Biopsychosocial Model for Addiction Treatment

Biopsychosocial vs. Biomedical Models

The biopsychosocial and biomedical model are two opposing methods of treatment that can be applied to addiction. Learn the difference here.

Biopsychosocial Model for Addiction Treatment

Biopsychosocial vs. Biomedical Models

The biopsychosocial and biomedical model are two opposing methods of treatment that can be applied to addiction. Learn the difference here.

The information presented on this page is a general overview and is offered here as a comprehensive resource. At Ampelis Recovery, our programs are customized and tailored to the individual’s needs. Specific details below that cover treatment protocols may not reflect the protocols used for our clients.

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What is the Biopsychosocial Model for Treatment?

The biopsychosocial model for treatment is a holistic treatment method that considers the complex social, psychological, and physical factors contributing to illness and suffering.1 Essentially, the biopsychosocial approach encourages medical practitioners to view health as a system rather than individual parts, i.e., mental, physical, etc. In this way, the biopsychosocial model for treatment creates a more holistic approach to health care by understanding the patient’s culture, mental state, and specific external contributors to illness.

The term biopsychosocial can be broken into two parts for better understanding. Bio – referring to biology and the body. Psychosocial – referring to the influence culture and environment have on an individual’s brain, mood, principles, etc. For example, the psychosocial definition of substance use may look at how a demanding job impacts mental health and family relationships, rather than just looking at physical issues. We will learn a lot more about the model by the end of this article, but let’s start with where the model came from.

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History of the Model

In 1977, physician George Engel published “The need for a new medical model: A challenge for biomedicine.” Before this publication, medical practitioners used a cause-effect model to diagnose and treat illness. For example, doctors using a cause-effect model will look at someone with an alcohol use disorder who develops acute liver failure and would treat only the liver failure and alcohol use disorder. In contrast, under the biopsychosocial approach, a doctor works to understand the cause of alcohol dependency first, allowing for a more effective treatment for the patient.2

Dr. George Engel, along with Dr. John Romano, created a patient-centered hierarchy to better visualize the diagnostic method of a biopsychosocial model. This visualization depicts societal contributors to illness such as family, mental state/illness, and subculture. It also depicts physical contributors such as genetics, organs, and tissues. The hierarchy places the individual between the societal and biological factors of illness.

George Engel

George Engel (1913-1999) was a John Hopkins educated physician who spent most of his career at the University of Rochester in N.Y. It was at the University of Rochester that Engel first developed the biopsychosocial model.

How is the Biopsychosocial Model Used in Addiction Treatment?

Under the biopsychosocial approach, a substance use disorder treats the cause of the dependency instead of the effects. Treatment with this viewpoint has stable, long-lasting effects. As it treats the root cause for dependency, which protects against relapse or overdose.

Biopsychosocial vs. Biomedical Models

The biopsychosocial and biomedical model are two opposing methods of treatment that can be applied to addiction.3 The biopsychosocial model sees the client as a partner in addiction treatment. The biomedical model sees the doctor as the authority, allowing the client little input or say in treatment. The biopsychosocial model considers how addiction shapes the brain and how societal, cultural, environmental factors shape addiction. Because the biomedical model doesn’t stress holistic causes of addiction, the unified treatment of the mind and body needed to provide the best medical care will be harder to find.

General Principles of the Biopsychosocial Model

The biopsychosocial model is based on the following principles.

Calibrating the Physician

​The biopsychosocial model of health emphasizes a doctor’s need to continually improve the interactions with clients. The model seeks to give the physician better knowledge and understanding of a client. During evaluations, the physician’s capabilities are judged by how they improve the client’s overall wellness for lasting health. It simultaneously views the physician as having both the potential to lower the wellness of a client and also a powerful factor to improve the client’s wellness.

Creating Trust

As a holistic treatment method, the biopsychosocial approach aims to cultivate trust between client and doctor. This bond is seen as essential for the treatment’s effectiveness and the overall speed at which a correct diagnosis is obtained. This trust is created by ensuring that the client feels as though their complaints and concerns are actively heard and addressed.

Encouraging Curiosity

The curiosity in this context is the curiosity a patient has about their illness and treatment options. By maintaining this curiosity, there arises the chance that the patient may provide vital insight into their condition. Additionally, this principle encourages an open mind and centered focus within the practitioner. For example, a practitioner may be able to rule in or out specific causes based on patient feedback. Lastly, this principle mandates treating all patients and diseases as equals. This means there are no good or bad illnesses or patients, but rather, there is a patient in need of treatment.

Acknowledging Self-Bias

From a phycological standpoint, bias and prejudice are unavoidable. The biopsychosocial approach places emphasis on acknowledgment and understanding of discrimination on the part of the practitioner. For example, the treatment they may or may not consider is based solely on creed, religion, personality, race, etc. Additionally, a practitioner must also consider these factors in the effectiveness of treatment. For example, based on religion, a person may be unwilling to abide by certain treatment options, thus rendering these options ineffective.

Educating Emotions

This principle dictates that the practitioner focuses on bettering their understanding of their emotions as a whole and how it affects treatment options and diagnostics.

Empirical Data over Intuition

At the time of Engel’s publications, many practitioners favored instinct over data. In modern times, instinct over data is less likely but still apparent. The biopsychosocial model concludes the effectiveness of empirical data over intuition. For example, if a specific illness is caused by factors X and Y, and a patient has said factors. The practitioner should scientifically either rule out said disease or treat it with the scientifically accurate treatment.

