BPS+ Model and Application
Shameless (Michael Hissrich and Terri Murphy 2011) is a television drama series that aired on Showmax for twelve seasons. The plot is on a family of six headed by Frank Gallager, who is an alcoholic. Their estranged mother, Monica, is also an addict. She moves away and comes back and when she is about to die of a terminal illness. The family suffers from poverty; they live on the south side, where social amenities are poor, and everyone occasionally gets into trouble with the law. Fiona, the eldest daughter, has to take care of her siblings. Phillip Gallager, the second-born, steps in when Fiona cannot not handle things. My analysis focuses on Philip (Lip) Gallagher, who is a straight A’s student. He becomes an addict in adulthood and starts going to AA to manage his addiction.
BPS + Model
The biopsychosocial- BPS + model is a formulation used in all psychiatry courses to help understand addiction patients and develop a treatment plan suited to their particular characteristics and vulnerabilities (Bio-Psycho Social-Spiritual Model, n.d.). A model is a practical approach to helping addicts gain recovery. According to the model, addiction should to be approached from biological, psychological, and social aspects of the addict’s life, which constituted their vulnerabilities. The BPS + model adds spirituality and culture as dimensions through which addiction should be approached and understood. The model also expands the social dimension to look at macro-societal and socio-structural determiners to consequent addiction. Still, the social dimension in the BPS+ model looks at factors rooted in socio-economic inequalities such as racism.
BPS+ model does not treat its multidimensional factors of study as independent when coming up with a treatment plan for an addict. It treats all the factors, i.e., biological, physiological, psychological, social, cultural, and spiritual, as intertwined. They are used to provide a well-rounded understanding of a patient’s substance use disorder to develop a treatment plan. The model is also pluralistic in that it does not depend upon one of the dimensions to explain addictive tendencies. Instead, this model is based upon the notion that all the dimensions play a role in making the patient vulnerable to addiction. Thus, all the dimensions are studied so that no aspect is overemphasized while another is disregarded when coming up with a treatment plan. Furthermore, the model remains open to upcoming theories about addicts and criticism of the existing knowledge (Herie & Skinner, 2014).The Biopsychosocial Plus model is subdivided into five dimensions to help counselors understand and apply knowledge in helping people with substance use disorder.
The Biological Dimension
The biological dimension seeks to understand how normal brain functioning is affected by substance abuse and how practitioners can reverse the effects. The expanded growth of knowledge in neuroscience has led to an irrefutable conclusion that addiction is a brain disease, and that has to be considered when addressing addiction problems. Technological advances have led to brain scanning and the discovery of how substance use changes brain normalcy (Herie & Skinner, 2014). It has also led to the development of pharmacotherapy which aids in curbing the euphoric effects of drugs, helps counter withdrawal symptoms, and helps the patient overcome urges to relapse. While these treatments have not always been proven as guaranteed, the biological dimension has shown that addiction is not a failure in a person’s morality but a health complication that emerging discovery in pharmacotherapy can treat. Therefore, the treatment of addiction today relies on having the counselors and psychiatrists realize the nature of the addiction so that they can have medicine intervene in the treatment of withdrawal and prevention of a relapse.
To understand the biological triggers to a patient’s addiction, a psychiatrist will have to look at the genetic history and understand whether addiction tendencies run in the family of the addict. The psychiatrist also looks at the patient’s condition during pregnancy and birth, history of endocrine illnesses, and any trauma they may have suffered (Bio-Psycho Social-Spiritual Model, n.d.). They also look at their current health status and whether they use any medicines connected to their addiction.
The psychological dimension focuses on the mind, while the biological dimension focuses on the brain. Many psychological theories such as the social learning theory, operant conditioning, and classical theories help in gaining information about addiction. Healthline Editorial Team (2018) theorized that addiction is a disorder of choice. It has been proven inaccurate since most addicts have claimed and shown to be unable to control their craving. Other theories have looked at consistent behavior being created by the reinforcement factors following the behavior. They posit that when behavior brings positive reinforcement, such as attaining euphoria from using drugs, a person is likely to use that drug again. However, when the drug ceases to give positive reinforcement, a person tries to avoid using that drug. Other theorists say that people addicted to opioids can stop their behavior when they are promised monetary rewards (Herie & Skinner, 2014). The psychological dimension focuses on why people behave in a certain way and consider it wrong or acceptable. A psychiatrist who wants to explore this dimension in a patient will examine whether the patient has experienced a traumatic event such as combat, rape, or severe illness. They will also explore how they coped (family, religion), their role model, and their self-image. Besides, they will look at the current life situations which have led to the patient’s deterioration.
The social dimension looks at a patient’s place within society. The role of society has been proven robust by both psychological and biological thinkers, who state that a person’s environment and development in life have been influenced by their surroundings and how the person makes choices. The social dimension is unique because treatment approaches cannot change the social dimension, unlike the biological and psychological dimensions. However, this dimension is of significant importance because it provides for treating addiction by helping the patient structure their life into what is socially acceptable to them and improve their self-image (Healthline Editorial Team, 2018). The social dimension has been used to fill up knowledge gaps that have been left by knowledge collected from exploring the biological and psychological dimensions. It has helped come up with treatment plans that have supplemented the former approaches.
The social factors have broadened from a focus on family, friends, and close social groups. The BPS model now looks at other macro societal factors such as race, gender, ethnicity, and social class and reviews these when considering a patient’s vulnerability to addiction. This view on prominent societal factors playing a role in creating vulnerability to addiction has led this to become a public health issue. Social disadvantages such as lack of employment, access to proper housing, a good education, food, infrastructure, and other social determinants can be a precursor to addictive behavior. Addiction has not only become an issue brought about by these factors, but it can also be a precursor to these other factors occurring in an environment.
