An understanding behind the habit: Biopsychosocial model relating to substance abuse and addiction

A multilevel analysis can be used to examine health outcomes and contextual influences which contribute to their health status. Pickett and Pearl (2001) suggest multilevel analysis provide useful information to guide public health policy, statistical analysis and preventative programs. Analysis is now becoming appropriate of a tool to examine group level effects on the health of individuals. Economic status is widely accepted as the most attributable to one’s health as it is a measurable basis of predictability of how well individual’s associate to the social determinants of health. Socioeconomic status and prevalence of health behaviors relate to social tolerance and normative attitudes towards health related behavior. However, multilevel analysis is now opening up to associating health outcomes to immeasurable contextual factors, some of which may operate at an aggregate level.

Mental health problems and illnesses are widely prevalent in Canada as 7.5 million people suffer from it. The five most prevalent mental health conditions are depression, bipolar disorder, alcohol and substance abuse, social phobias and major depressive disorder. Approximately, 2, 041, 230 people aged nine years and over live with a mental illness. These mental health problems have staggering effects on health outcomes. Mental health problems affect all populations, social inequality and disadvantages lead to disparities in mental health outcomes. Some populations are more likely to be exposed to lack of social determinants of health, which increases the likelihood of developing unhealthy behaviors such as food insecurity, inadequate housing, unemployment, low income, racism and less access to primary access to healthcare. This population requires effective public health approach to primary prevention and early intervention (Mental Health Commission of Canada, 2017). In a study of 15 Canadian cities, individuals with a low socioeconomic index were 3.4 times more likely to hospitalize for substance abuse disorders than people from higher socioeconomic areas (Canadian Centre on Substance Abuse, 2014).

The Addictions Foundation of Manitoba defines addiction accordingly as an unhealthy relationship between a person and a mood-altering substance, experience, event or activity, which contributes to life problems and their re-occurrence (Addictions Foundations of Manitoba, 2000).

Substance abuse and addiction can limit an individual’s human capabilities realize their own freedom and control in their lives. Individuals with low community socioeconomic status have high levels of social exclusion which leads to restricted access to many social programs and health services which are designed to improve daily living conditions. Low socioeconomic status can be further exacerbated in conjunction with substance abuse disorders. Pre-occupation with substance addiction may lead to inadequate incomes as money is spent on drugs instead of food, housing and essential amenities (Canadian Centre on Substance Abuse, 2014).

Healthcare services are designed to maintain, promote and prevent disease. Healthcare services for substance abuse including prevention, education, early identification, harm reduction (e.g., needle exchange programs), specialized treatment and acute care. The socioeconomic determinants of health are addressed through appropriately allocating resources and linking individuals to community services via partners and advocacy services. However, issues with substance abuse sustain often due to lack of communication with primary care staff upon discharge, as a result, continuity of services are lost. Healthcare professionals must evaluate symptoms and behaviors that have led to abuse and addiction.

The Biopsychosocial (BPS) approach is a comprehensive framework for understanding human development, health and functioning. It is based on the theory that “humans are inherently BPSl organisms in which biological, psychological and social dimensions are inextricably intertwined” (Griffiths, 2005). The BPS model is an alternative to the biomedical disease model that views addiction as the product of the interaction between biological, psychological, social, and cultural factors (Addictions Foundation of Manitoba, 2000).

Griffiths (2005) indicates that addictions are a result from an interaction and interplay between factors of biological and/or genetic predisposition, psychological factors (e.g. personality factors, unconscious motivations, attitudes, expectations and beliefs), their social environment (e.g. situational characteristics) and the nature of the activity itself (e.g. structural characteristics). It is the many factors and interconnection of all these faculties that results in the addictive behaviors. The considerations of layered context to health and dispositions contribute to addictive behaviors best assimilates with a BPS approach. The BPS model asserts that a medical diagnosis should consider the interaction of biological, psychological and social factors which leads to improved diagnosing, screening and better predictions about treatment and follow-up (Suls & Rothman, 2004).

For example, a study which evaluated the effectiveness of the BPS model to addiction for Muslims within an Islamic context. They found that individuals were preoccupied with obtaining drugs and problems escalated to a point in which it affected their spirituality. The BPS model considers psychological repercussions such as one’s spirituality. In this study, individuals were said to have been compliant with Islamic teachings but their drug and alcohol dependence had a negative impact on their spiritual life. This led to aggravation of depression, and anger symptoms as they felt they were committing a ‘sin’. These individuals were irritable and became social excluded from their religious communities. The challenges were defeating and further perpetuated a feeling of defeat and furthered them away from appropriating with social determinants of health (Ghaferi, Bond & Matheson, 2017).

A clinical example for which addiction and substance abuse is prevalent would be related to individuals using drugs as a coping mechanism. Addictions to substances could be used to help socially anxious individuals cope with any or all of these facets of social anxiety. For instance, some socially anxious individuals may use substances to help decrease physiological arousal (Buckner, Heimberg, Ecker & Vinci, 2013). The substances may be used to decrease or avoid unpleasant sensations associated with arousal and as a way to avoid scrutiny should others observe their physiological arousal. On a psychological focus, some may use to enhance enjoyment during social events, and some may strive to overcome their (perceived or actual) social deficits by using substances. Biologically, the same study indicates that individuals who have parents with alcohol-related problems appear more likely than those without such parents to have social anxiety disorder (Wand, 2008; Buckner, Heimberg, Ecker & Vinci, 2013). In regards to health-care professionals, the BPS model for addiction will allow for greater assessments of substance related dependencies for their patients as they consider context of one’s difficulties in their daily life.