Open Communication

The biopsychosocial model utilizes the patient as a member of the overall diagnostic team. This effect stresses the open communication of theories, findings, treatment options, and risks to the patient. This principle reinforces many of the other principles, such as trust and encouraging curiosity.

Biomedical Model of Medicine

The biomedical model of medicine focuses on the biological health of a patient. It stresses the diagnoses, cures, and treatments of disease. A biomedical doctor does not lose focus by considering the overall wellness of a patient; the doctor will try to make a diagnosis and find a treatment; psychosocial causes and prevention are left to other medical professionals. The biomedical model was the standard model for most of the history of medicine and has its place in healthcare. Here are some strengths and limitations of each model.

Strengths and Limitations for Each Model

Biopsychosocial Strengths

  • Encourages patient understanding of treatment and prevention of further conditions
  • Correct diagnoses are more likely
  • Treatment is more effective
  • Creates a humanizing method of treatment and recovery
  • Enhances the scope of the diagnostic team
  • Encourages more scientific thought in regards to treatment

Biopsychosocial Limitations

Because the biopsychosocial model creates more information and possible treatment pathways at the beginning of treatment. Addressing this data can delay treatment that a biomedical model would give immediately. The biopsychosocial model may also:
 

  • Create personalized tension between doctors and clients
  • Assign too much weight to client information
  • Encourage a client to go against doctor’s orders because the client is “part of the team”

 
Biopsychosocial assessments and treatments take time. Biopsychosocial assessments can prolong for weeks due to various factors. Because of this, the method is best suited for mid-to-long-term care. Overall, the downside of the biopsychosocial approach is its adherence to a philosophical, at times, a non-quantifiable form of treatment.

Biomedical Strengths6

  • Biomedical treatment offers an easily understandable cause and effect viewpoint for diagnostics
  • Biomedical methods have a richer history and, as such, clearer classifications for diseases and treatments
  • Biomedical methods are more widely taught and, as such, understood by medical practitioners

Biomedical Limitations

  • Places too much emphasis on physical causes of illness
  • Disregards for social, culture, and individual factors
  • Reduces the importance of client feedback

How is the Biopsychosocial Model Used as a Clinical Guide?

In modern times, the biopsychosocial model is used as a guide or starting point for treatment. The model encourages creative clinical and critical thinking within the diagnostic team. The biopsychosocial model also requires the team to understand the client holistically, allowing expanded testing and treatment options.7

Understanding a Client at Multiple Levels

A biopsychosocial assessment allows for understanding a client’s medical history, cultural history, community upbringing, and mental state and capacity. These interconnected factors are crucial to effective treatment. This also allows for more humanizing care. A biopsychosocial assessment allows an early opportunity to create a natural rapport with a client.

Letting a Client Actively Participate in Care

Ensuring that the client understands the goal of a biopsychosocial assessment is the first step to showing them they are an active part of the diagnostic team. This practice is more of a principle rather than a treatment method. However, it is achieved with more than just open communication. Letting a client actively participate in care also shows them that the medical team takes their input seriously when using diagnostic testing to support, or rule out, causes and treatments the client suggests.
 
Furthermore, this model encourages using a client’s close family and friends as members of the diagnostic team. The biopsychosocial approach suggests that the answer to treatment can come not only from the doctors but from interconnected sources who know the client’s history and circumstances.8

Biological Factors in Addiction

Addiction is seen in some cases as hereditary. Hereditary addiction or proneness to dependency is the first in a long line of biological addiction factors. These factors include:9

Age

Age can play a factor, especially in younger individuals with dependency. The inability to distinguish long-term effects and propensity to indulge in greater excess than adult counterparts play a factor.

Mental Capacity

An individual’s mental capacity plays a role in their life-long economic stressors and understanding of the effect of drugs and causes for the dependency.

Gender

Men are more likely to abuse substances.

Average Mental State

Mental health and illness play a factor in addiction. For example, someone with depression may abuse drugs that create feelings of euphoria. However, over time, tolerance is built, and the euphoric state lasts for a shorter time. Which, in turn, increases the amount needed to escape the depression or negative thoughts. Starting the cycle of addiction.

Psychosocial Factors in Addiction

Addiction is seen as a psychosocial event when viewed through the biopsychosocial model.10

Psychological Factors

  • Mood
  • Stress levels
  • Emotional intelligence
  • Lack of coping mechanisms
  • General mental illness

Social Factors

Cultural Acceptance of Abuse

For example, in some cultures, the ability to binge drink is widely praised.

Economic Status

Research shows that there are three economic measurements that correlate with alcohol use disorders and substance use disorders. Those three factors are:11

  1. High income families
  2. High net-worth families
  3. Parents with the most education

It is speculated that the pressures of growing in a family of high-achievers leads to a higher rate of anxiety and depression. The theories state that when you couple high rates of anxiety and depression with the ability to pay for substances, you get a perfect storm for developing addictions.11

Peer Pressure

Vulnerable people are more likely to succumb to peer pressure. Those with anxiety may also be more likely to abuse drugs and alcohol in an attempt to reduce feelings of stress.

Addiction Treatment Outcomes with the Biopsychosocial Model

Higher client satisfaction rates show the biopsychosocial approach’s effectiveness and how the holistic approach resonates with clients.12 Clients in medical studies also offered a higher level of feedback in terms of quality and frequency. Overall, this suggests that the biopsychosocial model of health is effective as a holistic longer-lasting treatment method.

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