Module 15 Biopsychosocial and the Biopsychosocial Dimensions of Substance Abuse

MODULE 15 BIOPSYCHOSOCIAL AND THE BIOPSYCHOSOCIAL DIMENSIONS OF SUBSTANCE ABUSE

Title 450 Chapter 18

Standards and Criteria for Alcohol and Drug Treatment Programs

450:18-1-2. Definitions "Biopsychosocial assessment" means face-to-face interviews conducted by a qualified service provider designed to elicit historical and current information regarding the behaviors, experiences, and support systems of a consumer, and identify the consumer’s strengths, needs, abilities, and preferences for the purpose of guiding the consumer’s recovery plan.

450:18-7-23. Biopsychosocial assessment

(a) All programs shall complete a Biopsychosocial assessment which gathers sufficient information to assist the consumer in developing an individualized service plan. The program shall develop a Biopsychosocial evaluation which contains, but is not limited to, the following:

(1) Identification of the consumer’s strengths, needs, abilities, and preferences;

(2) History of the presenting problem;

(3) Previous treatment history to include substance abuse and mental health;

(4) Health history and current biomedical conditions and complications;

(5) Alcohol and drug use history;

(6) History of trauma;

(7) Family and social history, including family history of alcohol and drug use;

(8) Educational attainment, difficulties, and history;

(9) Cultural and religious orientation;

(10) Vocational, occupational and military history;

(11) Sexual history, including HIV, AIDS and STD at-risk behaviors;

(12) Marital or significant other relationship history;

(13) Recreational and leisure history;

(14) Legal history;

(15) Present living arrangement;

(16) Economic resources;

(17) Level of functioning;

(18) Current support system including peer and other recovery supports;

(19) Current medications, if applicable, and shall include obtainable information regarding the name of prescribing physician, name of medication, strength and dosage, and length of time consumer was on the medication;

(20) Consumer’s expectations in terms of service; and

(21) Assessment summary or diagnosis, and signature of the assessor and date of the assessment.

450:18-7-24. Biopsychosocial assessment, time frame

(a) The assessment shall be completed during the admission process and within specific timelines established by the facility but no later than the following time frames:

(1) Residential services, seven (7) days [168 hours];

(2) Halfway house services, seven (7) days [168 hours];

(3) Intensive outpatient services, by the fourth visit;

(4) Outpatient services, by the end of the fourth visit.

(b) In the event of a consumer re-admission after one (1) year of the last Biopsychosocial assessment, a new Biopsychosocial assessment shall be completed. If readmission occurs within one (1) year after the last Biopsychosocial assessment, an update shall be completed.

The Biopsychosocial Assessment is an important document that sets up the rationale for all the work to follow in the clinical setting. All areas of this document need to be addressed in full. There are to be no blanks left on this document, as blank space suggests the writer did not address the information in that section. Full completion of the assessment is also an expectation from reviewers. One will need to enter "none reported" in any area where no check box is available – this indicates that there is no issue or need to be addressed.
CITATION” www. mc708.org/Committees/.../Completing_the_Biopsychosocial_Assessment.doc
A biopsychosocial assessment is a collaborative process that aims to identify the important factors that are relevant to creating a plan of psychopharmacological and psychotherapeutic treatment. Since every person is unique, every assessment is unique. As the assessment process unfolds it may become clear that more attention needs to be paid to one area (for instance, medical illnesses, or cognitive functioning) and this may lead to consultation with other experts. Nevertheless, there are some key elements of a biopsychosocial assessment that are appropriate for almost everyone, these include –
A history of mood symptoms - factors that lead to worsened symptoms, and those that alleviate symptoms; a history of treatment and response to treatment; the relationship of mood symptoms to other symptoms (such as anxiety, physical symptoms, etc.).
o  A general medical history
o  A developmental, social and cultural history – particularly paying attention to patterns and
recurring experiences in relationships.
o  A history of school and work
o  A review of psychiatric and medical symptoms
o  An assessment of cognitive functioning
o  Identification of strengths and problems
For many people it will also be useful to do a detailed history of mood episodes over time, what is called a retrospective mood chart. This not only clearly identifies the person’s unique pattern of mood variation, but it is also a very effective way of summarizing past treatment and response. Often a very detailed retrospective mood chart makes it clear what combination of treatment is most likely to be useful.
Assessment of the most appropriate treatment options will include an assessment for specialized treatment and treatment setting. If treatment is needed that is not provided by the assessor, then appropriate referrals will be provided.
When there is a need for more information we will use other sources including –
o  Past psychiatric, psychotherapy or medical records
o  Pharmacy records
o  Information from diaries, other records
o  Collateral history
When specialized assessments are indicated we will arrange for –
o  Substance abuse assessment
o  Psychological assessment
o  Nutritional assessment
CITATION: http://www.bipolaradvantage.com/AdvantageProgram/Assessment/Biopsychosocial.php
BIOPSYCHOSOCIAL MODEL OF ADDICTION
BIOPSYCHOSOCIAL-BPS
The biopsychosocial model of addiction is the result of additional work and an enhanced understanding of the reasons for addiction and addictive behavior.
This model was developed to include models related to addiction that were developed and researched over the past fifty years. It is a distillation of all other models. The biopsychosocial model of addiction does consider addiction to be an illness, but also includes perspectives of psychological, cognitive, social, developmental, environmental and cultural nature related to substance addiction. Hence, this model recognizes the fact that substance addiction is more than a mere disease and that the use of drugs is induced as a result of factors existing in the society, the peer group, a cultural tendency for substance abuse and has genetic links. In this model of addiction, the degradation of the body as a result of substance abuse causes disease which has to be treated along with the addiction.
TREATMENTS-MEDICATION
Medication and behavioral therapy, especially when combined, are important elements of an overall therapeutic process that often begins with detoxification, followed by treatment and relapse prevention. Easing withdrawal symptoms can be important in the initiation of treatment; preventing relapse is necessary for maintaining its effects. And sometimes, as with other chronic conditions, episodes of relapse may require a return to prior treatment components. A continuum of care that includes a customized treatment regimen—addressing all aspects of an individual's life, including medical and mental health services—and follow–up options (e.g., community – or family-based recovery support systems) can be crucial to a person's success in achieving and maintaining a drug–free lifestyle.
Treatment. Medications can be used to help reestablish normal brain function and to prevent relapse and diminish cravings. Currently, we have medications for opioids (heroin, morphine), tobacco (nicotine), and alcohol addiction and are developing others for treating stimulant (cocaine, methamphetamine) and cannabis (marijuana) addiction. Most people with severe addiction problems, however, are polydrug users (users of more than one drug) and will require treatment for all of the substances that they abuse.
Opioids: Methadone, buprenorphine and, for some individuals, naltrexone are effective medications for the treatment of opiate addiction. Acting on the same targets in the brain as heroin and morphine, methadone and buprenorphine suppress withdrawal symptoms and relieve cravings. Naltrexone works by blocking the effects of heroin or other opioids at their receptor sites and should only be used in patients who have already been detoxified. Because of compliance issues, naltrexone is not as widely used as the other medications. All medications help patients disengage from drug seeking and related criminal behavior and become more receptive to behavioral treatments.
Tobacco:A variety of formulations of nicotine replacement therapies now exist—including the patch, spray, gum, and lozenges—that are available over the counter. In addition, two prescription medications have been FDA–approved for tobacco addiction: bupropion and varenicline. They have different mechanisms of action in the brain, but both help prevent relapse in people trying to quit. Each of the above medications is recommended for use in combination with behavioral treatments, including group and individual therapies, as well as telephone quit lines.
