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Treating Mental Health and Forensic Populations

No longer is it possible to assess and/or treat a mental health population without also interfacing with forensic issues such as legal infractions, Courts, violence, sexual behavior problems, delinquency, crime, Not Guilty by Reason of Insanity, substance abuse, and others. The training and approaches to the mental health population is different than that for a forensic population. So what is to be done, if a person has both issues? We must be cross trained for dually affected clients.

How Are the Populations Different

A Mental Health population is comprised primarily Axis I disorders, such as Bipolar Disorder, Schizophrenia, Major Depression, PTSD, and Anxiety Disorders. Daily functioning is on a continuum. Recovery is quick for some and slow for others and is also on a continuum. Well controlled intermittent, mild to moderate episodes of a mood or anxiety disorder will not necessarily interfere with daily functioning. Someone with severe, chronic Schizophrenia or Mood Disorder requiring periodic hospitalizations and extensive community support, will have impairment in daily functioning. Goals for these folks are often pro-social and involve being an active member of society. A therapist can be fairly sure that the mental health client without forensic issues will be relatively honest in his or her interactions and the therapist can take most of what he/she says at face value. An emphasis on a strengths model works well when no personality disorder is involved.

A forensic population can be defined as having personality disorders, interpersonal difficulties, behavioral problems, multiple problems and life long courses of various levels of dysfunction or difficulty. Again, this population fills the full spectrum of effective daily functioning. However, social functioning is often the most severe impairment. There are issues of trust, appropriate relationships, ego centrism, moral development, honesty, manipulation, and danger to self and others. They often have a negative view of themselves and others, especially authority figures. Moral development is often delayed leaving them at the egocentric stage of development. This means that what serves the self is what matters and empathy for others and the ability to have an honest relationship with another person may not yet have developed. Their goals are often self-serving.

The capacity to understand the importance of the best interest of the group through laws and rules that we voluntarily follow, may not be well understood. Many, if not most, have histories of childhood abuse, neglect, or exposure to domestic violence. The assessment and interventions with this population is necessarily different that those for a people with no Axis II disorder or trait. The people with forensic issues do not always tell the truth because of their lack of trust in relationships. The therapist cannot take what he/she says at face value. The therapist must separate the sincere from the manipulative moves for self-gain. The internal boundaries are such that they need the therapist to put external boundaries into place for them. Information must be checked with other sources of information.

How Assessment Tools Differ

In a mental health population, assessment can quite effectively be done through instruments such as the MMPI-A, BASC, and MACI. These self-report tools are quite sufficient for this population and will elucidate psychological dynamics and mental illness, if present. Self-report is not as much of an issue as it is in the forensic population, where third party verification is more important. However when a youth has multiple problems, both mental health and forensic, a combination of tools is preferred.

Forensic evaluation tools rely less on self-report because of the trust issues and because it is not always in the client’s best interest to be completely truthful. Self-report assessment instruments can be used, but third party and official reports should also be used in the evaluation phase of a forensic assessment. Courts are concerned with public safety, therefore, the need for tools that assess future risk of dangerousness to others. Risk of future aggression and sexual behavior problems that have been derived from statistical models (actuarial tools) should be part of the evaluation since clinical assessment of risk of future dangerousness is only a little better than chance. While risk assessments are not perfect, they are better than clinical judgment in this area.

How are Interventions Different?

Major Mental Illnesses, while often chronic, can often be very effectively treated with medication and therapy. At the higher functioning end of the continuum, therapy can be supportive, psychotherapeutic, family, or cognitive behavioral. Therapists are trained to accept what the client presents and start where the client is functioning and how the client sees the world. The clients are usually self-motivated and seek therapy voluntarily. They accept responsibility for their behaviors and for making changes in their lives. Use of a strengths model is often very effective. Many people recover fully and lead quite “normal,” non-disrupted lives. When someone is on the lower end of the continuum, with major disruption in every day functioning (work and family),despite medication and therapy, major supports for housing, jobs, and activities of daily living and medication are needed for a very long time, perhaps a life time. However, their life goals are often still pro-social. Serlf-directed care works well with the mental health population without Axis II diagnoses.

In the area of intervention, different approaches are needed for the forensic population. Some level of social and family dysfunction is generally intergenerational and lifelong. These clients are often Court ordered to an assessment or therapy or they are having significant problems at work or within the family causing others to seek assessment or therapy for them. They do not always accept responsibility for their actions or for changing. There are skill deficits that need to be addressed, such as social skills, anger management, and problem solving. You cannot take what these clients say at face value. Third party information is always needed. This is because you need to trust someone in order to be honest with them and most of these folks have been abused, neglected, or exposed to domestic violence and a suspicious arm’s length treatment of others is a coping strategy that is difficult to give up.

This population often has multiple problems so that Multi-systemic Therapy that approaches many areas that need to be addressed is often effective (treating the whole person). Group work and trauma therapies are also good tools. Self-directed therapy may not be effective because of the need to protect oneself from what may appear to be an unsafe world. Nurturing, setting good boundaries, and structure are essential in this work. Motivational interviewing and stages of change can be very helpful. When clients have issues in the mental health and forensic arenas, both approaches must be used to the extent possible.

Conclusions

Clients in a mental health setting range from the single diagnosis of a major mental Illness to the dual diagnosis of a major mental illness and a personality disorder and/or forensic/legal issue. The approaches to these dissimilar populations is unique when clients are dually diagnosed, both approaches are needed. Assessments and treatment for a mental health population can be self-directed and strengths based.

However, the approach for the forensic population cannot be self-directed because the client’s goals are often antisocial and by definition counter to the best interests of society. The therapist or evaluator cannot accept everything the client says at face value because not being honest is part of the disorder that the therapist is treating. Motivational interviewing seems to blend the views of traditional mental health and forensics in a way that is beneficial for the client and society.

