Treating the Chemically Dependent as a Resurrection process is a very different concept and treatment goal for most clinicians. Looking at prisons as centers for fallen angels is probably at least three standard deviations from the norm. Yet for me this is the heart of the matter. To design and apply an effective treatment model of addictions, we must challenge and change the belief that the majority of the etiology of the problem resides in the individual not in the family, community and society. The individual can rise above the voices and contradictions that arise in the family and society, but only with a profound shift of awareness, a new relationship to their body, and a confident ability to use tools like exercise and meditation to take command of their emotional reactions, flow of thoughts and level of energy.
Before I compare and contrast the two paradigms-allopathic, symptom abatement to psychospiritual/humanological, it is important to know what criteria has to be met in order to give someone a diagnosis of Substance Abuse Dependence. Whatever paradigm one is operating under, one must carry out an assessment that leads to a diagnosis and then a treatment plan. To do that everyone uses the DSM-IV-TR.
What are the DSM-IV-TR criteria for Substance Abuse Dependence? The DSM is THE reference guide for providing a diagnosis that should lead to effective treatment but the authors of the DSM have stated that it is not the intended purpose of the DSM. It prescribes no treatment.
Furthermore, the DSM has come under attack for being culturally insensitive just as the I.Q. test has. And the DSM is itself a product of mind body dualism which it admits. "Although this volume is titled the diagnostic and Statistical Manual of Mental Disorders, the term mental disorders unfortunately implies a distinction between "mental" disorders and "physical disorders that is a reductionistic anachronism of mind/body dualism. (2) p30. I could not have said it better. "Inclusion of a disorder in the Classification (as in medicine generally) does not require that there be knowledge about its etiology. (3) Xxxiii. And finally, on page xxxiv, "Making a DSM-IV diagnosis is only the first step in a comprehensive evaluation. To formulate an adequate treatment plan, the clinician will invariably require considerable additional information about the person being evaluated beyond that required to make a DSM-IV diagnosis." (4) p.35
This is our point of departure. For clinicians operating under the psychospiritual approach, the DSM has much less utility. Not only is the DSM totally silent on making treatment recommendations, the allopathic model does not have a comprehensive, integrated holistic model of what a human being is that would allow for recommending serious effective alternative approaches for the treatment of the chemically dependent that would substantially raise the cure rate for both those inside and outside of prison.
The medical allopathic and social model substance abuse treatment programs have failed to increase cure rates much in the last three decades. Refer to the above statistics. However, it is good to be aware of the criteria for arriving at a substance abuse dependence diagnosis if only for the purpose of comparing treatment effectiveness of psychospiritual approaches to allopathic ones for the same diagnosis. I believe that this is in line with main purpose of the DSM in the first place.
Definitions and Criteria to be Met for a Substance Abuse Dependence Diagnosis
"The essential feature of Substance Dependence is a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues use of the substance despite significant substance-related problems. There is a pattern of repeated self-administration that can result in tolerance, withdrawal, and compulsive drug taking behavior. A diagnosis of substance dependence can be applied to every class of substances except caffeine. The symptoms of dependence are similar across the various categories of substances, but for certain classes some symptoms are less salient, and in a few instances not all symptoms apply (e.g., withdrawal symptoms are not specified for hallucinogen Dependence). Dependence is defined as a cluster of three or more of the symptoms listed below occurring at any time during the same 12 month period."(5), p.192
- Larger amounts over longer periods of time
- Persistent failures at stopping
- Continues to use with adverse consequences
The majority of inmates, patients and 3HO residents that I worked with qualified for substance dependence diagnosis. Many of them were Polysubstance dependent. This was also true for patients in the state mental hospital. Many patients were self-medicating to deal with the pain of their life as well as the pain of their mental illness.
Theories of Addiction
Theories of addiction try to answer why someone becomes addicted. Why would a person continue to do things that cause so much pain and suffering for them and others? One would want to know this so that one could design a treatment program that would address the "real" causes of addiction. Dr. David Dietch, The Director of the Addition Transfer of Technology Center at the University of San Diego, has reported the consensus in the field of addiction concerning etiology. He posits that there are four models.
A. Nurture vs. Nature
C. Genetic Transfer
- Tension Reduction
- Personality Disorders
- Pleasure Centers in the Brain.
