Journal of Addictive Behaviors,Therapy & RehabilitationISSN: 2324-9005

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Editorial, J Addict Behav Ther Rehabil Vol: 0 Issue: 0

Now is the Time: Why Addiction Treatment Professionals and Researchers Can No Longer Continue to Ignore Issues Related to the Other �S� in the BPSS Model

D. Gent Dotson*
Alabama State University, USA
Corresponding author : D. Gent Dotson, PhD
Department of Rehabilitation Studies, Alabama State University, USA
E-mail: [email protected]
Received: June 19, 2012 Accepted: June 20, 2012 Published: June 22, 2012
Citation: Dotson DG (2012) Now is the Time: Why Addiction Treatment Professionals and Researchers Can No Longer Continue to Ignore Issues Related to the Other “S” in the BPSS Model. J Addict Behav Ther Rehabil 1:1. doi:10.4172/2324-9005.1000e104

Abstract

Now is the Time: Why Addiction Treatment Professionals and Researchers Can No Longer Continue to Ignore Issues Related to the Other “S” in the BPSS Model

For many years, addiction treatment professionals and researchers have stressed the importance of holistic approaches to both treatment for and recovery from any form of addiction. Based in the “disease concept,” as initially outlined by the Alcoholics Anonymous Big Book and then later by the Narcotics Anonymous Basic Text,this very important insight has forever changed the addiction treatment field (and indeed society as a whole) for the better by stressing the interconnectedness of the physical, mental and spiritual aspects of addiction and recovery. More recently, prominent researchers, such as Juhnke and Hagedorn, Oakley and Ksir, DiClemente, Lawson et al., and Perkinson and Jongsma, have promoted the expansion of the traditional disease conceptinto the now prevalent Biopsychosocial Spiritual Model or BPSS Model. It has been observed that some addiction treatment professionals and researchers (especially those who have been practicing for many years using the traditional disease concept model as the foundation of their life’s work) have hesitated to adopt the use of the BPSS Model.

Keywords:

