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The 7 Dimension Addiction Treatment Model

The 7 Dimension Addiction Treatment Model. A Holistic Multidimensional Public Health Approach and Recovery Measurement System for Health & Wellness James Slobodzien, Psy.D ., CSAC Greg Lippert , MA, CSAC, ICADC. For 1500 Years - We thought the Sun Revolved around the Earth!. 2. 5.

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The 7 Dimension Addiction Treatment Model

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  1. The 7 Dimension Addiction Treatment Model • A Holistic Multidimensional Public Health Approach and Recovery Measurement System for Health & Wellness • James Slobodzien, Psy.D., CSAC • Greg Lippert, MA, CSAC, ICADC

  2. For 1500 Years - We thought the Sun Revolved around the Earth! 2 5

  3. For the Last 70+ YearsWe Have Been Measuring Recovery Success by What our Patient’s are “Not Doing” Discharge Summary (Example) Patient has successfully completed treatment as: • He/she has not consumed alcohol in 30 days; • He/she has not used drugs illegally in 45 days; • He/she has not had any mental health problems.

  4. Spiritual/ Religious Social/ Cultural Self-Regulation/ Impulse Control Mental/ Emotional Educational/ Occupational Financial/ Legal Medical/ Physical Isn’t it time for a Paradigm Shift? Outcome Measures Based on Therapeutic Activity of Life-functioning Dimensions

  5. Paradigm Shift • Can you see both women? • Can you make the change? Can you see both women? Can you make the change?

  6. How is Recovery Success Measured? • Moral Model (19th Century – Prohibition end) • Total abstinence (Not drinking) • AA Model (1935 - 1991) • Total abstinence • Medical treatment / AA 12-Step support groups offered for “Rehabilitation” (Had life-skills) • ASAM Model (1991 - present) • Success is still measured by what the patient is NOT DOING (Not drinking, not abusing spouse)

  7. Treatment Success Measurement Limitations • Present attempts at estimating client gains in the recovery process are limited by: • A therapist’s positive biased impressions • A client’s unreliable self-reports • Subjective reports from client’s family • Comparison of test scores that measure facets of therapeutic functioning (BDI)

  8. Evidenced-Based Treatment Outcome Measures • Systematic, prolonged & monitored - lifestyle changes are presumed to be a better predictor of how the client will behave in real life - following treatment (Lambert, 2001) • Quantitative methods of measuring changes in behaviors that are systematically monitored have been widely & effectively used & have become almost standard in assessment of progress outcomes (Butcher, Mineka, Hooley, 2004)

  9. Spiritual/ Religious Social/ Cultural Self-Regulation/ Impulse Control Mental/ Emotional Educational/ Occupational Financial/ Legal Medical/ Physical 7D Recovery Measurement SystemOutcome Measures Based on Therapeutic Activity Units 9

  10. 7 Dimension Health & Wellness Our bodies & minds are interrelated & each of the following domains need to work in harmony with one another for optimal health & balance: • Medical/Physical • Self-regulation/Impulse Control • Educational/Occupational • Social/Cultural • Financial/Legal • Mental/Emotional • Spiritual/Religious

  11. 7 “Life-Functioning” Dimensions • Medical/Physical Dimension • Regular exercise, good eating habits & sleeping routines, regular medical check-ups; endurance, strength, & flexibility • Self-Regulation/Impulse ControlDimension • Embodies the brain’s executive function of willpower that manages drives and emotions (The Marshmallow Test) • Replacing addictive/impulsive behaviors with healthy habits (substance use/abuse)

  12. 7 “Life-Functioning” Dimensions • Educational/Occupational Dimension • Preparing for vocational gifts, skills, talents by making plans for education, training & experiences & pursuing one’s career; • Vocational satisfaction, balance of work & leisure • Social/Cultural Dimension • Developing/maintaining trusted, valued family interpersonal relationships and friendships • Fostering good communication including a comfortable exchange of ideas, views and experiences. Community welfare concerns

