions are elevated in a homeostatic system. The reciprocity between spirituality and multidimensional life function progress creates the deepest inherent self-image and behavioral changes. The underlying 7 – Dimension theory claims that the combination of individuals & # 146; Elevated and balanced multiple life functional dimensions can produce a synergistically tough, resilient and spiritually positive individual homeostasis. Like the combination of alcohol and drugs (for example, valium) when combined, it produces a synergistic effect (strength effects are not added but multiplied) and can develop into an addiction or unbalanced lifestyle, positive treatment efficacy and successful results. a synergistic relationship with & # 147; The higher power. & # 148;
The 7 & # 150; Dimensions model recognition that family genetics and biopsychosocial, historical, and developmental conditioning factors are difficult and sometimes impossible to change in individuals. The standardized performance-based addiction measurement system philosophy incorporates a bio-psychosocial illness model that focuses on a cognitive-behavioral perspective in trying to change poorly adapted thinking and improve a person’s ability and behavior to solve problems and plan for sustained improvement. Many health care consumers of addiction addiction services have a genetic pre-disposition history for addiction. They have suffered and continue to suffer from past traumatic life experiences (e.g., physical, sexual, and emotional abuse, etc.) and often along with psychosocial stressors (e.g., occupational stress, family / marital problems, etc.), which have left behind them intense and confusing. feelings (eg anger, anxiety, bitterness, fear, guilt, sadness, loneliness, depression and inferiority, etc.) that strengthen their already low self-esteem. The complex interplay of these factors can leave the individual with much deeper mental health problems involving self-hatred, self-punishment, self-denial, low self-control, low self-esteem, and a seriously low self-esteem, with a total (sometimes hidden) negative self-identity.
The 7 & # 150; Dimensional model combines a multidimensional force field analysis of an individual & # 146; & rsquo; s unique problems in identifying positive strength prognostic factors, with behavioral contracting, and a symbol – & # 147; similar & # 148; – economy point system to carry out this task. Force field analysis is a process in which an individual behavior is assessed to determine which are the key forces that drive the addictive behavior and which are the key forces that limit the addictive behavior. A plan is implemented to identify the factors that hold the positive forces to somehow manipulate these forces to increase the likelihood of moving a person’s behavior in a pro-social recovery direction. Kurt Lewin (1947), who originally developed Force Field Theory argued that a subject is held in balance by the interaction of two opposing cancer kits & # 150; those who seek to promote change (driving forces) and those who seek to maintain the status quo (restraining forces). Any given social event occurs at a given frequency in a given social context, and the frequency of the event is dependent on forces acting to increase the event, as well as forces acting to decrease the event. At any given time, there is a & # 147; semi-stable equilibrium & # 148; where the frequency of the social event remains the same as long as there is no change in the number or strength of the forces acting to increase the social event, or any change in the forces acting to reduce the event . Equilibrium is altered in both directions by increasing the frequency or intensity of the driving force or retention forces, thereby creating a corresponding increase or decrease in the frequency of an individual & # 147; s & # 147; addictive & # 148; behavior.
The long-term goal is the health care consumer’s highest optimal function, not just the absence of pathology or symptom reduction. The short-term goal is to change the healthcare system to accommodate and assimilate to a multidimensional healthcare system perspective. The 7 & # 150; Dimension model addresses the low confidence – & # 147; addiction – common denominator & # 148; by helping individuals establish values, set and achieve goals, and monitor successful performance.
When we consider that addiction involves unbalanced lifestyles operating within semi-stable equilibrium strength fields, the 7 – Dimension philosophy promotes that there is a supernatural-like spiritual synergistic effect that occurs when an individual & # 146; Several life-functional dimensions are raised in a homeostatic human system. This bilateral spiritual connection reduces chaos and increases resilience to bring about individual harmony, wellness and productivity. ARMS takes an objective perspective on spirituality by assessing an individual & # 146; s positive and / or negative spiritual / religious dimension with the religious attitude inventory (e.g., RAI is able to identify extremely unhealthy cult-like spirituality with the rigid, and intolerant religious and militant orthodoxy practiced by some terrorists, etc.). RAI test results are also integrated into the forecasting scoring system.
The 7 & # 150; Dimensional model also promotes twelve-step recovery groups such as alcoholics and anonymous narcotics along with spiritual and religious restoration activities as a necessary means to maintain results effectiveness. The National Institute for Alcohol Abuse and Alcoholism’s recent research findings consider such active involvement with AA / NA as the decisive factor responsible for sustained improvement.
The 7 & # 150; The Dimensions Model does not claim to be a panacea for illnesses in addiction treatment courses and outcomes, but it is a step in the right direction to get clinicians to change the way they practice by changing treatment facility systems to incorporate evidence-based research findings into effective interventions. . The challenge for those interested in conducting outcome evaluations to improve their quality of care is to incorporate a system that will standardize their assessment procedures, treatment programs, and clinical treatment practices. By closely following a standardized system to obtain baseline outcome statistics of their treatment program effectiveness despite the outcome, they will be able to assess the effectiveness of subsequent treatment interventions.
For more info see:
Poly-Behavioral Addiction and the Addiction Recovery Measurement System (ARMS)
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Text Revision. Washington, DC, American Psychiatric Association, 2000, p 787 & p 731.
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Brain Repair, University of South Florida College of Medicine, Tampa; June 2005, the journal of
Gorski, T. (2001), Relapse Prevention in the Managed Care Environment. GORSKI-CENAPS Web
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