Addictions are prevalent for individuals suffering from chronic or acute levels of pain. HIV/AIDS patients experience increasing levels of pain related to biological stressors such as environmental and affective stressors contributing to pain. The psychological distress arising from changes in level of functioning may exacerbate depressive disorders. However, “Pseudo-addiction” has been defined as patient behavior that clinicians associate with addiction, such as requests for higher doses of opioids. Clinicians are quick to dismiss the increasing experience of pain for reasons that HIV/AIDS patients may have been drug abusers in the past, so may be drug seeking at this time. However, this stigma compromises the well-being of the patient. Uncontrolled pain and inadequate pain management is a key factor leading individuals in elevated levels of pain to turn to dependencies. Domains such as disability and distress levels should be determined in conjunction to pain assessments to regimen pain management (Marcus, Kerns, Rosenfeld & Breitbart, 2000).

This model (BPS) invites an appreciation for both the diversity and uniqueness of the individual problems which arise from the interaction of widely variable sets of contributing factors. A BPS model focuses attention on the diversity of client needs, reinforcing the importance of both client-centered clinical practices and the provision of a range of program options. The BPS model supports a view of individuals as powerful agents for self-determination. Rather than inviting a view of individual outcomes as being largely the product of complex of external determinants. As a best practices model, BPS accommodates and supports non-linear systems theories which place individuals and behaviours within contexts of biological, family and socio-cultural systems, and which view individuals as active participants in on-going system maintenance and change dynamics.

A BPS Model is consistent with current addiction research and health behaviour theory, and supports prevention and health promotion practices based on the Determinants of Health/ Population Health Model. In addictions related areas, researchers now almost universally accept the idea of BPS risk and protective factors as interdependent determinants of health outcomes (Addictions Foundation of Manitoba, 2000). The BPS model gets to the root of one’s issues due to its consideration of context behind behaviors and current health status. The follow-up for patients are ones that considers micro-level influences such as understanding one’s personal behaviors to macro-level influences to improving health status such as harm reduction initiatives. The BPS model does well to prevent stigma and social exclusion which contribute to problem behaviors. The BPS model had allowed for inequities to be minimized as a result of social exclusion, and societal initiatives such as rehabilitation centres are a supportive area for individuals to find employment and improve socio-economic status to improve contextual contributions to their problematic behaviors.

Resources

Addictions Foundation of Manitoba. (2000). Biopsychosocial model. Manitoba: Author. Retrieved from http://www.afm.mb.ca/wp-content/uploads/2013/03/BPS-FINAL.pdf

Buckner, J.D., Heimberg, R., Ecker, A. & Vinci, C. (2013). A biopsychosocial model of social anxiety and substance abuse. Depression and Anxiety, 2(3), 276. https://doi:10.1002/da.22032

Canadian Centre on Substance Abuse. (2014). System approach workbook: Socioeconomic determinants of health. Ottawa, ON: Author. Retrieved from http://www.ccsa.ca/Resource%20Library/CCSA-Systems-Approach-Socioeconomic-Determinants-2014-en.pdf

Ghaferi, H. A., Bond, C., & Matheson, C. (2017). Full length article: Does the biopsychosocial-spiritual model of addiction apply in an Islamic context? A qualitative study of Jordanian addicts in treatment. Drug and Alcohol Dependence, 17214-20. https://doi:10.1016/j.drugalcdep.2016.11.019

Griffiths, M. (2005). A ‘components’ model of addiction within a biopsychosocial framework. Journal of Substance Use, 10(4), 191-197. https://doi:10.1080/14659890500114359

Marcus, K. S., Kerns, R. D., Rosenfeld, B., & Breitbart, W. (2000). HIV/AIDS-related Pain as a Chronic Pain Condition: Implications of a Biopsychosocial Model for Comprehensive Assessment and Effective Management. Pain Medicine, 1(3), 260-273. https://doi.org/10.1046/j.1526-4637.2000.00033.x

Mental Health Commission of Canada. (2017). Strengthening the case for investing in Canada’s Mental Health System: Economic considerations. Ottawa, ON: Author. Retrieved from https://www.mentalhealthcommission.ca/sites/default/files/2017-03/case_for_investment_eng.pdf

Pickett, K.E., & Pearl, M. (2001). Multilevel analyses of neighbourhood socioeconomic context and health outcomes: a critical review. Journal of Epidemiology Community Health. ISBN 55:111–122. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1731829/pdf/v055p00111.pdf

Suls, J., & Rothman, A. (2004). Evolution of the Biopsychosocial Model: Prospects and Challenges for Health Psychology. Health Psychology, 23(2), 119-125. https://doi:10.1037/0278-6133.23.2.119

Wand, G. (2008). The Influence of Stress on the Transition From Drug Use to Addiction. Alcohol Research & Health, 31(2), 119–136. PMID: 23584814