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Although research has stagnated somewhat, SFBP group therapy appears to be effective for treating SUD, sometimes outperforming traditional programs [127]. This success may lie in allowing patients to choose their own goal structures and giving them more responsibility, which generally increases the likelihood of a positive therapeutic alliance between clinician and patient and typically yields better treatment outcomes [127]. Specifically, interpersonal functioning, symptom severity, and social roles pre- and post- treatment, have shown improvements in those receiving solution-focused interventions [127, 128, 129]. Meta-analyses have also shown that 23% of systematic reviews have reported positive trends in depression-related outcomes [130, 131].
Factors such as drug availability within the environment can increase craving and consequently the vulnerability for relapse (Weiss 2005). Recent research has suggested that enriched environments produce long-term neural modifications that decrease neural sensitivity to morphine-induced reward (Xu, Hou, Gao, He, and Zhang 2007). Accordingly, the social environment can increase the frequency of cravings, which may contribute to increased drug consumption, and thus increase the probability that affected individuals will participate in a series of habituated https://www.healthworkscollective.com/how-choose-sober-house-tips-to-focus-on/ behaviours that facilitate using (Levy 2007b). Recent advances in neuroscience provide compelling evidence to support a medical perspective of problematic substance use and addiction (Dackis and O’Brien 2005). Despite these developments, the science is still in its early stages, and theories about how addiction emerges are neither universally accepted nor completely understood. Current ethical and legal debates in addiction draw upon new knowledge about the biological and neurological modification of the brain (Ashcroft, Campbell, and Capps 2007).
Non-pharmacological treatments for addiction and chronic pain
Some mental health professionals focused on the biological factors, which are the genetic components and how one’s brain chemistry may be off balance. The famous psychologist Sigmund Freud focused on psychotherapy, and this was primarily through psychoanalysis. Although the methods of Freud aren’t as relevent today, he set the groundwork for psychotherapy, and this helps many people find the root of their problems.
This new ideal formed the foundation for behavioral and psychological conceptualizations of health and medicine [12]. The biopsychosocial model was originally created for Top 5 Tips to Consider When Choosing a Sober House for Living therapy when it comes to managing various mental illnesses. Therapists and psychologists over the years didn’t have a consensus around how to treatment mental illness.
Addiction Neuroethics in the Clinical Context
A systems approach strives to achieve a unification of disciplines neuroscience, biology, psychology, sociology, philosophy, economics, politics and law by examining interacting and emerging patterns from each discipline, rather than focusing on common material components (Heylighen et al. 2007). In this light, the addition of systems to the prototype biopsychosocial model allows for the inclusion of macrosocial systems as well as smaller components, such as cells and genes. A systems approach allows for the inclusion of psycho-social and socially systemic explanations of addiction, which extend well beyond neurobiology while still interacting with it (Bunge 1991).
Accordingly, the matrix of a person’s socio-historical context, life narrative, genetics, and relationships with others influence intention, decision, and action, and thus shape the brain. Autonomy, therefore, is not adequately defined just by the events in the brain or the “quality” of the decision being made. As Gillett (2009) remarks, “a decision is…not a circumscribed event in neuro-time that could be thought of as an output, and an intention is not a causal event preceding that output, but both are much more holistically interwoven with the lived and experienced fabric of one’s life” (p. 333).
Social and Environmental Factors
General psychosocial factors include affect, trauma, social/interpersonal disposition, sex- and race-related disparities, and pain-specific psychosocial factors include catastrophizing, coping, expectations, and self-efficacy [54]. Another way of conceptualizing the division is factors that predispose an individual to develop chronic pain and those that emerge as a consequence of pain. As discussed below, there is a high degree of overlap between the psychosocial aspects of chronic pain and addiction, and it is not always easy to make the distinction between cause and consequence in SUD. We argue therefore for a biopsychosocial systems model of, and approach to, addiction in which psychological and sociological factors complement and are in a dynamic interplay with neurobiological and genetic factors. As Hyman (2007) has written, “neuroscience does not obviate the need for social and psychological level explanations intervening between the levels of cells, synapses, and circuits and that of ethical judgments” (p.8).
It also takes into consideration the socio-structural perspective of the individual as it relates strongly to the many decisions that are made around addictions. This also takes into consideration the social determinants of health, social factors, culture, age, gender and other stressful situations that were experienced. A biopsychosocial systems approach does not portray people as only controlled by the state of their brains. Addictive behaviours are neither viewed as controlled or uncontrolled but as difficult to control a matter of degree. Further, the clinically observed defining feature of addiction a loss of control is understood as a socially normative notion. Thus the claim that “an addict cannot be a fully free autonomous agent” (Caplan 2008, p.1919) is debatable.