For many years, addiction treatment professionals and researchers have stressed the importance of holistic approaches to both treatment for and recovery from any form of addiction. Based in the “disease concept,” as initially outlined by the Alcoholics Anonymous Big Book [1] and then later by the Narcotics Anonymous Basic Text [2], this very important insight has forever changed the addiction treatment field (and indeed society as a whole) for the better by stressing the interconnectedness of the physical, mental and spiritual aspects of addiction and recovery. More recently, prominent researchers, such as Juhnke and Hagedorn [3], Oakley and Ksir [4], DiClemente [5], Lawson et al. [6], and Perkinson and Jongsma [7], have promoted the expansion of the traditional disease concept into the now prevalent Biopsychosocial Spiritual Model or BPSS Model. It has been observed that some addiction treatment professionals and researchers (especially those who have been practicing for many years using the traditional disease concept model as the foundation of their life’s work) have hesitated to adopt the use of the BPSS Model. While there have been times that this reality has caused me to feel some concern, what has become clear to me, after having many different conversations with several long-term addiction treatment professionals and researchers, is that much of the hesitation about using the BPSS Model was founded in a sincere belief that most, if not all, of the “social” aspects of the BPSS model were already contained within the realm of the spiritual, as it often advocated in 12-step recovery literature. Being familiar with the broad implications of spirituality espoused by such programs and having read the portions of recovery books that were routinely being mentioned, this idea did not seem too far-fetched, especially considering that several research projects that had been conducted on the topic of spiritually, as a part of the recovery process, had shown clearly that spiritual practices, such as honesty, open-mindedness, willingness, trust, etc., are extremely valuable and affective in regards to mending strained and broken relationships, which is undoubtedly one of the most important aspect of the social aspects of a person’ life [8]. I would contend however, that such an argument fails to recognize a very real and very serious issue in regards to the social aspects or consequences of addiction. Despite the many benefits of using one’s sense of spirituality to help improve a person’s perception of themselves and actions towards others, the fact remains that the most harmful social issues or obstacles for individuals with an addiction cannot be addressed though practicing a spiritual program (self-help or otherwise), developing a spiritual belief system or even by making sincere attempts to live by so called “spiritual principles.” The real issue that contains the highest level of negative effects is connected to the fact that our society continues to consider individuals with addiction-related disorders at the very least as social outcasts, but more often than not, these individuals are treated as criminals who must get with the complete-and-totalabstinence- for-the-rest-of-your-life program “or else.”
Many “abstinence-only” programs do not consider the true social implications of addiction. For example, it not a fact that many drugs of abuse have been made completely illegal, and for people to purchase such a substance they have no choice, other than to conduct business on the black market, constantly putting themselves at severe risk of harm-risk that can at times be so bad that they make being arrested a relief? Could it not be that the immense markup on the prices of illicit drugs created by the current system of interdiction and incarceration plays a large part in the all too often dynamic of draining an individual and his/her finances, which then leads him/her to conduct desperate acts in order to get more drugs or more money for the purchase of those drugs? Is it not those desperate acts that then get put into the category of “spiritual” sickness? What about the societal delusion of being able to keep individuals from seeking out substances to change the way they feel through criminalization? This delusion has now been fully imbedded in American society for well over 100 years and has spawned such epic failures as Alcohol Prohibition and the “War on Drugs”. However, the truly disturbing reality is that many treatment professionals and researchers have chosen to be part of the status quo instead of standing up for practices that they know will bring about true meaningful change. So why then have these before mentioned addition issues and consequence become the norm? While there is certainly no one to answer that question, what is clear is that we, as addiction professionals and researchers, share a lot of the blame. I have heard the excuses from former colleagues during my clinical/practicum classes many times: It’s the law. What can you do? Ninety-five percent of our referrals for treatment are sent to us by the Criminal Justice system...if I told them how I really felt they might stop sending people here. While such issues could potentially be problematic if one works in an extremely conservative and/or ignorant and bigoted area of the country, my own experience did not play out that way. I personally worked in the addictions treatment field in two of the most conservative places in our country, or maybe even the entire developed world (Mississippi and Alabama) for four years prior to going on into my doctoral program. I was amazed at how many individuals working in the criminal justice field had very similar views to me as a rehabilitation professional in regards to how messed up a system of laws are that force individuals to spend months or even years of their lives behind bars just because they got caught possessing a drug they were addicted to. While I could say much here about how to work with individuals who have people in their life such as a probation or parole officer, that is for another time. What I really want to address in this editorial is what we all know well, and far too often ignore—the reality that the “or else” mentioned earlier (being arrested, fined, imprisoned, cast aside, chastised, disgraced, etc.) can often cause just as many, if not more, “social” problems as the addiction can; therefore, in order to develop effective, efficient, and humanitarian treatment strategies, we must address the current drug policies that force individuals to become criminals.
