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Relapse Prevention Modalities are no Cure for Obesity/Overweight

The search box in Wikipedia brought up this article after the word addiction was typed in. Replace the word Food instead of Opiod and/or drug in the following discussion.

Opioid dependence From Wikipedia.

Opiod dependency is a medical diagnosis characterized by an individual’s inability to stop using opiods (morphine, heroin, codeine, hydrocodone, etc.)even when objectively it in his or her best interest to do so. In 1964 the WHO Expert Committee on “dependence” as “A cluster of physiological, behavioural and cognitive phenomena of variable intensity, in which the use of a psychoactive drug (or drugs) takes on a high priority. The necessary descriptive characteristics are preoccupation with a desire to obtain and take the drug and drug dependence may be biological, psychological, or social, and usually interact”. The core concept of the WHO definition of “drug dependence” requires the presence of a strong desire of a sense of compulsion to take the drug; and the WHO and DSM-IV-TR clinical guidelines for a definite diagnosis of “dependence” require that three or more of the following six characteristic features be experienced or exhibited:

1. A strong desire of sense of compulsion to take the drug: 2. Difficulties in controlling drug-taking behaviour in terms of its onset, termination, or levels of use; 3. A physiological withdrawal state when drug use is stopped or reduced, as evidences by: the characteristic withdrawal syndrome for the substance; or use of    the same (or a closely related) substance with the intention of relieving or avoiding withdrawal symptoms; 4. Evidence of tolerance, such that increased doses of the drug are required in order to achieve effects originally produced by lower doses; 5. Progressive neglect of alternative pleasures or interests because of drug use, increased amount of time necessary to obtain or take the drug or to    recover from its effects 6. Persisting with drug use despite clear evidence of overtly harmful consequences, such as harm to the liver, depressive mood states or impairment of cognitive functioning. The article goes on to describe:

Symptoms of withdrawal

Psychological symptoms

Dysphoria Malaise Cravings Anxiety/Panic Attacks Paranoia Insomnia Dizziness Nausea Depression Treatment

Opioid dependence is a complex health condition that often requires long-term treatment and care. The treatment of opioid dependence is important to reduce its health and social consequences and to improve the well-being and social functioning of people affected. The main objectives of treating and rehabilitation persons with opiod dependence are to reduce dependence on illicit drugs; to reduce the morbidity and mortality caused by the use of illicit opioids, or associated with their use, such as infectious diseases; to improve physical and psychological health; to reduce criminal behaviour; to facilitate reintegration into the workforce and education system and to improve social functioning. The ultimate achievement of a drug free state is the ideal and ultimate objective but this unfortunately not feasible for all individuals with opiod dependence, especially in the short term. As no single treatment is effective for all individuals with opiod dependence diverse treatment options are needed, including psychosocial approaches and pharmacological treatment.(1) Relapse following detoxification alone is extremely common, and therefore detoxification rarely constitutes an adequate treatment of substance dependence on its own. However, it is a first step for many forms of longer-term abstinence-based treatment. Both detoxification with subsequent abstinence-oriented treatment and substitution maintenance treatment are essential components of an effective treatment system for people with opiod dependence.(2)

The previous article was taken from Opiod dependence From Wikipedia (Redirected from Opiod addiction)

Addressing the WHO and DSM-IV-TR clinical guidelines for a definite diagnosis of “dependence” require that three or more of the six characteristic must be experienced or exhibited as determinants for a diagnosis of “dependence.” The reader must consider factors when putting food into this category of. First, food has as all the six characteristic features when defining “drug dependence.” Secondly, there must be a seventh characteristic added if food/eating is put into this diagnosis, and that is:

7.If you give up this drug of choice, you’ll die.

Opoids can be given up completely. The previous article stated that both detoxification with subsequent abstinence-oriented treatment and substitution maintenance treatment are essential components of an effective treatment system for people with opiod dependence. The research attests to the fact that the probability for curing drug addictions is increased contingent upon the individual completely giving up the drug completely. Granted, the success rate is low, but, it is possible to “cure” opoid addictions.

It is impossible to “cure” the behaviors that contribute to obesity/overweight. Discover magazine, June, 2011 had an article by Dan Hurley called; “The Hungry Brain”. In this article scientists consider obesity to be incurable. Kelly Brownell points out that if a strict definition of “cure” obesity is adopted (such as a reduction to an ideal weight and maintenance at that point for at least 5 years), an individual is more likely to recover from most forms of cancer than to satisfy that criterion.(3)

Every weight control system, up-to-date, puts the management of obesity/overweight within the protocol of the medical model, that is: Obesity/overweight is a disease that has to be cured. The medical model puts food/eating in the same category for all other addictions and the treatment modality is applies the theory of Relapse Prevention. Relapse is the process of falling back to unhealthy habits or attitudes following a period of abstinence.(4)

The well-documented tendency for clients to regain the weight they have lost in therapy or treatment programs represents a central problem to the treatment of the obese and overweight individual.(5) Despite the prevalence and clinical importance of obesity, traditional, dietary and medical treatments have been notoriously unsuccessful. however, it is important to note that there have been relatively few long-term follow-up studies, and when such studies have been reported, it it not clear which factors predicted the maintenance of weight loss.(6) The National Weight Control Registry(NWCR)began in 1994 by R.R. Wing and J.O. Hill. The data was collected from a self-selected population recruited primarily through newspapers, magazines articles, radio and television. In 1997 this study provided evidence that long-term weight loss is possible and help identified the specific approaches associated with long-term success,(7). The information collected from this study was drawn from a population of successful maintainers. This is based on the Actuarial collection of data, the outcome: Actuarial Description of results. Actuarial description occurs when there are explicit rules specifying the attributes of individuals that identify them as falling into certain categories. Such descriptions, if accurate and reliable, must be based on demonstrated, empirical-based associations between variables. The purpose of research is to determine accurate causal predictions. The starting point must be to establish a reliable and valid data base. The objective is to evaluate whether current behaviors could be utilized as effective predictors of future behavior/outcome.

