When inspecting that pathological eating disorders and their linked diseases now afflict more habitancy globally than malnutrition, some experts in the curative field are presently purporting that the world’s whole one condition question is no longer heart disease or cancer, but obesity. agreeing to the World condition assosication (June, 2005), “obesity has reached epidemic proportions globally, with more than 1 billion adults overweight - at least 300 million of them clinically obese - and is a major contributor to the global burden of persisting disease and disability. Often coexisting in developing countries with under-nutrition, obesity is a complicated condition, with serious group and psychological dimensions, affecting virtually all ages and socioeconomic groups.” The U.S. Centers for Disease operate and arresting (June, 2005), reports that “during the past 20 years, obesity among adults has risen significantly in the United States. The most recent data from the National town for condition Statistics show that 30 percent of U.S. Adults 20 years of age and older - over 60 million habitancy - are obese. This growth is not minuscule to adults. The division of young habitancy who are overweight has more than tripled since 1980. Among children and teens aged 6-19 years, 16 percent (over 9 million young people) are carefully overweight.”
Morbid obesity is a condition that is described as being 100lbs. Or more above ideal weight, or having a Body Mass Index (Bmi) equal to or greater than 30. Being obese alone puts one at a much greater risk of suffering from a mixture of some other metabolic factors such as having high blood pressure, being insulin resistant, and/ or having abnormal cholesterol levels that are all linked to a poor diet and a lack of exercise. The sum is greater than the parts. Each metabolic question is a risk for other diseases separately, but together they multiply the chances of life-threatening illness such as heart disease, cancer, diabetes, and stroke, etc. Up to 30.5% of our Nations’ adults suffer from morbid obesity, and two thirds or 66% of adults are overweight measured by having a Body Mass Index (Bmi) greater than 25. inspecting that the U.S. habitancy is now over 290,000,000, some estimate that up to 73,000,000 Americans could advantage from some type of education awareness and/ or treatment for a pathological eating disorder or food addiction. Typically, eating patterns are carefully pathological problems when issues about weight and/ or eating habits, (e.g., overeating, under eating, binging, purging, and/ or obsessing over diets and calories, etc.) come to be the focus of a persons’ life, causing them to feel shame, guilt, and embarrassment with linked symptoms of depression and anxiety that cause important maladaptive group and/ or occupational impairment in functioning.
What Is Pre Occupational Therapy
We must reconsider that some habitancy establish dependencies on unavoidable life-functioning activities such as eating that can be just as life threatening as drug addiction and just as socially and psychologically damaging as alcoholism. Some do suffer from hormonal or metabolic disorders, but most obese individuals simply consume more fat than they burn due to an out of operate overeating Food Addiction. Hyper-obesity resulting from gross, habitual overeating is carefully to be more like the problems found in those ingrained personality disorders that involve loss of operate over appetite of some kind (Orford, 1985). Binge-eating Disorder episodes are characterized in part by a feeling that one cannot stop or operate how much or what one is eating (Dsm-Iv-Tr, 2000). Lienard and Vamecq (2004) have proposed an “auto-addictive” hypothesis for pathological eating disorders. They record that, “eating disorders are linked with abnormal levels of endorphins and share clinical similarities with psychoactive drug abuse. The key role of endorphins has recently been demonstrated in animals with regard to unavoidable aspects of normal, pathological and experimental eating habits (food restriction combined with stress, loco-motor hyperactivity).” They record that the “pathological management of eating disorders may lead to two greatest situations: the absence of ingestion (anorexia) and immoderate ingestion (bulimia).”