The social dimension is also characterized by the norms, assumptions, presumptions, and regularities guiding principles. These are made differently based on age, gender, education, race, and many more factors. To understand the social dimension regarding a patient’s addiction, a psychiatrist would have to explore who the patient goes when they need help. They would also look into their social life and whether they have one and the kind of social life they would like to keep. They would look at their satisfaction levels with their jobs, finances, housing arrangements, and other aspects of their lives connected with outside agencies.
The word culture has a wide range of connotations. It mainly refers to people who share a certain commonality which unites them, and impacts their emotions in a significant way. People who share a culture have different activities that they carry out together. One’s culture or the absence of it can result in a person becoming vulnerable to using drugs. A culture with well-defined expectations from its members and rewards good behavior can play an essential role in helping a person avoid vulnerability to drugs. Cultures have different takes on what comprises addiction. Therefore, a psychiatrist is tasked with understanding a patient’s addiction based on the patient’s cultural perspective. The cultural perspective calls for examining cultural factors in a particular way so that the patient gets help.
Many people have a spiritual belief system that anchors them during crises in their lives. Spirituality could either be religious or non-religious. It is a deeply helpful belief. Spiritualism flows from the inner person and helps a person gain wisdom and insight. A counselor should support a person with addiction on their spiritual beliefs. Spirituality is suitable for anyone because it encourages one to be mindful of their health and general well-being. Strong spiritual people have low tendencies of having an addiction. Spiritualism can also open paths for an addicted person to recover and grow.
To understand a patient’s spiritualism level, the psychiatrist has to inquire from the patient about the spiritual belief system, how they meet their spiritual needs, childhood experience with religion, and any contact with a religious community. A psychiatrist should also trend carefully so that they are always respectful of a patient’s spiritualism. Spiritualism can be a patient’s anchor as they try to gain sobriety. It should be respected and encouraged in every patient.
Application of BPS+ Model to Phillip Gallagher in Shameless (Michael Hissrich and Terri Murphy 2011)
Phillip Gallager is vulnerable to getting addicted from the biological dimension. His father is an alcoholic who develops alcoholic dementia in his golden ages. His mother, Monica, is also an unstable woman who also takes drugs. It would not be entirely wrong to assume that Monica drank alcohol and took other substances while pregnant with Phillip. Phillip is therefore susceptible to addiction due to inherited genes and possible exposure during prenatal growth.
Lip is faced with a lot of psychological issues. He had a traumatic childhood because his parents were not serious and committed to raising their children. It made him develop abandonment issues and build the exterior of being a strong and rough person. He has trouble being vulnerable and does not want anyone to see that he has a sensitive side. Lip lacks positive role models in his life. The professor who attempts to help him has five DUIs. Lip also has sexual relations with his professor because he is in the habit of impulsive behavior. He feels that he lost his parents because they are not there for him. He is forced to use his genius to come up with unscrupulous means of fending for the family. As a straight A’s student, his family has high hopes for him. It puts pressure on him, which he fights off by rejecting their expectations and becoming wild and unruly. His attitude makes him take cigarettes, marijuana, and alcohol. Consequently, he becomes an addict.
Lip grows up in a small house with his five siblings. Their house is on the south side, which is a socially disadvantaged area. His parents do not help with the family’s economic needs, and Lip comes up with illegal schemes to make money for his family. He is a straight A’s student and a second born. His siblings look up to him for social and psychological support, whereas he lacks this support from his parents. He gets into trouble with the law and is in juvenile detention for a while. He lives in a community of drug addicts and peddlers. Nobody seems to care about a person drinking or using drugs. He quickly starts using and picks up the habit till he is addicted. Lip recognizes when his addiction causes more harm than gratification. He goes to AA so that he can alter his addictive behavior.
Philip is not a member of a well-defined culture. People form factions based on what they have in common. His culture could come from his family, and they do not have any restrictions on substance abuse. Lip has no culture to fall back on so that it could help him make the right decision. He lives in a world with no moral regulations. Lip therefore has no qualms when he starts his habit of taking drugs. His culture does not object to using drugs.
Neither Phillip nor any of his friends or family have spiritual ground. They do not have any beliefs in God or any higher power. Philip is not affiliated with any spiritual community. His parents, Frank and absentee mother Monica do not have any spiritual affiliation. Lip and his siblings are not introduced to spiritualism as children and do not pick it up in adulthood. He, therefore, does not have spiritual reliance to help him with his substance use disorder.
Addiction is a disease that counselors can treat with medicine. However, a person’s inner and outer environment plays a significant role in recognizing addiction and treating it. For Phillip Gallager was vulnerable to using drugs biologically, psychologically, socially, and culturally. His parents predisposed him to this vulnerability by being addicts themselves. He has had a rough upbringing which does not help. Phillip, however, sought help when the negative consequences of his drug use outweighed the benefits. The social dimension came in handy to help him notice his behavior needed to be altered. The social theories, therefore, could help come up with a treatment plan for Phillip Gallager.
Bio-Psycho Social-Spiritual Model (n.d). The University of Nevada, Reno School of Medicine. Retrieved 22 September 2021, from https://med.unr.edu/psychiatry/education/resources/bio-psycho-social-spiritual-model
Healthline Editorial Team (2018). How to Be Human: Talking to People with Addiction. healthline.com. Retrieved 22 September 2021, from https://www.healthline.com/health/addiction/how-to-be-human-language-around-substance-abuse#dependence-vs-addiction
Herie, M., & Skinner, W. (2014). Fundamentals of Addiction: A Practical Guide for Counsellors [Ebook] (4th ed.). Centre for Addiction and Mental Health. Retrieved 22 September 2021.
Shameless (Michael Hissrich and Terri Murphy 2011).