At the present time there is NEITHER A CONSENSUS ON THE CAUSE OF ADDICTION NOR ON THE CURE FOR ADDICTION. All may contribute to addiction. There is a general consensus that AA and NA are the most successful interventions that lead to sobriety and maintain it. The most damaging assessment of treating the chemically dependent is that the knowledge base in the industry does not permit exact customization of a treatment plan. This is why the allopathic, symptom abatement paradigm is in crisis. Furthermore it does not have the knowledge base to sequence the interventions for maximum effect. This is not a limitation of the psychospiritual model when one includes state of the art diagnostic, assessment and treatment protocols that are available today and familiar to me.
Major Assumptions of the Allopathic Paradigm
It is necessary to identify the assumptions embedded in the allopathic paradigm as well as the anomalies or crises of this paradigm in treating the chemically dependent. Then we can see how the psychospiritual paradigm addresses these anomalies with solutions not available in the former paradigm.
As you know when one is preparing a business plan one is making projections of return on investment over time. Underlying these projections are always assumptions that these projections are based upon. What are the underlying assumptions of the allopathic and psychospiritual models? See Table below.
||Psychospiritual Humanological Model
|1. Alcoholism and addition are diseases.
||1. Your state of health is determined by your choices.
|2. The best an addict or alcoholic can achieve is temporary sobrietyï¿½one day at a time. It is heresy to suggest that one can get recovered.
||2. Ecstasy of consciousness is your birthright.
|3. One gets sick because some germ from the outside invades you.
||3. You are a spiritual being having a human experience. You are not a human being seeking a spiritual experience.
|4. Doctors know best. They are seen as Gods
||4. Body, mind and spirit are not separate. Your behavior and attitudes are derivative from your state of awareness and consciousness.
|5. Individual has little or no responsibility for their illness
||5. Addiction is a spiritual disease.
|6. Only the doctor can cure them
||6. You are perfect just the way you are.
|7. Your disease will be eliminated some day when we find the gene that is causing you the problem.
||7. You create your own reality. If you do not like the one you have created, you can create another. The television has many channels playing at the same time, change the channel and you tune into a different frequency and you get a different picture.
|8. Life style is seen neither as a cause of your problem nor as a solution to it.
||8. Every physical symptom has both a psychological and spiritual meaning.
|9. Embraces mind body dualism. Mind is separate from body.
||9. We have been conditioned to be more comfortable with pain and suffering than with joy and bliss
|10. Environmental and cultural factors have nothing to do with disease
||10. Changing oneï¿½s consciousness is the therapeutic task.
|11. Attempting to discredit and punish alternative therapists are acceptable practices and in the best interest of the public.
||11. It is possible to get recovered.
Humanology-The New Paradigm for Human Services for the Next Millennium
Humanology is the science of being human. The science of being human is not a soft science. It is based upon ancient wisdom and truth that has survived the test of time. It meets the two major criteria of every science. It has predictive ability and one can duplicate the results. Kuhn ï¿½ developed the concept of paradigm to demonstrate the process of how scientists change their allegiance to a different model that appeared to better address the anomalies of the present dominant paradigm. He wanted to know how an emerging paradigm gains adherents and prominence in the scientific community.
These enumerated beliefs form the basis of the humanological paradigm. It was not meant to be exhaustive but exemplary of the humanological paradigm. As you can see, if you embrace this paradigm, you have a very different sense of your identity and purpose. You certainly, if you are counselor, therapist, and healer would have a very different way of addressing the chemically dependent. Basically what these premises are saying is that if you identity your true identity which is infinity and you practice techniques that assist you in keeping you aligned with your identity, you will be healthy, happy, and holy.
Emerging Programs with Humanological Elements
Besides AA/NA meetings, Therapeutic Communities have had tremendous success in treating the chemically dependent. The Therapeutic community model is a starting point towards exemplifying an ideal treatment program based upon a humanological/psychospiritual paradigm. The reasons why it is an ideal beginning is shown by the enduring principles that Dr. Dietch uncovered in his research to identify the origins of the basic principles of the Therapeutic Community Movement. He found that they came from the Essenses who lived during the time of Christ.