When inspecting that pathological eating disorders and their linked diseases now afflict more habitancy globally than malnutrition, some experts in the healing field are presently purporting that the world’s number one condition question is no longer heart disease or cancer, but obesity. according to the World condition club (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 chronic disease and disability. Often coexisting in developing countries with under-nutrition, obesity is a complex condition, with serious communal and psychological dimensions, affecting virtually all ages and socioeconomic groups.” The U.S. Centers for Disease control and prevention (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 increase is not tiny to adults. The percentage 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 aggregate 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 assessment that up to 73,000,000 Americans could advantage from some type of instruction awareness and/ or medicine for a pathological eating disorder or food addiction. Typically, eating patterns are carefully pathological problems when issues with regard to 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 primary maladaptive communal and/ or occupational impairment in functioning.
Dc Motor Theory
We must think that some habitancy construct dependencies on positive 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 naturally consume more calories than they burn due to an out of control 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 control over appetite of some kind (Orford, 1985). Binge-eating Disorder episodes are characterized in part by a feeling that one cannot stop or control 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 description 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 positive aspects of normal, pathological and experimental eating habits (food restriction combined with stress, loco-motor hyperactivity).” They description that the “pathological administration of eating disorders may lead to two ultimate situations: the absence of ingestion (anorexia) and inordinate ingestion (bulimia).”
Co-morbidity & Mortality
Addictions and other mental disorders as a rule do not construct in isolation. The National Co-morbidity explore (Ncs) that sampled the entire U.S. habitancy in 1994, found that among non-institutionalized American male and female adolescents and adults (ages 15-54), approximately 50% had a diagnosable Axis I mental 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 mental disorder diagnosis, and nearly 25% of women will have superior for a serious mood disorder (mostly major depression). A primary finding of note from the Ncs study was the allembracing 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 added 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) description that, “the most foremost 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 foremost cause of preventable morbidity and mortality was risky behavior lifestyles, the U.S. prevention 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 medicine 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 effective medicine strategies. But why do 47% of patients treated in underground medicine programs (for example) relapse within the first year following medicine (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 naturally 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 possibly be that patients with multiple addictions are being under diagnosed (with a particular dependence) naturally due to a lack of diagnostic tools and resources that are incapable of resolving the complexity of assessing and treating a outpatient with multiple addictions?
Diagnostic Delineation
Thus far, the Dsm-Iv-Tr has not delineated a analysis for the complexity of multiple behavioral and substance addictions. It has reserved the Poly-substance Dependence analysis for a man who is repeatedly using at least three groups of substances during the same 12-month period, but the criteria for this analysis do not involve any behavioral addiction symptoms. In the Psychological Factors Affecting healing Condition’s section (Dsm-Iv-Tr, 2000); maladaptive condition behaviors (e.g., overeating, unsafe sexual practices, inordinate alcohol and drug use, etc.) may be listed on Axis I only if they are significantly affecting the course of medicine of a healing or mental condition.
Since successful medicine outcomes are dependent on suitable assessments, exact diagnoses, and allembracing individualized medicine planning, it is no wonder that repeated recovery failures and low success rates are the norm instead of the exception in the addictions field, when the most recent Dsm-Iv-Tr does not even include a analysis for multiple addictive behavioral disorders. medicine clinics need to have a medicine planning principles and referral network that is equipped to wholly collate multiple addictive and mental condition disorders and linked medicine needs and comprehensively contribute education/ awareness, prevention strategy groups, and/ or exact addictions medicine services for individuals diagnosed with multiple addictions. Written medicine goals and objectives should be specified for each separate addiction and dimension of an individuals’ life, and the desired doing outcome or completion criteria should be specifically stated, behaviorally based (a graphic activity), and measurable.
New Proposed Diagnosis
To sustain in resolving the tiny Dsm-Iv-Trs’ diagnostic capability, a multidimensional analysis of “Poly-behavioral Addiction,” is proposed for more exact analysis foremost to more effective medicine planning. This analysis encompasses the broadest kind of addictive disorders that would include an individual manifesting a aggregate 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 mental 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 chronic physical, mental, emotional, cultural, sexual and/ or spiritual/ religious intoxication. These assorted types of intoxication are produced by repeated obsessive thoughts and compulsive practices complex in pathological relationships to any mood-altering substance, person, organization, trust system, and/ or activity. The individual has an overpowering desire, need or compulsion with the presence of a tendency to intensify their adherence to these practices, and evidence of phenomena of tolerance, abstinence and withdrawal, in which there is always corporal and/ or psychic dependence on the effects of this pathological relationship. In addition, there is a 12 - month duration in which an individual is pathologically complex 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 chronic dependence on multiple 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 recovery determination System’s (Arms) theory 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 control 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., house history, communal support, years of potential dependence, and co-morbid psychopathology), physiological states (e.g., corporal 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 corollary in large qualitative changes at the global level and patterns at the global level of a principles emerge solely from numerous tiny interactions.
