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.

If you would like to learn more about Ampelis Recovery and our customized programs for professional men, please do not hesitate to reach out.

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What Is the Biopsychosocial Model for Treatment?

The biopsychosocial model for treatment is a holistic treatment method. It 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, social). In this way, the biopsychosocial model for treatment creates a more holistic approach to health care by understanding the client’s culture, mental state, and specific external contributors to illness.

The term biopsychosocial breaks into two parts. Bio refers to biology and the body. Psychosocial refers to the influence culture and environment have on an individual’s brain, mood, principles, and general mental health. 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 us start with the model’s history.

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Biomedical Model’s Successful Past

For more than a century, the biomedical model, derived from Louis Pasteur’s germ theory of disease, has been the dominant force in medicine.2 The biomedical model asserts that all disease is a product of a biologic defect often initiated by a biologic pathogen. The model is reductionist, seeking to explain all diseases in biological terms.2

The biomedical model was hugely successful at drastically reducing deaths from infectious diseases.3 Childhood mortality saw the largest reduction because of germ theory and the biomedical model.3 In 1900, 30.4% of all deaths occurred among children aged less than five years; dropping to only 1.4% in 1997. In 1900, the three leading causes of death were pneumonia, tuberculosis, diarrhea, and enteritis. These infectious diseases caused one third of all deaths.3 Of these deaths, 40% were among children aged less than five years. 3 The biomedical model’s germ theory of disease essentially eliminated these infectious diseases as the primary cause of death.2 By the end of the 20th century, chronic conditions like heart disease, cancer, and stroke became the leading causes of death. These changes, attributed to the biomedical model, increased average life expectancy from 47 years in 1900 to 77 years in 2000.2

The Rise and History of the Biopsychosocial 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 would 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 client.4

Dr. George Engel, along with Dr. John Romano, created a client-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 Johns 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.

Strengths and Limitations for Each Model

Biopsychosocial Strengths5

  • Encourages client understanding of treatment and prevention of further conditions
  • Increases the chances of a complete diagnosis
  • Creates a holistic method of treatment and recovery
  • Enhances the scope of the diagnostic team
  • Encourages doctors to actively listen to clients

Biopsychosocial Limitations

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 take weeks due to various factors. Because of this, the method is best suited for mid-to-long-term care.

Biomedical Strengths6

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

Biomedical Limitations

  • Places too much emphasis on physical causes of illness
  • Reduces the importance of client feedback

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 in Addiction Treatment

The biopsychosocial and biomedical model are two opposing methods of treatment applied to addiction.7 The biopsychosocial model sees the client as a partner in addiction treatment. The biomedical model sees the doctor as the sole authority. The biopsychosocial model considers how addiction shapes the brain and how societal, cultural, environmental factors shape addiction. Because the biomedical model does not stress holistic causes of addiction, it makes it harder to create the unified treatment of the mind and body needed to provide the best medical care.

General Principles of the Biopsychosocial Model

The biopsychosocial model uses the following principles.8

Calibrating the Physician

The biopsychosocial model of health emphasizes a doctor’s need to improve the interactions with clients continually. 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 a client’s wellness and 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. The doctor and client see this bond as essential for the treatment’s effectiveness. Furthermore, the bond shortens the overall speed at which a doctor obtains a correct diagnosis. The doctor builds trust by making the client feel like the doctor hears and respects their complaints and concerns.

Encouraging Curiosity

Curiosity in this context is the curiosity a client has about their illness and treatment options. Fostering this curiosity allows the client to provide vital insight into their condition. Additionally, this principle encourages the doctor to keep an open mind that enables a diagnosis to evolve and become more precise. For example, a doctor may rule out an initial diagnosis based on a client’s feedback and self-knowledge. The doctor-client relationship grows when both sides keep open minds and are willing to adjust care based on feedback.

Acknowledging Self-Bias

From a psychological standpoint, bias and prejudice are unavoidable. The biopsychosocial approach places emphasis on acknowledging and exploring biases they bring to the doctor-client relationship. For example, a doctor’s creed, religion, personality, race, and other factors can subtly bias a diagnosis or interactions with the client. Once a doctor accepts that bias is unavoidable and stops seeing it as a criticism, treatment options may change for the better.

Understanding Emotional Reactions

This principle allows both the doctor and client to understand how their emotions affect treatment options and diagnosis. The doctor views the client’s emotions without judgment, allowing the doctor and client to overcome emotional issues that could hurt treatment outcomes.

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 occurs. The biopsychosocial model stresses the importance of empirical data over intuition. For example, if diagnostics show X and Y cause a client’s illness, the doctor should treat X and Y with the best medical practices. If the doctor still feels that X and Y’s diagnosis is incorrect, they must rule them out with further diagnostics.

Open Communication

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

How Is the Biopsychosocial Model Used as a Clinical Guide?

In modern times, the biopsychosocial model guides starting points 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.9

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 understanding also allows for care focused on humanizing the client and the client’s concerns. 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, making the client an integral part of treatment requires more than just open communication. Letting a client actively participate in care 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.10

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:11

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.12

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:13

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

The pressures of growing up in a family of high-achievers lead to a higher rate of anxiety and depression. The theories state that coupling high rates of anxiety and depression with the ability to pay for substances creates a perfect storm for developing addictions.13

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 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.14 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.

 

Resources

 

  1. www.annfammed.org/content/2/6/576?fbclid=IwAR0_RoNjdXAmAyReX0RY26oHNQ5FaoNN-mUR09niV3lQD-nrEcb-tx92xcQ
  2. https://www.apa.org/monitor/2012/09/pc
  3. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm4829a1.htm#:~:text=In%201900%2C%20the%20three%20leading,than%205%20years%20(1)
  4. www.ncbi.nlm.nih.gov/pmc/articles/PMC6069638/?fbclid=IwAR3B455eq4HddThxJxskW5aXcuUvtXt63pPhHUqkbwf24plOcTToB5iQrGw
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6069638/
  6. https://is.muni.cz/el/1423/jaro2018/PSY109/um/68207459/Biopsychosocial_Model_of_Addiction_Miller_P__2013__Principles_of_Addiction.pdf
  7. https://www.researchgate.net/publication/277346377_The_Biopsychosocial_Model_in_Health_Research_Its_Strengths_and_Limitations_for_Critical_Realists
  8. https://www.ncbi.nlm.nih.gov/books/NBK207234/
  9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1466742/
  10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC535463/
  11. https://www.ncbi.nlm.nih.gov/pmc/PMC3935152/articles/
  12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3959021/
  13. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3410945/#B13
  14. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5914237/

 

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