Co-morbidity & Mortality
Addictions and other reasoning disorders as a rule do not establish in isolation. The National Co-morbidity explore (Ncs) that sampled the whole U.S. habitancy in 1994, found that among non-institutionalized American male and female adolescents and adults (ages 15-54), roughly 50% had a diagnosable Axis I reasoning disorder at some time in their lives. This survey’s results indicated that 35% of males will at some time in their lives have abused substances to the point of qualifying for a reasoning disorder diagnosis, and nearly 25% of women will have mighty for a serious mood disorder (mostly major depression). A important looking of note from the Ncs study was the whole occurrence of co-morbidity among diagnosed disorders. It specifically found that 56% of the respondents with a history of at least one disorder also had two or more further disorders. These persons with a history of three or more co-morbid disorders were estimated to be one-sixth of the U.S. Population, or some 43 million habitancy (Kessler, 1994).
McGinnis and Foege, (1994) record that, “the most prominent contributors to mortality in the United States in 1990 were tobacco (an estimated 400,000 deaths), diet and action patterns (300,000), alcohol (100,000), microbial agents (90,000), toxic agents (60,000), firearms (35,000), sexual behavior (30,000), motor vehicles (25,000), and illicit use of drugs (20,000). Acknowledging that the prominent cause of preventable morbidity and mortality was risky behavior lifestyles, the U.S. arresting Services Task Force set out to investigate behavioral counseling interventions in condition care settings (Williams & Wilkins, 1996).
Poor Prognosis
We have come to realize today more than any other time in history that the treatment of lifestyle diseases and addictions are often a difficult and frustrating task for all concerned. Repeated failures abound with all of the addictions, even with utilizing the most sufficient treatment strategies. But why do 47% of patients treated in private treatment programs (for example) relapse within the first year following treatment (Gorski,T., 2001)? Have addiction specialists come to be conditioned to accept failure as the norm? There are many reasons for this poor prognosis. Some would proclaim that addictions are psychosomatically- induced and maintained in a semi-balanced force field of driving and restraining multidimensional forces. Others would say that failures are due simply to a lack of self-motivation or will power. Most would agree that lifestyle behavioral addictions are serious condition risks that deserve our attention, but could it perhaps be that patients with manifold addictions are being under diagnosed (with a particular dependence) simply due to a lack of diagnostic tools and resources that are incapable of resolving the complexity of assessing and treating a outpatient with manifold addictions?
Diagnostic Delineation
Thus far, the Dsm-Iv-Tr has not delineated a prognosis for the complexity of manifold behavioral and substance addictions. It has reserved the Poly-substance Dependence prognosis for a someone who is repeatedly using at least three groups of substances while the same 12-month period, but the criteria for this prognosis do not involve any behavioral addiction symptoms. In the Psychological Factors Affecting curative Condition’s section (Dsm-Iv-Tr, 2000); maladaptive condition behaviors (e.g., overeating, unsafe sexual practices, immoderate alcohol and drug use, etc.) may be listed on Axis I only if they are significantly affecting the procedure of treatment of a curative or reasoning condition.
Since prosperous treatment outcomes are dependent on appropriate assessments, spoton diagnoses, and whole individualized treatment planning, it is no wonder that repeated recovery failures and low success rates are the norm instead of the irregularity in the addictions field, when the most recent Dsm-Iv-Tr does not even contain a prognosis for manifold addictive behavioral disorders. treatment clinics need to have a treatment planning system and referral network that is adequate to completely compare manifold addictive and reasoning condition disorders and linked treatment needs and comprehensively provide education/ awareness, arresting strategy groups, and/ or definite addictions treatment services for individuals diagnosed with manifold addictions. Written treatment goals and objectives should be specified for each separate addiction and size of an individuals’ life, and the desired operation outcome or completion criteria should be specifically stated, behaviorally based (a graphic activity), and measurable.
New Proposed Diagnosis
To aid in resolving the minuscule Dsm-Iv-Trs’ diagnostic capability, a multidimensional prognosis of “Poly-behavioral Addiction,” is proposed for more spoton prognosis prominent to more sufficient treatment planning. This prognosis encompasses the broadest class of addictive disorders that would contain an individual manifesting a mixture of substance abuse addictions, and other obsessively-compulsive behavioral addictive behavioral patterns to pathological gambling, religion, and/ or sex / pornography, etc.). Behavioral addictions are just as damaging - psychologically and socially as alcohol and drug abuse. They are comparative to other life-style diseases such as diabetes, hypertension, and heart disease in their behavioral manifestations, their etiologies, and their resistance to treatments. They are progressive disorders that involve obsessive reasoning and compulsive behaviors. They are also characterized by a preoccupation with a continuous or periodic loss of control, and continuous irrational behavior in spite of adverse consequences.