The validity of the NWCR findings are contingent on a select population of successful maintainers. The hypothesis is that compliance to specific behaviors will result in long-term weight loss. This study provides a meaningful data base for the design of programs that intervene at specific points-with the goal of changing specific high-risk behaviors. The NWCR's focus does not address the fact that the majority of dieters end up regaining the weight they lost in the all the various methods and programs offered today.

The lack of longitudinal outcome data since the early 1980's for losing weight and keeping it off leaves the consumer no options but to continually seek out methods that have been defined by the medical community as an “incurable disease.” It is this authors opinion that as long as the protocol for opoid addiction is used when dealing with obesity/weight loss, the medical model will continue to control how this national crisis is dealt with. William Weiss, a management professor as Seattle University states: “Obesity industries, including commercial weight-loss programs, weight-loss drug purveyors, and bariatric surgery centers will likely top $315 billion dollars this year alone-nearly 3% of the overall U.S. economy. the industry will continue to be the $315 billion dollar a year business, an industry with over a “95% failure rate.”(8)

Relapse prevention is the accepted protocol for weight loss. This policy must be re-directed towards a classification of behaviors that will better enable the consumer to take manageable, and realistic approaches to their weight management goals. The only alternative will be: when an individual deviates away from behaviors that are consistent with goal achievement (weight loss or weight management), the preferred treatment must always factor in strategies that will assure recovery from regressions. This approach to weight management must be the primary focus of future methods. Learning how to recover from “counter-productive” behaviors will make compliance more likely. Unlike heroin, weight loss, and its management, is not something that can ever be cured. Consumers must have options available besides the medical approach to losing weight. Options will come about when the consumer is able to research behavioral strategies that are necessary for meeting their unique needs.

Locus of Control as Predictor of outcome:

An important theoretical variable is the degree to which individuals feel that they can control their own fate: this is the expectance variable that Rotter referred to as the internal-external (IE) control of reinforcement.(9) The concept refers to a continuum, with the variable of concern being the degree to which an individual believes that events that occur to him or her are able to be influenced by personal actions. The individual who perceives that those external events as being subject to personal control is said to have an internal locus of control, while the individual who feels that he or she has no control and that those events occur independently is said to have an external locus of control.

A logical application of the I-E framework is in the area of understanding and studying health behaviors. Internals would b expected to be more likely to believe that they could take specific actions to improve their health: in the case of obesity, to believe that they could themselves undertake certain behaviors that would lead to weight loss. Externals, on the other hand, would not have that same perception. Instead, their external locus of control would lead them to attribute their obesity to fate or to external variables over which they can exert no control. Individuals with such an external locus would thus be seen as less likely to be helped in the context of weight loss programs requiring considerable personal responsibility. Since the middle of the last century, being obese or overweight was and is categorized within medical model of relapse prevention that is: Obesity and overweight are seen as a disease that must be cured. The medical framework has created a population of consumers that are dependent upon seeking a "cure" from experts that will give them the answers they are looking for. Until consumers believe that they are responsible for their weight loss fates, there will be no end to programs that promise the answers only to assure the 95% failure rate that the weight loss industry has perpetuated.

1. Substitution maintenance therapy in the management of opiod dependence and HIV/AIDS prevention. World Health Organization. 2004. ISBN 92-4-15911503 2. Chen,Kevin W.; Banducci, Annie N.; Guller, Leila; MacAtee, Richard J.; Lavelle, Anna; Daughters, Stacey B.; Lejuez, C.W. (2011). “An examination of psychiatric co-morbidities as a function of gender and substance type within an impatient substance use treatment program”. Drug and Alcohol Dependence 118 (2-3):92-9. 3. Brownell, K.D. (1983). Obesity: understanding and treating a serious prevalent and refractory disorder. Journal of Consulting and Clinical Psychology,50, 820-840 4. Dennis C. Daley, 1989. Relapse Prevention: Treatment Alternatives and Counseling Aids 5. Stunkard, J.A., & Renick, S.B. (1979). Behavior modification in the treatment obesity: The problem of maintaining weight loss. Archives of General Psychiatry, 35, 801-8067. 6. Graham, L.E., Taylor, C.B., Hovell, M.F., & Siegel, W. (1983) Five-year follow-up to a behavioral weight-loss program. Journal of Consulting Psychology, 51,322-323 7. Klem, M.L., Wing, R.R., RcGuire, M.T., Seeyle, H.M., Hill, J.O. A descriptive study of individuals successful at long-term maintenance of substantial weight loss. Am. J Clin Nutr 1997;66 239-467. 8. Stunkard, A.J., and McLaren-Hume, J: The results of treatment for obesity. Arch. Inter. Med., 103: 79-85, 1959. 9. Rotter, J.: Some problems and misconceptions related to the construct of internal versus external control of reinforcements. J. Consult. Clin. Psychol., 43: 56-57

DrdeenagailDrdeenagail (talk) 20:30, 15 October 2012 (UTC)