screening for polybehavioral addiction
Screening for Poly-Behavioral Addiction
Writen by James Slobodzien
With the end of the Cold War, the threat of a world nuclear war has diminished considerably. It may be hard to imagine 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, when considering that food addictions and their related diseases now afflict more people globally than malnutrition. The behavioral addiction disorders (e.g., food addictions, pathological gambling, and other obsessively-compulsive behavioral-patterns to religion, and/ or sex / pornography, etc.) are just as damaging, psychologically and socially as alcohol and drug abuse.
On a more serious note, lifestyle diseases and addictions are the leading cause of preventable morbidity and mortality taking more than one million (1,000,000) U.S. lives a year, yet brief preventive behavioral assessments and counseling interventions are under-utilized in health care settings (Whitlock, 2002). The U.S. Preventive Services Task Force concluded that effective behavioral counseling interventions that address personal health practices hold greater promise for improving overall health than many secondary preventive measures, such as routine screening for early disease (USPSTF, 1996). Common health-promoting behaviors include healthy diet, regular physical exercise, smoking cessation, appropriate alcohol/ medication use, and responsible sexual practices to include use of condoms and contraceptives.
Multiple Addictions and Poor Prognosis
Since it is impossible to expect treatment for one addiction to be beneficial when other addictions co-exist, the initial therapeutic intervention for any addiction needs to include an assessment for other addictions. National surveys revealed that a very high correlation exists between substance abuse and behavioral addictions. Repeated failures abound with all of the addictions, even with utilizing the most effective treatment strategies. But why do 47% of patients treated in private addiction treatment programs (for example) relapse within the first year following treatment (Gorski, T., 2001)? Have addiction specialists become 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 health risks that deserve our attention, but could it possibly be that patients with multiple addictions are being under diagnosed (with a single dependence) simply due to a lack of diagnostic tools and resources that are incapable of resolving the complexity of assessing and treating a patient with multiple addictions?
The Addictions Recovery Measurement System (ARMS), along with 350 national organizations and 250 State public health, mental health, substance abuse, and environmental agencies support the U.S. Department of Health and Human Services, “Healthy People 2010″ program. This national initiative recommends that primary care clinicians utilize 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. The ARMS theory proposes a new diagnosis. 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 (Slobodzien, J., 2005).
The ARMS prognostication system supports the Five A’s construct (a model adapted from tobacco cessation interventions) as a brief screening behavioral counseling system. This guideline (Morgan and Fox, 2000) provides different brief interventions for treating patients based on their lifestyle disease indicators and addictive behavior status. Health care providers should: