Addictions Recovery Measurement & the Seven Dimensions Model

Introducing a Multidimensional Recovery Measurement Model for AddictionsThe sun was thought to revolve around the earth for 1500 years. It wasn’t 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 ultimately ushered in a major paradigm shift in astronomy and physics. Every model or viewpoint for recovery maintains the integrity and importance of its own position, often to the exclusion of other explanations. For example, there are recovery models and theories for: biological, psychological, social, cultural, and spiritual viewpoints that can all explain human behavior. Unfortunately, these viewpoints may thus “blind” their adherents to alternative interpretations until some new insight is achieved that resolves the problems left unsolved. It is my hope that the 7 – Dimensions model for addictions recovery measurement is a step towards a “Copernicus” type paradigm shift.Because human behavior is so complex, an attempt to understand the reasons individuals continue to use, and/ or abuse themselves with substances and/ or maladaptive behavioral addictions to the point of developing self-defeating behavior patterns and/ or other life-style dysfunctions or self-harm is enormously difficult to achieve. Many researchers therefore prefer to speak of risk factors that may contribute, but not be sufficient to cause addictions. They point to an eclectic bio-psychosocial approach that involves the multi-dimensional interactions of genetics, biochemistry, psychology, socio-cultural, and spiritual influences.
Risk Factors / Contributory Causes / Influences:1. Genetics (family history) – is known to play a role in causing susceptibility through such biological avenues as metabolic rates and sensitivity to alcohol and/ or other drugs or addictive behaviors.2. Biochemistry – the discovery of morphine-like substances called endorphins (runners high, etc.) and the so-called “pleasure pathway” – the mesocorticolimbic dopamine pathway (MCLP). This is the brain center or possible anatomic site underlying addictions at which alcohol and other drugs stimulate to produce euphoria – which then becomes the desired goal to attain (tolerance – loss of control – withdrawal).3. Psychological Factors – developmental personality traits, vulnerability to stress, and the desire for tension and symptom reduction from various mental health problems and traumatic life experiences.Our present healthcare system is set up to focus on acute care rather than chronic illnesses. It focuses on a Unitary Syndrome model in which the sole marker of treatment response or success is specific symptom-reduction. Healthcare consumers are increasingly advocating for a multidimensional model that takes into account an array of life-functioning domains that influence patient treatment progress. Evidenced-based meta-analysis studies also purport the prognostic power of life-functioning variables to predict outcome as well as their importance for treatment planning over a unitary model that has had little empirical support. Accurate diagnosis is also dependent on a thorough multidimensional assessment process along with the possible help of a multidisciplinary treatment team approach. Behavioral Medicine practitioners have come to realize that although a disorder may be primarily physical or primarily psychological in nature, it is always a disorder of the whole person – not just of the body or the mind.American Society of Addiction Medicine (ASAM)The American Society of Addiction Medicine’s (2003), “Patient Placement Criteria for the Treatment of Substance-Related Disorders, 3rd Edition”, has set the standard in the field of addiction treatment for recognizing a multidimensional, bio-psychosocial assessment process. ASAM developed the following six dimensions specifically for the addictions field with the intent to provide clinicians with decision-making guidelines for patient placement of care:1. Acute Intoxication and/ or Withdrawal Potential2. Biomedical Conditions and Complications3. Emotional/ Behavioral Conditions and Complications4. Treatment Acceptance / Resistance5. Relapse / Continued Use Potential6. Recovery EnvironmentThe ASAM dimensional delineations were developed to assess severity of illness (alcoholism/ drug addiction). The severity of illness level is then used to determine the match to type and intensity of treatment to help guide placement into one of four levels of care. The dimensional assessments would involve asking if the patient’s daily living activities were significantly impaired to interfere with or distract from abstinence, recovery, and/ or stability treatment goals and efforts.Seven Dimensions ModelIn 2004, the Addictions Recovery Measurement System (ARMS), was published – describing the following seven life-functioning therapeutic activity dimensions for progress outcome measurements. As can be seen below, the ASAM (Severity of Illness) dimensions do not compete with the seven “Life-functioning” dimensions, but rather add depth in describing the Abstinence/ Relapse – 7th Dimension. Each of the seven dimensions has individualized assessment criteria:1. Social/ Cultural – Dimension2. Medical/ Physical – Dimension3. Mental/ Emotional – Dimension4. Educational/ Occupational – Dimension5. Spiritual/ Religious – Dimension6. Legal/ Financial – Dimension7. Abstinence/ Relapse – Dimensiona. Acute Intoxication and/ or Withdrawal Potentialb. Biomedical Conditions and Complicationsc. Emotional/ Behavioral Conditions and Complicationsd. Treatment Acceptance / Resistancee. Relapse / Continued Use Potentialf. Recovery EnvironmentNote: These seven dimensions have been delineated in the book entitled, Poly-behavioral Addiction and the Addictions Recovery Measurement System (Slobodzien, 2005).The 7 – Dimension recovery model is not based upon an expanded version of the ASAM dimensions. As noted above, it was initially designed to measure patient progress by assessing therapeutic life-functioning activities. Researched may prove it to be effective as a generalized model for recovery, from all pathological diseases, disorders, and disabilities. It’s multidimensional assessment/ treatment process includes the internal interconnection of multiple dimensions from biomedical to spiritual – taking into account the effects of feedback and the existence of each dimension mutually influencing each other simultaneously. Because of the complexity of human nature, treatment progress needs to be initially tailored and guided by an individualized treatment plan based on a comprehensive bio-psychosocial assessment that identifies specific problems, goals, objectives, methods, and timetables for achieving the goals and objectives of treatment.Life-style addictions may affect many domains of an individual’s functioning and frequently require multi-modal treatment. Goals of treatment include reduction in the use and effects of substances or achievement of abstinence, reduction in the frequency and severity of relapse, and improvement in psychological and social functioning. Real progress requires time, commitment, and discipline in thinking about it, planning for it, working the plan, and monitoring the successes made to prevent relapse. It also requires appropriate interventions and motivating strategies for each progress area of an individual’s life.7 – Dimensions is a nonlinear, dynamical, non-hierarchical model that focuses on interactions between multiple risk factors and situational determinants similar to catastrophe and chaos theories in predicting and explaining addictive behaviors and relapse. Multiple influences trigger and operate within high-risk situations and influence the global multidimensional functioning of an individual. The process of relapse incorporates the interaction between background factors (e.g., family history, social support, years of possible dependence, and co morbid psychopathology), physiological states (e.g., physical withdrawal), cognitive processes (e.g., self-efficacy, cravings, motivation, the abstinence violation effect, outcome expectancies), and coping skills (Brownell et al., 1986; Marlatt & Gordon, 1985). To put it simply, small changes in an individual’s behavior can result in large qualitative changes at the global level and patterns at the global level of a system emerge solely from numerous little interactions. The clinical utility of the 7 – Dimensions recovery model is in its ability to assist health care providers to quickly gather detailed information about an individual’s personality, background, substance use history, affective state, self-efficacy, and coping skills for prognosis, diagnosis, treatment planning, and outcome measures.The 7 – Dimensions hypothesis is that there is a multidimensional synergistically negative resistance that individual’s develop to any one form of treatment to a single dimension of their lives, because the effects of an individual’s addiction have dynamically interacted multi-dimensionally. Having the primary focus on one dimension is insufficient. Traditionally, addiction treatment programs have failed to accommodate for the multidimensional synergistically negative effects of an individual having multiple addictions, (e.g. 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, decrease 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 addiction. The 7 Dimensions’ theory is that a multidimensional treatment plan must be devised addressing the possible multiple addictions identified for each one of an individual’s life dimensions in addition to developing specific goals and objectives for each dimension.The 7 – Dimensions’ theory promotes a synergistically positive effect that can ignite and set free the human spirit when an individual’s life functioning dimensions are elevated in a homeostatic system. The reciprocity between spirituality and multidimensional life functioning progress, establish the deepest intrinsic self-image and behavioral changes. The underlying 7 – Dimensions theory purports that the combination of an individuals’ elevated and balanced multiple life-functioning dimensions can produce a synergistically tenacious, resilient, and spiritually positive individual homeostasis. Just as the combination of alcohol and drugs (for example valium) when taken together produce a synergistic effect (potency effects are not added together, but multiplied), and can develop into an addiction or unbalanced life-style, positive