Alcohol:Three medications have been FDA–approved for treating alcohol dependence: naltrexone, acamprosate, and disulfiram. A fourth, topiramate, is showing encouraging results in clinical trials. Naltrexone blocks opioid receptors that are involved in the rewarding effects of drinking and in the craving for alcohol. It reduces relapse to heavy drinking and is highly effective in some but not all patients—this is likely related to genetic differences. Acamprosate is thought to reduce symptoms of protracted withdrawal, such as insomnia, anxiety, restlessness, and dysphoria (an unpleasant or uncomfortable emotional state, such as depression, anxiety, or irritability). It may be more effective in patients with severe dependence. Disulfiram interferes with the degradation of alcohol, resulting in the accumulation of acetaldehyde, which, in turn, produces a very unpleasant reaction that includes flushing, nausea, and palpitations if the patient drinks alcohol. Compliance can be a problem, but among patients who are highly motivated, disulfiram can be very effective.
The often painful symptoms of drug withdrawal may last for several days and can stand as a barrier to the treatment of a drug abuse problem. Some practitioners use"rapid" or "ultra rapid"detoxification methods to condense the withdrawal process into a considerably shorter period of time, about two hours, while the addict is asleep. Rapid detox patients placed under anesthesia while given treatment drugs, such as naltrexone, can avoid the extreme pain associated with such treatments, say proponents, and bypass the major effects of withdrawal. Critics argue that the treatments can be very expensive and that safety has not been sufficiently demonstrated.
A 2005 clinical study on "ultra rapid detox" for heroin addicts, comparing buprenorphine-assisted or clonidine-assisted opioid detoxification to anesthesia-assisted detoxification, reported that anesthesia patients commonly underwent withdrawal when they awoke from, had a similar study dropout rate (approximately 80%), and some anesthesia patients experienced severe medical complications. Another 2005 study compared clonidine-assisted detoxification to (rapid) clonidine-naloxone precipitated withdrawal under anesthesia, reporting no significant differences in degree or duration of pain, withdrawal severity, or drug craving, with similar withdrawal sequelae, oral naltrexone compliance levels, and abstinence from heroinfour weeks following detoxification.
What if science made a pill to protect us from addiction — keeping us from smoking cigarettes, getting fat or abusing drugs and alcohol? They are working on that right now. It's is called TA-CD.
TREATMENT-BEHAVIORAL
Cognitive Behavioral Therapy. Seeks to help patients recognize, avoid, and cope with the situations in which they are most likely to abuse drugs. H.A.L.T HIGH RISK SITUATIONS - People, Places and Things.
Cognitive behavior therapy is based on the idea that feelings and behaviors are caused by a person's thoughts, not on outside stimuli like people, situations and events. People may not be able to change their circumstances, but they can change how they think about them and therefore change how they feel and behave. The goal of cognitive behavior therapy is to get the person to learn or relearn better coping skills.
Motivational Incentives. Uses positive reinforcement such as providing rewards or privileges for remaining drug free, for attending and participating in counseling sessions, or for taking treatment medications as prescribed.
Motivational Interviewing. Employs strategies to evoke rapid and internally motivated behavior change to stop drug use and facilitate treatment entry.
Group Therapy. Helps patients face their drug abuse realistically, come to terms with its harmful consequences, and boost their motivation to stay drug free. Patients learn effective ways to solve their emotional and interpersonal problems without resorting to drugs.
Recovery is about change!
NOTHINGCHANGES IF NOTHING CHANGES
QUITTING: It’s easy, I have done it hundreds of times.
Mark Twain
INSANITY: repeating the same actions over and over but expecting different results.
Albert Einstein.
The benchmark for the theory of change is: “Substance Abuse Treatment and the Stages of Change” by Dr. Gerard J. Connors-PhD, Dr. Dennis M. Donovan-PhD and Carlo C. Diclemente-PhD. They propose there are fivestagesof change:
·  Pre contemplation- the persondeniesthere is a problem and is resistant to change.
·  Contemplation- person begins to reevaluate self- maybe my behavior is causing all these negative outcomes and begins to concede there might be a problem.
·  Preparation-Acknowledges there is a problem and wants to do something about it and makes plans to do so.
·  Action- implements plan.
·  Maintenance- working the action plan, learning from success and failures.
·  Some people have a problem with the "higher power" idea to which Kahil Gibran-18th century philosopher/poet responded:
I was too smart to believe in a power greater than me. What I started to realize was that ifIwas the greatest power in my life, I was in deep, trouble....Kahlil Gibran
"There is nochemicalsolution for aspiritualproblem."
RELAPSE
THE FIRST RULE OF RECOVERY
You don't recover from an addiction by stopping using. You recover by creating a new life where it is easier to not use. If you don't create a new life, then all the factors that brought you to your addiction will eventually catch up with you again.
RECOVERY SKILLS ​
Relaxation is not an optional part of recovery. It's essential to recovery. There are many ways to relax. They range from simple techniques like going for a walk, to more structured techniques like meditation. Meditation is an important part of that mix because the simple techniques don't always work. If you're under a lot of stress, you may need something more reliable like meditation. Use any of these techniques, or any combination. But do something every day to relax, escape, or reward yourself, and turn off the chatter in your mind.
Healthy ways to relax and recharge
Go for a walk.
Spend time in nature.
Call a good friend.
Sweat out tension with a good workout.
Write in your journal.
Take a long bath.
Light scented candles
RELAPSE PREVENTION
Don't look where you fall, but where you slipped. ~African Proverb
The Stages of Relapse
Relapse is a process, it's not an event. In order to understand relapse prevention you have to understand the stages of relapse. Relapse starts weeks or even months before the event of physical relapse. In this page you will learn how to use specific relapse prevention techniques for each stage of relapse. There are three stages of relapse.