In order to address this issue, we must consider all aspects of the BPSS Model. Times have never been better in regards to our knowledge of the biological aspects of addiction. A plethora of research is available on the ways in which many different substances affect the brain [9,10]. This well done, solid scientific data shows that genetics play an even larger role in an individual’s development of a “dependency” diagnoses than was once thought. New innovations such as the positron emission tomography, or PET scan, can show us specifically what is going on in the brain to a level of accuracy never seen before. In part, the results of conducting such research and using highly advanced medical assessment equipment, have led to ground-breaking medications, such as buprenorphine, naltrexone and acamprosate, to help individuals work towards abstinence and/or maintain licit substance use while decreasing the chances for a person to turn back to the use of illicit drugs. The even better news is that there are many more medications currently being developed.
In our field, there is little doubt that psychological interventions for the treatment of addiction are very important and that they will continue to be important into the very distant future. At the current time we have an extensive list of evidence-based best practices that have helped to develop and will continue to help develop more effective client-centered treatments plans that can be used to bring about the best possible outcomes for individuals with addictionrelated disorders. For example, the National Institute on Drug Abuse, the National Institutes of Health and the U.S. Department of Health and Human Services collaborated to produce a research-based guide entitled Principles of Drug Addiction, which included over sixty studies proven to have successful psychological components in the treatment of addiction based disorders [11]. There is no reason to think then that the psychological aspect of the BPSS model is in any danger of becoming obsolete any time soon; however, I personally can imagine that as we move forward, we will learn even more about the specific ways in which certain types of addictions affect the brain and/or the role genetics play in how individuals react to certain substances. As a result, there will be less of a distinction made between what we now view as the psychological aspects of addition and what we will view as being more of a biological aspect of addiction. Regardless of if that turns out to be the case and to what level, psychological interventions will continue to play an important role in the treatment of addictions from a holistic perspective due to their proven track record of helping individuals with addiction related disorders.
In regards to the spiritual aspects of addiction, there has long been debate as to what it means or doesn’t mean to have a “spiritual” sickness, and there is no reason to believe that there will ever be a single answer to such questions that will be agreeable to everyone. What is clear is that anyone wishing to seek help with such issues has no shortage of options available to them. We now live in a time where it is much easier to find a “spiritual” self-help group for addiction, than it is to find a non-spiritual one. If traditional 12-step programs, such as Alcoholics Anonymous or Narcotics Anonymous, are not to a person’s liking, there are many other options that offer such similar support, such as Celebrate Recovery.
So then what about the “social” aspects of addiction, the other S in the BPSS model? How far have we come with these issues? In my estimation, we’ve traveled a long distance, but in the wrong direction. While the social consequences of addiction are well known: loosing face, going broke, losing touch with family and loved ones, becoming destitute, selling one’s possessions and body, etc., the role that our current drug policies play in these issues often goes ignored. Moralistic and judgmental attitudes of many U.S. citizens empower like-minded politicians to implement public policies and laws based primarily on fear, hatred and bigotry. Many of these policies are not supported on empirical research and seem to please a basic primal instinct to punish, humiliate and separate the “other.” We should all be concerned aboutthe ways in which our society continues to perpetuate the lie that the life of a person who is addicted to drugs is “less than” or “less than human.”
One of the most frustrating situations I have encountered in my professional career was trying to reason with unreasonable individuals. Over the past eleven years of my professional life, I have attempted many times to advocate for common sense drug laws, using fact-based research to debate with individuals who believed that so called “spiritual issues,” such as demonic possession or immorality, are the primary cause of addiction. However, my frustration has not deterred me from continuing to discuss the real issues of the “other” S, and my hope is that other individuals, who know what is at stake, will take a stand as well. If we continue our current course, we could easily become a society that incarcerates more people than it educates—a society who budgets far more for the incarceration of individuals with drug-related crimes than it does for higher education.
Today, you would have a hard time finding many individuals in the addiction treatment and research world who believe that they have a constitutional right to put whatever they want in their body (outside of Libertarian or extremely liberal circles). However, our personal views on drug use should not get in the way of accepting the reality that our current system of criminalizing those who have addiction disorders is the wrong thing to do morally, fiscally, and socially. We should change the larger dynamic in the country; we should stop ignoring the “elephant in the room” because we, as treatment professionals and researchers, know firsthand the detrimental effects of the criminalization of drug use.
Although we may not all agree on the causes of addiction or which aspect of the BPSS Model should take precedence in recovery from addiction, we should all agree that the time has come to stop accepting the unacceptable. That is, we can use the compassion and empathy that lead us into this field of work to collaborate for the humane treatment of individuals with addictions. The fact is that people have always and will always use substances to change the way they feel. Sometimes, the use of those substances can become an addiction. The good news is that addiction is not a hopeless state; people can and do get better. Even though everyone does not get better in the same way or at the same pace, no one should have to live their lives in prison for being addicted! Addiction is not a crime. Addiction is a truly disabling condition, recovery from which is easier for some than it is for others, and humane treatment for individuals with addictions will never come as long as we ignore the “other” S in the BPSS model. With our combined research, clinical experience, and personal experience to support the need for changes in our government’s drug policies, there is no excuse for us to continue to support the status quo.

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