Unlike, say, the Henle-Koch postulates or Evans’ criteria for causality (Evans 1976), the BPSM does not articulate epistemic principles that would allow researchers to distinguish true cause-effect relationships from spurious correlations. Furthermore, because the BPSM is really an atheoretical model (Brendel 2003; Ghaemi 2011; Skarmeta et al. 2019), it obviously cannot establish which explanations make theoretical sense. Thus, https://theseattledigest.com/top-5-advantages-of-staying-in-a-sober-living-house/ although the BPSM tells us we can list a huge array of factors as disease causes (see Fig. 1), the model itself does not tell us how to determine which factors play a causal role in any given case. It also takes into consideration aspects of health functioning such as addictive behaviour, diet, exercise, self-care, nutrition, sleep and genetics. We look at all aspects of health, whether it is positive, neutral or challenging.
Substance abuse: Implications of a biopsychosocial model for prevention, treatment, and relapse prevention.
In Los Angeles, nutrition services are offered at less than a third of SUD treatment centers (198). Our work has shown educational and culinary interventions can be effective despite operational challenges (199). Nutritional protocols for OUD have been described elsewhere (200) and specific group education topics for SUD treatment have also been recommended (201).
A revitalized biopsychosocial model: core theory, research paradigms, and clinical implications
SUD and recovery should be understood using the same coherent approach—as an interplay between biological and psychological factors and social, political and cultural contexts. This study emphasised that inpatient treatment is necessary but inadequate for many people with SUD, and long-time access to various professional and social support systems is crucial in the recovery process. Receiving such support is not understood as a defeat, and each person’s resources and vulnerabilities should be recognized and acknowledged. It is often intermingled with the question-begging arguments found in the TMD literature. For example, the articles discussed in the previous section each in some way referenced the BPSM’s authority in constructing TMD as a “complex disease” (Ohrbach 2021; Ohrbach and Dworkin 2016; Slade et al. 2016).
- Second, the BPSM itself does not provide intellectual tools for establishing causality.
- It is perhaps the transformation of the way illness, suffering, and healing are viewed that may be Engel’s most durable contribution.
The Biopsychosocial Model 25 Years Later: Principles, Practice, and Scientific Inquiry
A systems approach allows for the inclusion of psycho-social and socially systemic explanations of addiction, which extend well beyond neurobiology while still interacting with it (Bunge 1991). There are several processes that actively contribute to substance use with inputs and outputs on biological and psycho-social levels. One example is drug craving that may be experienced as strong, intense urges for immediate gratification that may impair rational thought about future planning (Elster and Skog 1999).
Policy Interventions
- Such new iterations of systems theory concentrate on the cognitive and social processes wherein the construction of subjective knowledge occurs.
- Efforts to prevent violence must therefore be balanced against the need to respect people’s civil liberties and autonomy.
- These factors may indicate a certain level of group risk for problematic substance use, but cannot verify either the likelihood of substance use occurring within the group or which individuals within the group are more likely to be affected.
- We hypothesized that sociodemographic factors, while crucial to the comprehensive risk model, would not be critical predictors, when they were included with socioecological and health factors, or with other substance dependence or abuse.
A considerable amount of research has connected adverse childhood experiences (ACEs) to a dose-dependent increase in risk for drug abuse (70, 71). Strong links between ACEs and the initiation of opioid use have been described (72, 73). ACEs have been linked to age of opioid initiation, intravenous use of the drug, and lifetime overdose in a graded, dose-response manner (73). Potential mechanisms mediating this relationship could be environmental (e.g., poverty, parental criminal justice involvement) as well as biological (e.g., genetic heritability, altered neurodevelopment). Given the significant associations with childhood abuse and prescription opioid use, several authors have identified child maltreatment as an important social and environmental factor (path B) which should be considered in prevention and intervention efforts amidst the crisis (74, 75).
In highlighting these problems, this study provides further evidence that the sorts of fallacious arguments in medicine noted by Binney (2019) are relatively widespread, consequential, and in need of remediation. For a non-TMD-related example of question-begging argumentation, see the discussion of chronic pain in the Appendix. National Institutes of Health (NIH) funded Top 5 Advantages of Staying in a Sober Living House a major TMD study known as “OPPERA.” The OPPERA study has been highly significant in the field of TMD research. It is referenced frequently in the literature, and has provided the data underlying many claims made about TMD and its causes. In several descriptions of the OPPERA project offered by field leaders, we find additional question-begging transformations of TMD.
Along with “national security,” “public health” is one of the few imperatives that readily justifies state abrogation of individual rights. Thus, the production of a new and expansive public health problem in the “gun violence disease” discourse has the potential to significantly increase the power of the state, and not just that of the medical field per se. Engel’s proposal in the late 1970s that a new model was needed to take account of not only biological factors affecting health and disease, but also psychological and social factors, was made at a time when the theoretical and empirical backing for it was not established but was rather in construction.
Subsequently, between July 2016 and September 2017 deaths due to illicit opioid overdose increased by 30%, leading to an emergency declaration in 45 states [4]. Biopsychosocial characteristics such as socioecological and health indicators, as well as other substance dependence or abuse were stronger predictors of opioid misuse and use disorder than sociodemographic characteristics. Efforts to address the opioid epidemic are being led by pharmaceutical companies promoting new medications (MAT) as the solution. One major shortcoming is that it does not address individuals’ underlying psychological and emotional issues that contribute to addiction susceptibility. It examines the “macro” but not the “micro” environment, and one could argue that psychosocial factors require increased public health attention.
We propose a ‘biopsychosocial systems’ model where psycho-social factors complement and interact with neurogenetics. A systems approach addresses the complexity of addiction and approaches free choice and moral responsibility within the biological, lived experience and socio-historical context of the individual. We examine heroin-assisted treatment as an applied case example within our framework. We conclude with a discussion of the model and its implications for drug policy, research, addiction health care systems and delivery, and treatment of substance use problems. As a conceptual framework, it can still serve as a useful tool for organizing and communicating information on the determinants of health and illness. There is now a large body of research indicating that psychosocial factors often play important roles in shaping health outcomes (Bolton and Gillett 2019; Edwards et al. 2016; Gatchel et al. 2014; Vogele 2015).