Poly-behavioral addiction would be described as a state of periodic or persisting physical, mental, emotional, cultural, sexual and/ or spiritual/ religious intoxication. These discrete types of intoxication are produced by repeated obsessive thoughts and compulsive practices complicated in pathological relationships to any mood-altering substance, person, organization, confidence system, and/ or activity. The individual has an overpowering desire, need or promulgation with the proximity of a tendency to intensify their adherence to these practices, and evidence of phenomena of tolerance, abstinence and withdrawal, in which there is always physical and/ or psychic dependence on the effects of this pathological relationship. In addition, there is a 12 - month period in which an individual is pathologically complicated with three or more behavioral and/ or substance use addictions simultaneously, but the criteria are not met for dependence for any one addiction in particular (Slobodzien, J., 2005). In essence, Poly-behavioral addiction is the synergistically integrated persisting dependence on manifold physiologically addictive substances and behaviors (e.g., using/ abusing substances - nicotine, alcohol, & drugs, and/or acting impulsively or obsessively compulsive in regards to gambling, food binging, sex, and/ or religion, etc.) simultaneously.
New Proposed Theory
The Addictions rescue measurement System’s (Arms) system is a nonlinear, dynamical, non-hierarchical model that focuses on interactions in the middle of manifold risk factors and situational determinants similar to catastrophe and chaos theories in predicting and explaining addictive behaviors and relapse. manifold influences trigger and operate within high-risk situations and sway the global multidimensional functioning of an individual. The process of relapse incorporates the interaction in the middle of background factors (e.g., family history, group support, years of inherent 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 ensue in large qualitative changes at the global level and patterns at the global level of a system emerge solely from numerous minuscule interactions.
The Arms hypothesis purports that there is a multidimensional synergistically negative resistance that individual’s establish to any one form of treatment to a particular size of their lives, because the effects of an individual’s addiction have dynamically interacted multi-dimensionally. Having the traditional focus on one size is insufficient. Traditionally, addiction treatment programs have failed to accommodate for the multidimensional synergistically negative effects of an individual having manifold addictions, (e.g. Nicotine, alcohol, and obesity, etc.). Behavioral addictions interact negatively with each other and with strategies to heighten whole functioning. They tend to encourage the use of tobacco, alcohol and other drugs, help growth violence, decrease functional capacity, and promote group isolation. Most treatment theories today involve assessing other dimensions to identify dual prognosis or co-morbidity diagnoses, or to compare contributing factors that may play a role in the individual’s traditional addiction. The Arms’ system proclaims that a multidimensional treatment plan must be devised addressing the inherent manifold addictions identified for each one of an individual’s life dimensions in addition to developing definite goals and objectives for each dimension.
The Arms acknowledges the complexity and unpredictable nature of lifestyle addictions following the commitment of an individual to accept assistance with changing their lifestyles. The Stages of turn model (Prochaska & DiClemente, 1984) is supported as a model of motivation, incorporating five stages of readiness to change: pre-contemplation, contemplation, preparation, action, and maintenance. The Arms system supports the constructs of self-efficacy and group networking as outcome predictors of time to come behavior over a wide collection of lifestyle risk factors (Bandura, 1977). The Relapse arresting cognitive-behavioral approach (Marlatt, 1985) with the goal of identifying and preventing high-risk situations for relapse is also supported within the Arms theory.
