The 7 Dimension Addiction Treatment Model

A Holistic Multidimensional Public Health Approach and Recovery

Measurement System for Health & Wellness

James Slobodzien, Psy.D., CSACGreg Lippert, MA, CSAC, ICADC

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

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For the Last 70+ Years We Have Been Measuring Recovery Success by

What our Patient’s are “Not Doing”

Discharge Summary (Example)

Patient has successfully completed treatment as:

1. He/she has not consumed alcohol in 30 days;

2. He/she has not used drugs illegally in 45 days;

3. He/she has not had any mental health problems.

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Isn’t it time for a Paradigm Shift? Outcome Measures Based on

Therapeutic Activity of Life-functioning Dimensions

Spiritual/ Religious

Social/ Cultural

Self-Regulation/

Impulse Control

Mental/

Emotional

Financial/ Legal

Educational/Occupational

Medical/ Physical

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Paradigm Shift

•Can you see both women?

•Can you make the change?

• Can you see both women?

• Can you make the change?

 

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How is Recovery Success Measured?

1. Moral Model (19th Century – Prohibition end)

• Total abstinence (Not drinking)

2. AA Model (1935 - 1991)

• Total abstinence

• Medical treatment / AA 12-Step support groups offered for “Rehabilitation” (Had life-skills)

3. ASAM Model (1991 - present)

• Success is still measured by what the patient is NOT DOING (Not drinking, not abusing spouse)

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Treatment Success Measurement Limitations

• Present attempts at estimating client gains in the recovery process are limited by:

1. A therapist’s positive biased impressions

2. A client’s unreliable self-reports

3. Subjective reports from client’s family

4. Comparison of test scores that measure facets of therapeutic functioning (BDI)

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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)

7D Recovery Measurement SystemOutcome Measures Based on

Therapeutic Activity Units

Spiritual/ Religious

Social/ Cultural

Self-Regulation/

Impulse Control

Mental/

Emotional

Financial/ Legal

Educational/Occupational

Medical/ Physical

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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:

1. Medical/Physical

2. Self-regulation/Impulse Control

3. Educational/Occupational

4. Social/Cultural

5. Financial/Legal

6. Mental/Emotional

7. Spiritual/Religious

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7 “Life-Functioning” Dimensions

1. Medical/Physical Dimension• Regular exercise, good eating habits & sleeping routines,

regular medical check-ups; endurance, strength, & flexibility

2. Self-Regulation/Impulse Control Dimension• 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)

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7 “Life-Functioning” Dimensions

3. 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

4. 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

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7 “Life-Functioning” Dimensions

5. Financial/Legal Dimension• Maintaining financial & legal obligations

• Making wise decisions regarding personal finances

6. Mental/Emotional Dimension• Managing one’s thoughts & feelings appropriately

• Stress management and relaxation, self-awareness and acceptance

7. Spiritual/Religious Dimension• Searching for meaning & purpose, values, hope,

optimism, belief system

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7D Therapeutic Activity Survey

21 Questions (3 for each of the 7 Dimensions)

1. Are you currently active in or maintaining good “physical health?”

2. What activities are you presently participating in? (Medical/Physical Dimension: diet, exercise, sleeping habits, etc.)

3. 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

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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:

1. Helps you consider what’s off balance.

2. Gives you a vivid visual representation of your current life & motivates you to change it.

3. Provides a systematic approach for evaluating treatment progress & documenting outcome measures.

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7 Dimension

Wheel of Life

Therapeutic Unit (TU)

1 TU = 30 min.

Of Therapeutic

Activity per day

that decreases

stress/increases resiliency

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7 Dimension TUOutcome Measures

Enrollment: (Pink) Sept. 08

Discharge: (Yellow) Dec. 08

• TUs Increased 62% Within 4 Months

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7 Dimension Wellness Plan

Based on the 7 Dimension Intervention Scores:

1. Health & Wellness Goals are set: (Example)a. Attain optimal physical health

2. Specific Objectives are committed to:a. I will exercise daily for 20 min.

3. Stages of Change (Contemplation, Preparation, Action, etc.) and start/ completion dates are documented.a. Start date: _______Completion date: _____

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7 Dimension Intervention

Diathesis-Stress Model

1.Adverse Childhood Experiences

2.Psycho-Social Stressors

3.Therapeutic Activity (TU) Outcomes Measures

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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

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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.

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Adoption of Health-risk Behaviors

Social, Emotional, & Cognitive Impairment

EarlyDeath

Adverse Childhood Experiences

Death

Disease, Disabilityand Social Problems

Conception

Diathesis-Stress Model

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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.

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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%

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ACE Summary

• Adverse Childhood Experiences (ACES) are:

1. Common, 2. Destructive, 3. Have an effect that lasts a lifetime,4. They increase medical care costs, disease,

and death 50 years later,5. They are the most important determinant of

the health and well-being of our nation.

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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)

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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)

• Past Stressors = 11 (Blue) 39

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7D Psychosocial Imaging

• 7D Combo Analysis

1. Ace Score

2. Stressors Score

3. Therapeutic Activities Score

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7D Addiction Treatment Model

1. Develops insight and awareness

2. Enhances positive movement through the stages of change

3. Initiates health and wellness

4. Manages stress

5. Prevents physical and mental disorders,

6. Builds resiliency

7. Measures recovery progress to improve overall wellness

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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.

The 7 Dimensions Model Applied to

TEAP

“Changing Trainees One Therapeutic Unit at a

Time”

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)

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

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

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

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

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

Therapeutic Units Pre and Post TEAP Across the

7 Dimensions (May-Oct 11)

Medica

l/Phy

sical

Abs/R

elap

se

Ed/O

cc

Socia

l/Cul

tura

l

Finan

cial/L

egal

Menta

l/Em

otio

nal

Spiri

tual

/Rel

igio

us

Avera

ge0

5

10

15

20

25

30

13

8

19

16

8

15

10

21

25

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18

23

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Behavioral Outcome Measures (TU’s) Combined

Pre and Post TEAP (May-Oct 11)

10%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

42%

73%

Pre TEAP

Post TEAP

Difference %:31% in-crease in Therapeu-tic Units (TU)

N=35

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

Questions????