When working with those who wish to change addictive behavior I am often struck by how many issues require attention after conducting an evaluation. Not only do most struggle with multiple addictions, but there are often mental health, legal, financial, social, housing, and employment issues to grapple with as well.
Combined, these problems can easily seem overwhelming, particularly if you are of a mindset that every issue needs some specific intervention.
Systems thinking
Here is where systems thinking plays a key role in successful treatment and long term management. In short, systems thinking helps us to understand that addictive behavior is an outcome of a complex system of interacting issues:
In this diagram, mutliple mental health, addiction, physical and environmental problems combine to create many problems for this individual. In treatment, we identified the different issues, and then spent time drawing arrows between them and talking about how they all relate.
Leverage points
We then uncovered a key leverage point for change that in all prior treatment episodes had been missed – an undiagnosed sleep apnea. Turns out it is hard to make progress on much in life if you are constantly in a daze. After a night at the sleep disorders lab and a confirmed diagnosis, we started treating the sleep problem and within days were making progress on the other issues.
Of all the problems listed for this patient, would you have thought the key to making significant progress was a sleep issue? The most powerful leverage points are most often not obvious.
That’s a great point, and a very thought-provoking diagram. In order to treat addiction, all these factors must be taken into consideration. This is why addiction treatment at this time needs to reevaluate the effectiveness of their punitive measures and put more focus into consulting healthcare professionals as well as addicts themselves. I think that at some level, we do realize that there is no single approach to treating even the same types of addictions, let alone different ones. However, that realization can be quite scary to society because such a tactic requires much greater effort than simply putting individuals behind bars until they have ‘learned their lesson’.
Dear Dr. John Fitzgerald,
As it is explained in the diagram above, sleeping is the key of the whole problem. Thus, should we have some solution or advice about the sleeping disorders? I look up the answers and question, and i haven’t seen anyone mention about that problem. Thank you very much for your informative blog!
Sincerely,
Tran Hoang
This is a very important topic, cohesive and all inclusive treatment. The idea of considering all aspects and areas of a persons life in treating addictions seems like a simple idea, but it is something that is not done in all treatment plans. There are many things that trigger addictions, we know that, but there are also many things that determine if treatment will be successful or not and how much it will hinder or help the treatment. Thinking of treatment in a systems approach fashion is the best way to ensure recovery and successful treatment by changing certain areas of life. Little things like sleep disorders and childhood traumas are things that can be overlooked easily, but can potentially have a huge impact on addiction treatment effectiveness.