The Arms hypothesis purports that there is a multidimensional synergistically negative resistance that individual’s construct to any one form of medicine to a particular dimension of their lives, because the effects of an individual’s addiction have dynamically interacted multi-dimensionally. Having the original focus on one dimension is insufficient. Traditionally, addiction medicine programs have failed to adapt 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 heighten allembracing functioning. They tend to encourage the use of tobacco, alcohol and other drugs, help increase violence, decrease functional capacity, and promote communal isolation. Most medicine theories today involve assessing other dimensions to identify dual analysis or co-morbidity diagnoses, or to collate contributing factors that may play a role in the individual’s original addiction. The ArMs’ principles proclaims that a multidimensional medicine plan must be devised addressing the potential multiple addictions identified for each one of an individual’s life dimensions in expanding to developing exact 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 aid with changing their lifestyles. The Stages of change 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 principles supports the constructs of self-efficacy and communal networking as outcome predictors of time to come behavior over a wide variety of lifestyle risk factors (Bandura, 1977). The Relapse prevention 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 recovery Groups such as Food Addicts and Alcoholics Anonymous along with spiritual and religious recovery activities as a primary means to utter outcome effectiveness. The beneficial effects of Aa may be attributable in part to the transfer of the participant's communal network of drinking friends with a fellowship of Aa members who can contribute motivation and withhold 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 medicine settings, thereby foremost to reductions in alcohol consumption (Niaaa, June 2005).
Treatment strengthen Dimensions
The American society of Addiction Medicine’s (2003), “Patient Placement Criteria for the medicine of Substance-Related Disorders, 3rd Edition”, has set the suitable in the field of addiction medicine for recognizing the totality of the individual in his or her life situation. This includes the internal interconnection of multiple dimensions from biomedical to spiritual, as well as external relationships of the individual to the house and larger communal groups. Life-style addictions may influence many domains of an individual's functioning and often need multi-modal treatment. Real strengthen however, requires suitable interventions and motivating strategies for every dimension of an individual’s life.
The Addictions recovery determination principles (Arms) has identified the following seven medicine strengthen areas (dimensions) in an effort to: (1) sustain clinicians with identifying added motivational techniques that can increase an individual’s awareness to make progress: (2) portion within medicine progress, and (3) portion after medicine outcome effectiveness:
Pd- 1. Abstinence/ Relapse: strengthen Dimension
Pd- 2. Bio-medical/ Physical: strengthen Dimension
Pd- 3. Mental/ Emotional: strengthen Dimension
Pd- 4. Social/ Cultural: strengthen Dimension
Pd- 5. Educational/ Occupational: strengthen Dimension
Pd- 6. Attitude/ Behavioral: strengthen Dimension
Pd- 7. Spirituality/ Religious: strengthen Dimension
Considering that addictions involve unbalanced life-styles operating within semi-stable equilibrium force fields, the Arms philosophy promotes that positive medicine effectiveness and successful outcomes are the corollary of a synergistic association with “The Higher Power,” that spiritually elevates and connects an individuals’ multiple life functioning dimensions by reducing chaos and expanding resilience to bring an individual harmony, wellness, and productivity.
Addictions recovery determination - Subsystems
Since chronic lifestyle diseases and disorders such as diabetes, hypertension, alcoholism, drug and behavioral addictions cannot be cured, but only managed - how should we effectively manage poly-behavioral addiction?
The Addiction recovery determination principles (Arms) is proposed utilizing a multidimensional integrative assessment, medicine planning, medicine progress, and medicine outcome determination tracking principles that facilitates rapid and exact recognition and assessment of an individual’s allembracing life-functioning strengthen dimensions. The “Arms”- systematically, methodically, interactively, & spiritually combines the following five versatile subsystems that may be utilized individually or incorporated together:
1) The Prognostication principles – composed of twelve screening instruments advanced to rate an individual’s total life-functioning dimensions for a allembracing bio-psychosocial assessment for an objective 5-Axis analysis with a point-based Global assessment of Functioning score;
2) The Target Intervention principles - that includes the Target Intervention portion (Tim) and Target strengthen Reports (A) & (B), for individualized goal-specific medicine planning;
3) The strengthen Point principles - a standardized performance-based motivational recovery point principles utilized to produce in-treatment strengthen reports on six life-functioning individual dimensions;
4) The Multidimensional Tracking principles – with its Tracking Team Surveys (A) & (B), along with the Arms discharge criteria guidelines utilizes a multidisciplinary tracking team to sustain with discharge planning; and
5) The medicine Outcome determination principles – that utilizes the following two determination instruments: (a) The medicine Outcome portion (Tom); and (b) the Global assessment of strengthen (Gap), to sustain with aftercare medicine 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 foremost 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 closed that effective behavioral counseling interventions that address personal condition practices hold greater promise for improving allembracing condition than many secondary preventive measures, such as routine screening for early disease (Uspstf, 1996). base health-promoting behaviors include healthy diet, regular corporal exercise, smoking cessation, suitable alcohol/ medication use, and responsible sexual practices to include use of condoms and contraceptives.
350 national organizations and 250 State communal health, mental health, substance abuse, and environmental agencies withhold the U.S. Division of condition and Human Services, “Healthy habitancy 2010” program. This national initiative recommends that original care clinicians use clinical preventive assessments and brief behavioral counseling for early detection, prevention, and medicine 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 medicine programs are a necessity in addressing the multi-task explication to poly-behavioral addiction. I encourage you to withhold the mental condition and addiction programs in America, and hope that the (Arms) resources can sustain you to personally fight the War on pathological eating disorders within poly-behavioral addiction.
For more info see:
Poly-Behavioral Addiction and the Addictions recovery determination 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/
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