The Arms continues to promote Twelve Step rescue Groups such as Food Addicts and Alcoholics Anonymous along with spiritual and religious rescue activities as a important means to claim outcome effectiveness. The beneficial effects of Aa may be attributable in part to the replacement of the participant's group network of drinking friends with a fellowship of Aa members who can provide motivation and sustain for maintaining abstinence (Humphreys, K.; Mankowski, E.S, 1999) and (Morgenstern, J.; Labouvie, E.; McCrady, B.S.; Kahler, C.W.; and Frey, R.M., 1997). In addition, Aa's approach often results in the amelioration of coping skills, many of which are similar to those taught in more structured psychosocial treatment settings, thereby prominent to reductions in alcohol consumption (Niaaa, June 2005).
Treatment enlarge Dimensions
The American society of Addiction Medicine’s (2003), “Patient Placement Criteria for the treatment of Substance-Related Disorders, 3rd Edition”, has set the appropriate in the field of addiction treatment for recognizing the totality of the individual in his or her life situation. This includes the internal interconnection of manifold dimensions from biomedical to spiritual, as well as external relationships of the individual to the family and larger group groups. Life-style addictions may sway many domains of an individual's functioning and oftentimes require multi-modal treatment. Real enlarge however, requires appropriate interventions and motivating strategies for every size of an individual’s life.
The Addictions rescue measurement system (Arms) has identified the following seven treatment enlarge areas (dimensions) in an endeavor to: (1) aid clinicians with identifying further motivational techniques that can growth an individual’s awareness to make progress: (2) portion within treatment progress, and (3) portion after treatment outcome effectiveness:
Pd- 1. Abstinence/ Relapse: enlarge Dimension
Pd- 2. Bio-medical/ Physical: enlarge Dimension
Pd- 3. Mental/ Emotional: enlarge Dimension
Pd- 4. Social/ Cultural: enlarge Dimension
Pd- 5. Educational/ Occupational: enlarge Dimension
Pd- 6. Attitude/ Behavioral: enlarge Dimension
Pd- 7. Spirituality/ Religious: enlarge Dimension
Considering that addictions involve unbalanced life-styles operating within semi-stable equilibrium force fields, the Arms religious doctrine promotes that unavoidable treatment effectiveness and prosperous outcomes are the ensue of a synergistic association with “The Higher Power,” that spiritually elevates and connects an individuals’ manifold life functioning dimensions by reducing chaos and addition resilience to bring an individual harmony, wellness, and productivity.
Addictions rescue measurement - Subsystems
Since persisting lifestyle diseases and disorders such as diabetes, hypertension, alcoholism, drug and behavioral addictions cannot be cured, but only managed - how should we effectively conduct poly-behavioral addiction?
The Addiction rescue measurement system (Arms) is proposed utilizing a multidimensional integrative assessment, treatment planning, treatment progress, and treatment outcome measurement tracking system that facilitates rapid and spoton recognition and estimate of an individual’s whole life-functioning enlarge dimensions. The “Arms”- systematically, methodically, interactively, & spiritually combines the following five versatile subsystems that may be utilized individually or incorporated together:
1) The Prognostication system – composed of twelve screening instruments industrialized to value an individual’s total life-functioning dimensions for a whole bio-psychosocial estimate for an objective 5-Axis prognosis with a point-based Global estimate of Functioning score;
2) The Target Intervention system - that includes the Target Intervention portion (Tim) and Target enlarge Reports (A) & (B), for individualized goal-specific treatment planning;
3) The enlarge Point system - a standardized performance-based motivational rescue point system utilized to furnish in-treatment enlarge reports on six life-functioning individual dimensions;
4) The Multidimensional Tracking system – with its Tracking Team Surveys (A) & (B), along with the Arms extraction criteria guidelines utilizes a multidisciplinary tracking team to aid with extraction planning; and
5) The treatment Outcome measurement system – that utilizes the following two measurement instruments: (a) The treatment Outcome portion (Tom); and (b) the Global estimate of enlarge (Gap), to aid with aftercare treatment planning.