treatment effectiveness and successful outcomes are the result of a synergistic relationship with “The Higher Power.”The 7 – Dimensions model acknowledges that family genetics, and bio-psychosocial, historical, and developmental conditioning factors are difficult and sometimes impossible to be changed within individuals. The standardized performance-based Addictions Recovery Measurement System philosophy incorporates a bio-psychosocial disease model that focuses on a cognitive behavioral perspective in attempting to alter maladaptive thinking and improve a person’s abilities and behaviors to solve problems and plan for sustained recovery. Many healthcare consumers of addiction recovery services have a genetic pre-dispositional 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 present with psychosocial stressors (e.g. occupational stress, family/ marital problems, etc.) leaving them with intense and confusing feelings (e.g. anger, anxiety, bitterness, fear, guilt, grief, loneliness, depression, and inferiority, etc.) that reinforce their already low self-esteem. The complex interaction 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-respect, and a severe low self-esteem condition, with an overall (sometimes hidden) negative self-identity.The 7 – Dimensions model combines a multidimensional force field analysis of an individual’s unique problems to identify positive strength prognostic factors, with behavioral contracting, and a token-“like”- economy point system to accomplish this task. Force field analysis is a process whereby an individual’s behavior is assessed to determine which are the key forces driving the addictive behaviors and which are the key forces restraining the addictive behaviors. A plan is implemented to identify the positive strength restraining factors to somehow manipulate those forces in order to increase the likelihood of moving an individual’s behavior in a pro-social recovery direction. Kurt Lewin (1947) who originally developed the Force Field Theory argued that an issue is held in balance by the interaction of two opposing sets of forces – those seeking to promote change (driving forces) and those attempting 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 upon forces acting to increase the event as well as forces acting to decrease the event. At any given point in time, there is a “semi-stable equilibrium” whereby the frequency of the social event will remain the same so long as there is neither change in the number or strength of the forces acting to increase the social event nor any change in the forces acting to decrease the event. Equilibrium is altered in either direction by increasing the frequency or intensity of the driving or the restraining forces and thereby creating a corresponding increase or decrease in the rate of an individual’s “addictive” behaviors.The long-term goal is the health-consumer’s highest optimal functioning, not merely the absence of pathology or symptom reduction. The short-term goal is to change the health care system to accommodate and assimilate to a multidimensional health care perspective. The 7 – Dimensions model addresses the low self-esteem – “addiction – common denominator” by helping individuals establish values, set and accomplish goals, and monitor successful performance.Additionally, when we consider that addictions involve unbalanced life-styles operating within semi-stable equilibrium force fields, the 7 – Dimensions philosophy promotes that there is a supernatural-like spiritually synergistic effect that occurs when an individuals’ multiple life functioning dimensions are elevated in a homeostatic human system. This bilateral spiritual connectedness reduces chaos and increases resilience to bring an individual harmony, wellness, and productivity. The ARMS takes an objective perspective on spirituality by assessing an individual’s positive and/ or negative spiritual/ religious dimension with the Religious Attitudes Inventory (e.g., the RAI is capable of identifying 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 prognostication scoring system.The 7 – Dimensions model also promotes Twelve Step Recovery Groups such as Alcoholics and Narcotics Anonymous along with spiritual and religious recovery activities as a necessary means to maintain outcome effectiveness. The National Institute of Alcohol Abuse and Alcoholism’s most recent research findings regard such active involvement with AA/ NA as the crucial factor responsible for sustained recoveryConclusionThe 7 – Dimensions Model is not claiming to be the panacea for the ills of addictions treatment progress and outcomes, but it is a step in the right direction for getting clinicians to change the way they practice, by changing treatment facility systems to incorporate evidence-based research findings on 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 diligently following a standardized system to obtain base-line 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 Addictions Recovery Measurement System (ARMS)
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Addiction Help – Where to Turn