  13. 7 “Life-Functioning” Dimensions • Financial/Legal Dimension • Maintaining financial & legal obligations • Making wise decisions regarding personal finances • Mental/Emotional Dimension • Managing one’s thoughts & feelings appropriately • Stress management and relaxation, self-awareness and acceptance • Spiritual/Religious Dimension • Searching for meaning & purpose, values, hope, optimism, belief system

  14. 7D Therapeutic Activity Survey 21 Questions (3 for each of the 7 Dimensions) • Are you currently active in or maintaining good “physical health?” • What activities are you presently participating in? (Medical/Physical Dimension: diet, exercise, sleeping habits, etc.) • How many days per month? (At least 30 min. per day) Total score ___ divided by 210 = ___ % Therapeutic Activity = Activities that decrease stress and increase resilience

  15. 7 Dimension Wheel of Life • Therapeutic Activity Units (TUs): plotted to motivate patients to develop & monitor a personalized Wellness Plan • A bird’s eye view of your life: • Helps you consider what’s off balance. • Gives you a vivid visual representation of your current life & motivates you to change it. • Provides a systematic approach for evaluating treatment progress & documenting outcome measures.

  16. 7 Dimension Wheel of Life Therapeutic Unit (TU) 1 TU = 30 min. Of Therapeutic Activity per day that decreases stress/increases resiliency

  17. 7 Dimension TUOutcome Measures Enrollment: (Pink) Sept. 08 Discharge: (Yellow) Dec. 08 • TUs Increased 62% Within 4 Months

  18. 7 Dimension Wellness Plan Based on the 7 Dimension Intervention Scores: • Health & Wellness Goals are set: (Example) • Attain optimal physical health • Specific Objectives are committed to: • I will exercise daily for 20 min. • Stages of Change (Contemplation, Preparation, Action, etc.) and start/ completion dates are documented. • Start date: _______Completion date: _____

  19. 7 Dimension Intervention Diathesis-Stress Model • Adverse Childhood Experiences • Psycho-Social Stressors • Therapeutic Activity (TU) Outcomes Measures

  20. Diathesis-Stress Model • Diathesis: Predisposition or “vulnerability” (derived from biological, psychological, and/ or socio-cultural causal factors) towards developing a disorder • Stress: Response of an individual to demands that are perceived as exceeding personal resources • Mental Disorders/Addictions: Develop as a result of a combination of psychosocial stressors operating on a person who has had childhood trauma - that developed into a diathesis for that disorder

  21. Adverse Childhood Experiences (ACE Study) • Conducted by: Centers for Disease Control & Prevention and Kaiser Permanente’s Health Appraisal Clinic • Largest investigation ever conducted • (Over 17,000 subjects) • Links between childhood maltreatment & later-life health since 1984 • Over 25 yrs. of evidence-based research Principle Investigator: V.J. Feletti, M.D.

  22. Adverse Childhood Experiences Social, Emotional, & Cognitive Impairment Disease, Disability and Social Problems Early Death Adoption of Health-risk Behaviors Diathesis-Stress Model Death Conception 26

  23. Your ACE Score? Experiencing any of the following conditions prior to age 18 identifies your ACE score (1 pt. for each one): • 1. Recurrent physical/emotional abuse • 2. Contact sexual abuse • 3. An alcohol &/or drug abuser in the household • 4. An incarcerated household member • 5. Chronic depression, violence, mental illness, & • suicidality in the household • 6. One or no parents • 7. Physical/emotional neglect, etc.