National Movement
With the end of the Cold War, the threat of a world nuclear war has diminished considerably. It may be hard to fantasize that in the end, comedians may be exploiting the humor in the fact that it wasn’t nuclear warheads, but “French fries” that annihilated the human race. On a more serious note, lifestyle diseases and addictions are the prominent cause of preventable morbidity and mortality, yet brief preventive behavioral assessments and counseling interventions are under-utilized in condition care settings (Whitlock, 2002).
The U.S. Preventive Services Task Force done that sufficient behavioral counseling interventions that address personal condition practices hold greater promise for improving whole condition than many secondary preventive measures, such as disposition screening for early disease (Uspstf, 1996). coarse health-promoting behaviors contain healthy diet, quarterly physical exercise, smoking cessation, appropriate alcohol/ medication use, and responsible sexual practices to contain use of condoms and contraceptives.
350 national organizations and 250 State group health, reasoning health, substance abuse, and environmental agencies sustain the U.S. Branch of condition and Human Services, “Healthy habitancy 2010” program. This national initiative recommends that traditional care clinicians use clinical preventive assessments and brief behavioral counseling for early detection, prevention, and treatment of lifestyle disease and addiction indicators for all patients’ upon every healthcare visit.
Partnerships and coordination among assistance providers, government departments, and society organizations in providing treatment programs are a necessity in addressing the multi-task solution to poly-behavioral addiction. I encourage you to sustain the reasoning condition and addiction programs in America, and hope that the (Arms) resources can aid you to personally fight the War on pathological eating disorders within poly-behavioral addiction.
For more info see:
Poly-Behavioral Addiction and the Addictions rescue measurement System,
By James Slobodzien, Psy.D., Csac at:
[http://www.geocities.com/drslbdzn/Behavioral-Addictions.html]
Food Addicts Anonymous: http://www.foodaddictsanonymous.org/
Alcoholics Anonymous: http://www.alcoholics-anonymous.org/
References
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American society of Addiction Medicine’s (2003), “Patient Placement Criteria for the
Treatment of Substance-Related Disorders, 3rd Edition,. Retrieved, June 18, 2005, from:
http://www.asam.org/
Bandura, A. (1977), Self-efficacy: Toward a unifying system of behavioral change. Psychological Review,
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Brownell, K. D., Marlatt, G. A., Lichtenstein, E., & Wilson, G. T. (1986). Comprehension and preventing relapse. American Psychologist, 41, 765-782.
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Kessler, R.C., McGonagle, K.A., Zhao, S., Nelson, C.B., Hughes, M., Eshleman, S., Wittchen, H. H,-U, & Kendler, K.S. (1994). Lifetime and 12-month prevalence of Dsm-Iii-R psychiatric disorders in the United
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Morgenstern, J.; Labouvie, E.; McCrady, B.S.; Kahler, C.W.; and Frey, R.M (1997). Affiliation with Alcoholics Anonymous after treatment: A study of its therapeutic effects and mechanisms of action. J Consult Clin Psychol 65(5):768-777.
Orford, J. (1985). immoderate appetites: A psychological view of addiction. New York: Wiley.
Prochaska, J. O., & DiClemente, C. C. (1984). The transtheoretical approach: Crossing the boundaries of therapy. Malabar, Fl: Krieger.
Slobodzien, J. (2005). Poly-behavioral Addiction and the Addictions rescue measurement system (Arms), Booklocker.com, Inc., p. 5.
Whitlock, E.P. (1996). Evaluating traditional Care Behavioral Counseling Interventions: An Evidence-based Approach. Am J Prev Med 2002;22(4): 267-84.Williams & Wilkins. U.S. Preventive Services Task Force. Guide to Clinical Preventive Services. 2nd ed. Alexandria, Va.
U.S. Branch of condition and Human Services. healthy habitancy 2010 (Conference Edition). Washington, Dc: U.S. Government Printing Office; 2000.
World condition Organization, (Who). Retrieved June 18, 2005, from: http://www.who.int/topics/obesity/en/
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