Perhaps you have realized that you may have a drug addiction problem and are ready to seek addiction help. Or maybe you have a friend or loved one who is struggling with a drug addiction problem. Addiction help is everywhere, but trying to sort out the different types of assistance can be confusing and slightly overwhelming. The type of help that you need depends on such factors as the specific addiction, your previous history of drug addiction, your financial situation and the level of severity of your drug addiction problem.Seeking addiction help is the first step on the road to recovering from a disabling problem involving drugs or alcohol. Recognition of a problem and the desire to change can put the wheels in motion to a healing process that can truly change lives. Many people discount how much is being said through the cry for help, but those within the deadly spiral of drug addiction know just how much can happen with a little assistance.Addiction help comes in many forms, but those with drug addiction issues often do not know where to look. If you have a friend or loved one who is struggling with an addiction problem, you need to learn the different types of assistance and help that is available to him or her.Addiction help often includes a trip to inpatient drug rehab. Rather than the scary, institutional setting often depicted in film and legend, inpatient drug rehab units tend to be modern, open, airy and pleasant. In an inpatient drug rehab program, you will have the opportunity to work through not only the detoxification process but also the issues that led up to your drug addiction problem. A stay at an inpatient drug rehab will generally be short-term, lasting no longer than 30 days, unless your individual situation requires a longer stay. The major advantage of inpatient drug rehab is that you will have access to 24 hour a day, 7 day a week help and support. The major disadvantage to inpatient drug rehab is the cost. You will need to determine if your private insurance will cover your stay and if not, whether the facility offers a sliding scale rate based on ability to pay.Twelve step programs is another solution that works well for many addics. Twelve step programs are often run by counselors who were once addicted to drugs themselves. This form of addiction help is either free or very low cost and generally provides you with a strong support network of those who understand your drug addiction. The major disadvantage to this type of program is also its major advantage: that it puts the full responsibility for working the program on you. Whether or not you are able to handle this responsibility while living in your current situation is a decision you must make carefully.Outpatient counseling with a trained addictions therapist is another option for addiction help. You will see a therapist as frequently as twice a week or as infrequently as once a month, depending on your individualized treatment plan. Your therapist will help you to work through the issues that caused your drug addiction problem as well as assisting you in detoxification from your current drug of choice. Another option for addiction help is outpatient counseling. This is done with a trained addictions therapist and occurs about twice a week or possibly a few times a month. This all depends on the individual’s treatment plan. A therapist will help work through the problems and issues that caused the drug addiction to occur in the first place, offering assistance in many forms.Outpatient counseling is a common form of assistance. This occurs with the help of a trained therapist who helps work through some of the background issues that brought the drug addiction situation about in the first place. Detoxification therapies are also offered, as is full-time counseling.Whatever form of addiction help you choose, remember that getting over drug addiction is a lifelong process. While some former alcoholics claim that they are now able to drink responsibly, current professional thought on the topic is that it is a dangerous game to play. Once you been addicted to a drug, your likelihood of relapse is much higher than the risk of addiction for someone who has never been addicted. It is best for you to remain free of that drug and any others for the rest of your life.There is no one best solution to the problem of drug addiction. Many people find it best to utilize a range of addiction help services as they move through the process of becoming drug free. Your decisions will ultimately be based on a variety of factors and should ideally be made with the help of a trained and licensed addictions counselor. In terms of drug addiction, you should know that there is no one best solution. It is perhaps a better approach to utilize a wide range of addiction help services and move towards becoming drug free by using many resources. Decisions as to what type of drug treatment is best will likely be based on personal experience, cost and other necessary considerations.There is no one solution in terms of drug addiction help and treatment. The problem of drug addiction is individualized and individuals must know how to seek help on their own terms. One of the key components to drug treatment is making alert and proper decisions as to suitable treatment, so using many resources is often the preferred method of discovery.