Understanding the Biopsychosocial Model of Health

A biopsychosocial approach to healthcare understands that these systems overlap and interact to impact each individual’s well-being and risk for illness, and understanding these systems can lead to more effective treatment. It also recognizes the importance of patient self-awareness, relationships with providers in the healthcare system, and individual life context. Simply put, alcohol or other drug use is more likely if positive outcomes are expected than if negative outcomes are expected. Results from the 2016 Monitoring the Future study of middle and high school students are informative here.

• In this first demonstration of Palovian conditioning (also known as “classical” or “respondent” conditioning), Pavlov showed that a previously neutral stimulus could come to elicit a biologically relevant response if it was paired with a biologically relevant stimulus (Pavlov, 1927).
• Addiction treatment needs a set of metacontingencies, operating within an individual’s social environment, that brings organizational structure to the multitude of individual contingencies determining behavior.
• Supporting someone with a porn addiction can be challenging, especially if they do not want help or do not agree that they have a problem.
• In this sense, it is psychology and biology that made the theory changes critical to the BPSM, thereby becoming more aligned with concepts familiar in the social sciences.
• As Searle (2004) argues, “there is a striking difference between the passive character of perceptual consciousness and the active character of what we might call ‘volitional consciousness’“ (41).

New Approaches to the Study of the Addictive Process: Neuroinflammation

There is a paucity of high-quality evidence regarding the role of nutrition in OUD recovery. Nutrition does not easily lend itself to randomized controlled trials given the amount of time needed for measurable outcomes, and the presence of confounders introduced during this period. Therefore, nutrition research has been constrained to reductionistic approaches, such as looking at https://financeinquirer.com/top-5-advantages-of-staying-in-a-sober-living-house/ single nutrients or single outcome measures such as changes in weight. Conducting research on SUD populations creates additional challenges, as there are often high attrition rates (146). Biopsychosocial approaches to future nutrition research will hopefully renegotiate the boundaries between physical and mental health by targeting the gut-brain axis and examining novel outcomes.

• An argument is thus constructed that emphasizes the need for an organized structure of metacontingencies, operating within an individual’s social environment, that targets the functional relationships between the factors that drive drug use.
• The prominent belief several decades ago was that addiction resulted from bad choices stemming from a morally weak person.
• Multivariable regression models are applicable within the BMM, including biological variables only, but the expanded BPSM framework also accommodates inclusion of psychological and social variables, estimating their independent, additive, and interaction effects (e.g. Guloksuz et al., 2019).
• All of these individuals are correct in their observations, but they are only seeing part of the picture – a picture that is exceedingly complex because it’s in a constant state of motion.

Subtypes in addiction and their neurobehavioral profiles across three functional domains

Because it is entirely possible to advocate for shared decision making without challenging the notion of the cold technician, we propose to move the emphasis to an approach that emphasizes human warmth, understanding, generosity, and caring. Research suggests that when a person learns something while under the influence of a drug, it is possible that they will not be able to retrieve what they learned later, when the person is in a sober state—there simply will not be enough retrieval cues available to trigger the recall. This information processing framework not only has tremendous implications for how individuals function when taking psychotropic substances, but also how they often have to re-learn many things once they enter into recovery or quit using after a period of regular use. This area of cognitive psychology explains how substance use can affect the way that a person takes in (perceives) information from the environment, stores the information as a short-term memory, moves information into long-term memory, and later retrieves information in order to influence behavior.

• Genome-wide association studies of complex traits have largely confirmed the century old “infinitisemal model” in which Fisher reconciled Mendelian and polygenic traits [51].
• Conducting research on SUD populations creates additional challenges, as there are often high attrition rates (146).
• Engel says a lot of interesting things about all these things in his 1997 paper and others around that time (Engel, 1980, 1982), and they can be considered as part of what is covered by the BPSM.
• The biopsychosocial (BPS) framework was originally proposed in 1980 by Dr. George Engel stemming from his dissatisfaction with the biomedical model of illness (20).
• However, maybe I will never just quit and stay without substances for the rest of my life, as others do.

A brain disease? Then show me the brain lesion!

This concept has been described as a “biological embedding” of the environment and of one’s lived experiences (214, 215). In the LCP, environment includes access to health and social services, which is directly linked to SES as well as cultural norms within that context. Top 5 Advantages of Staying in a Sober Living House LCP includes complex concepts such as epigenetics and is therefore a much broader way of understanding health. Transgenerational inheritance of addiction-like behavior appears supported by epigenetic mechanisms (i.e., environmental exposure) over genetic factors (107).

COMPLEXITY SCIENCE: CIRCULAR AND STRUCTURAL CAUSALITY

Bandura’s theory was novel in arguing that (1) behavior, (2) the environment, and (3) personal factors internal to the individual (including biological characteristics and abilities), have reciprocal influences on one another – events that impact one of these components will also impact the others. For Bandura, the causes of behavior are both internal and external to the individual, and they are functionally related to one another. Similar to Skinner, he argued that behavior was goal-directed – and from a teleological perspective, the “goal” was both the consequence and end purpose of the behavior. Following a behavior analytic tradition, Bandura argued the purpose of behavior was to produce a functional change in the external environment. Unlike Skinner, however, Bandura argued the goal is cognitively formed and thus an outgrowth of the internal desires and values of the individual. Because of its cognitive origins, the goal did not necessarily have to benefit the individual or even have survival value (Bandura, 1986).

The neurobiology of drug addiction: cross-species insights into the dysfunction and recovery of the prefrontal cortex

Finally, individuals who have experienced early adversity may have greater difficulties with affect regulation and engaging in rewarding relationships, which may render them vulnerable to turn to drug use as a means of coping (Crittenden, 2015; Fonagy & Target, 2008). Taken together, an attachment perspective affords the opportunity to adopt a developmental stance in the understanding of addiction and the contribution of neurobiology and psychoanalysis in this endeavor. All support groups guided by the 12-step principles address the functional relationships that determine drug use.

• Agency is greater than a simple summation of the personal, behavioral, and environmental factors that contribute to its development and can only be explained by the functional and reciprocal interactions they have with one another.
• This may limit the value of neurobiological approaches to addiction when considered in isolation of these subjective and relational factors.
• Research that involves providing drugs to individuals living with an addiction must negotiate between science, ethics, politics, law, and evidence-based medicine.
• Neuroimaging studies have shown that trauma has a measurable, enduring effect on the functional dynamics of the brain, even in the absence of clinically diagnosable PTSD (64).

Psycho-Social Systems

Rather, successful translation of social learning principals into clinical practice involves creating treatments that are socially and environmentally invasive – in much the same way that new treatments for pancreatic cancer and valvular heart disease are physiologically invasive. Borrowing from Bandura’s model, “drug use” can be considered the critical behavior of interest. Both personal factors internal to the individual and environmental factors external to the individual directly impact the likelihood of using drugs. Moreover, all three of these factors mutually influence one another, leading to continually evolving functional relationships that both directly and indirectly influence the use of drugs (Figure 1B). Using this model, four fundamental questions that are central to the phenomenology of addiction can be addressed. Importantly, the initiation of substance use does not necessitate a pathway that leads to abuse and dependence.