His approach included examining the psychological, environmental, and social components and how they influence one’s biological functioning related to mental health disorders. The degrees in which self-control is exerted, free choice is realized and desired outcomes achieved are dependent on these complex interacting biopsychosocial systems. Many post-modern theorists such as Christman (2004) have challenged the original Kantian privileging and definition of autonomy. One claim is based on the fact that decisional autonomy, or rationality, is not the most valuable human characteristic, and the individual-as-independent does not adequately characterize human beings (Russell 2009).
- Parental catastrophizing, spousal/partner depression or avoidant, anxious attachment styles, lack of social support at work, and negative interactions with co-workers and workmans compensation programs can all promote chronic pain and disability [54].
- Two experimental studies also implicate sociocultural influences in the development of body image concerns in young children.
- Recent research has suggested that enriched environments produce long-term neural modifications that decrease neural sensitivity to morphine-induced reward (Xu, Hou, Gao, He, and Zhang 2007).
Both social norms and laws influence attitudes, perceptions, and beliefs of the effects of substances and considerably affect consumption rates (Babor, Caetano, Casswell et al. 2003; Hawkins, Catalano, and Miller 1992). Proponents of a ‘war on drugs’, for example, believe that laws and policies that are lenient towards substance use are linked with greater prevalence of use and criminal activity. In one study comparing cannabis use in San Francisco (where cannabis is criminalized) and Amsterdam (de facto decriminalization), there was no evidence to support claims that criminalization laws reduce use or that decriminalization increases use. In fact, San Francisco reported a higher cannabis use rate than Amsterdam (Reinarman, Cohen and Kaal 2004).
Further research is needed to gain a better understanding of how complex social and structural factors shape risk for chronic pain and SUD. Utilizing mindfulness in the context of treating chronic pain is new to Western society. Eastern practices, such as Zen Buddhism and Hatha yoga, have been applied to a plethora of physical ailments for centuries, but now these are combined with traditional psychotherapies such as CBT and acceptance and commitment therapy [114]. As in addiction treatment, a non-judgmental stance is vitally important to MBSR-based treatment of chronic pain. The patient focuses their attention on uncomfortable physical sensations with no attempt to alter them, instead developing compassion toward both positive and aversive bodily experiences [114, 115]. Neuroimaging studies support the notion that MBSR strategies have allowed patients to adopt a new perception of their chronic pain.
- If you’ve ever received substance use services, or if you’ve ever worked in a treatment setting, you are likely well aware of the emphasis that is placed on forming new relationships with new people who do not use substances.
- Although more research is needed, the authors suggest that a more integrated approach for managing chronic pain and addiction should include clinical mental health therapeutic techniques, discussed below.
- Yet many other elements are idiosyncratic, such as the intensity of the experience of reward and the functioning of the individual’s mesolimbic dopaminergic pathway in the brain.
- It is important to note that one person’s reaction to the reward experience may be quite different from another’s.
Third, Clarkin (2013) conducted a meta-analysis of DBT for BPD that demonstrated a significant benefit over TAU for anger, parasuicidality, and mental health. And finally, Frazier and Vela (2014) reported similar effects for anger and aggression in various populations (not solely BPD participants) in their meta-analysis. Overall, in a review, Burmeister et al. (2014) concluded that the effects from these meta-analyses are robust and stable, and the effects of individual RCTs and small-scale studies support the promise of DBT adaptations for wider aspects of human suffering. Peer factors have also been proposed to influence the development of body image attitudes in sociocultural and biopsychosocial models, and there is support for the role of peer influences in young girls. We already mentioned how addiction could be triggered when one suffers from a mental health disorder. It is very common for young men who feel sad, depressed, anxious, and stressed out to turn to alcohol or drugs.
The biopsychosocial model of addiction (Figure 1) posits that intersecting biological, psycho-social and systemic properties are fundamental features of health and illness. The model includes the way in which macro factors inform and shape micro systems and brings biological, psychological and social levels into active interaction with one another. It is a model based on Engel’s original biopsychosocial model (Engel 1977) for which he argued that to develop a scientific and comprehensive description of mental health, theories that promote biological reductionism should be dismissed in favour of those that adhere to general systems theory. The contemporary model, adapted for addiction, reflects an interactive dynamic for understanding substance use problems specifically and addressing the complexity of addiction-related issues. The empirical foundation of this model is thus interdisciplinary, and both descriptive and applied.
- In this chapter, the authors have discussed conceptualizing chronic pain and SUD using a similar biopsychosocial framework and suggest that both can be more effectively managed by including clinical mental health therapeutic techniques as opposed to a purely biomedical approach.
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- Hunt (2004) takes the rights-based notion further and identifies and characterizes two ethics of harm reduction.
Therefore, each of the following explanations of addiction informs us about the many causes of addiction. Furthermore, they each propose a model for recovery based upon the presumed causes of addiction. Each model will necessarily leave out some aspects of recovery that might be highly relevant and beneficial to some people. It is up to each person to select, and to decide, which models are most relevant and beneficial. Different people will make different choices based upon their particular needs and circumstances. For instance, if I understand the theoretical reasons a ship floats and moves through the water in a certain way, I can build a model of a ship.