  24. ACE Scores That = 4 or Greater (16%) • Ace Scores 4 or Greater 0 Difference • Depression 40%/60% 14%/19% 26%/41% • Attempted Suicide 18% 2% 16% • Drug Problems 12% 1% 11% • Current Smoking 18% 7% 11% • Heart Disease 5.5% 3.5% 2% • Obesity 12% 5% 7% • Teen Sex 40% 19% 21% • STDs 18% 6% 12% • HIV Risks 18% 6% 12% • Domestic Violence 3%/13% 1%/3% 2%/11%

  25. ACE Summary • Adverse Childhood Experiences (ACES) are: • Common, • Destructive, • Have an effect that lasts a lifetime, • They increase medical care costs, disease, and death 50 years later, • They are the most important determinant of the health and well-being of our nation.

  26. Psychosocial Stressors • Axis IV (DSM-IV-TR): Psychosocial and environmental problems that affect diagnosis, treatment, & prognosis of mental disorders • 7D Psychosocial Stressors Inventory (PSI)170 – item screening tool: facilitates comprehensive & systematic evaluation of an individual’s stressful life experiences (J. Slobodzien, 2005)

  27. 7D Psychosocial Stressor Inventory • Axis IV (DSM-IV-TR) • 7D – Stressor Rating • High Risk = 21 - 30 • Mod. Risk = 11 - 20 • Low Risk = 1 - 10 • Current Stressors = 18 (Red) • PastStressors = 11 (Blue) 39

  28. 7D Psychosocial Imaging • 7D Combo Analysis • Ace Score • Stressors Score • Therapeutic Activities Score

  29. 7D Addiction Treatment Model • Develops insight and awareness • Enhances positive movement through the stages of change • Initiates health and wellness • Manages stress • Prevents physical and mental disorders, • Builds resiliency • Measures recovery progress to improve overall wellness

  30. Want to Learn More? • Request a 7D packet: drslobodzien@gmail.com • Resources: • Adverse Childhood Experiences • www.acestudy.org • The Addiction Severity Index at 25: Origins, Contributions, and Transitions.

  31. The 7 Dimensions Model Applied to TEAP“Changing Trainees One Therapeutic Unit at a Time”

  32. 7D and TEAP Overview • Hawaii Job Corps TEAP program • Workbook • 7D Pre TEAP (Therapeutic Units) • 7D Adverse Childhood Experiences (ACE) • 7D Psychosocial Stressors Inventory (PSI) • 7D Health and Wellness Plan • 7D Post TEAP (Therapeutic Units)

  33. 7D Pre-Therapeutic Units • Score the Therapeutic Outcome Measurement Wheel (Pre survey) • Answer all seven questions and plot the number of days per month per dimension • Add up the number of days per month and divide by 210 to get % of functioning

  34. 7D Adverse Childhood Experiences (ACE) • Conduct the ACE 7D Wheel with statistical outcome measurement • Add up all number of “Yes” answers • Multiply by 3 and plot on the wheel in each dimension

  35. 7D Psycho-Social Stressors Inventory (PSI) • Conduct 7D PSI • Multiply all SUD scores by 3 and then plot on the wheel • Add all of the multiplied SUD’s scores and divide by 210 to get % of stress

  36. 7D Health and Wellness Plan • Fill out the H&W plan based off of the pre-functioning wheel and the PSI • Using the pre-TEAP functioning, prioritize issues by least functioning to most functioning • Take the dimension with lowest score and make it problem #1

  37. 7D Post-Therapeutic Units • Therapeutic Outcome Measurement Wheel • Post survey • Simply answer the initial 7 questions and plot the number of days on the wheel

  38. Therapeutic Units Pre and Post TEAP Across the 7 Dimensions (May-Oct 11)

  39. Behavioral Outcome Measures (TU’s) Combined Pre and Post TEAP (May-Oct 11)

  40. References • Slobodzien, J. (2009). The 7-dimension intervention-A holistic diathesis-stress approach to stress management. Retrieved online from: http://ezinearticles.com/?The-7---Dimension-Intervention---A--Holistic-Diathesis-Stress-Approach-to-Stress-Management&id=2808633

  41. Questions????

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