Modern Methods For Biochemistry Analysis

A biochemisty analyser is a device designed to perform a variety of biochemical tests. Invented by Hans Baruch, they were introduced to the medical community, commercially, in 1959, and allowed medical laboratories and hospitals to process more samples more quickly and effectively than before. With this automated testing process, the testing time went from days – sometimes weeks – to mere minutes.

Before then, the most common form of biochemical analysis involved open test tubes placed in racks which were then either moved along a track or spun in a carousel. To protect the samples from contamination, and the laboratory staff from illness or injury, closed tube sampling soon followed. The automated biochemistry analysers did not remove the need for clinical lab technicians, however, but it did make working in the labs safer, and helped reduce errors.

There are a variety of tests a biochemistry analyser performs. They can range from testing enzymes for liver function tests, to testing ions for sodium and potassium levels. Blood glucose, creatine, and serum albumin – a plasma protein – among others, can also be analysed.

There are three categories of biochemistry analysers: The wet type, the dry type and the bio sensor. The wet type method involves mixing a test sample with a reagent to encourage a chemical reaction. A reading device, such as a spectrophotometer or a calorimeter can then be used to read the color change before and after the reaction, allowing for analysis. However, this form of testing requires expensive instruments and the ability to keep the reagents valid for long periods of time.

The dry type biochemistry analyser requires the application of a chemical reagent to a test strip, such an antibody or enzyme, which will react directly with the test sample. With the dry type of testing there is a greater risk of oxidation of the test strip which can allow for faulty readings.

When using a biosensor type biochemistry analyser, the test sample may be oxidized and placed on a thin film which is placed onto the surface of an electrode, such as pillar hydrogen peroxide, which is among the most common, and then a polarized potential is applied to the anode and cathode, which releases elctrodes, which may be measured. However, the pillar electrodes require constant maintenance which can lead to cross pollution which can lead to mistaken readings.

Some tests require more specialized tests and require a separate biochemistry analyser. This analyser may be used for several tets, or a single test. Some of these are performed frequently, but others are not, and the majority are expensive to perform, as well as time consuming. Due to the shortage of skilled clinical laboratory professionals, manufacturers are working to develop automated systems for these rare tests.

With the recent contributions in biology, chemistry and genetics, the biochemistry analyser has been evolving and improving. Biochemical research is being pushed, and is now moving from the study of a few molecules to the functional study of all biomolecules. Today, biochemical analysers are being used to help tag proteins and nucleic acids with special dies thhat allow scientists to make great headway in their quest to sequence the human genome.

Italian Food – An Overview

Italian food is more than a form of nourishment; it’s a way of life in a country where family, friendship and feasts are all indelibly linked. Italian food is simple, vibrant and good for you. From roasts to risotto, pasta to preserves, soups to sauces, Italian food is popular all year round. Italian food is highly famed: greatly loved and tirelessly imitated the world over, it has been a source of endless pleasure and joie-de-vivre in countries far and wide. Italian food is not just for Italians, but for everyone.

Cooking

For hundreds of years Italian cooking has followed a very simple principle: food is best when it’s cooked fresh and in season. I am a great fan of Italian cuisine, and a firm believer that cooking is an art, not a task. Most traditional Italian dishes as we know today, are on the whole derived from simple peasant cookery, for example the Pizza, which could be found a couple of centuries ago on the streets of Naples being sold by street vendors to those that had no cooking facilities of their own at home. The regional cooking depends on a number of factors, not only as to what ingredients are most abundant each region, but also historical factors. The recipes of Northern and Southern Italian dishes are quite different and use different methods of cooking. With the exception of a few areas near lakes that exert a moderating influence, Northern Italy is too cold for olive trees to grow, and as a result much of the population used butter for cooking.

Pasta

Pasta, no doubt, plays a large part in most traditional Italian food, and few cultures know how to employ a tomato the way that Italians can. Pasta and olive oil are considered the characteristics of southern Italian food, while northern food focuses on rice and butter (although today there are many exceptions). Italian food is all about combinations of delicious local flavours, a simple sauce, a sprinkling of Parmesan and of course real Italian pasta.

Ingredients

Ingredients used in Italian cooking, such as pasta, olive oil, garlic, tomatoes and red wine have proved to be contributory factors to a healthier lifestyle. Finding the right balance of ingredients is vital in creating vibrant good food. Although there are essential ingredients that every Italian kitchen should have, basil, garlic and olive oil, the most important ingredient is creativity. Italian cookery is exceptionally varied, nutritious and healthy; traditions have been handed down from one family to the next over the centuries, and are associated mainly with country life in that dishes are directly linked to what the Earth produces over the changing seasons: in other words, wholesome cooking whose goodness depends on all-natural ingredients.

Somebody once said “The trouble with eating Italian food is that 5 or 6 days later you’re hungry again”. Italian food is not just for Italians, but for everyone. Did you know that Italian food is the most popular cuisine for eating out throughout the world? I think the success of Italian food is that it’s the food that is easiest to live with.

Bariatric Athlete Fuel Guide Without Carb Loading

We often hear that in order to fuel workouts and races an athlete needs to carb load. And for good reason, carbohydrates are the body’s main fuel source. However, this practice could be a threefold problem for bariathletes. For one, the word ‘load’ alone is not recommended for a small pouch. And when looking at the post-op macronutrient breakdown, protein is in the lead. Lastly, for those who have had the gastric bypass often can not tolerate carbohydrates because they induce dumping syndrome. So what is a bariathlete to do?

Although the body does prefer carbohydrates, loading per se may not be needed. More and more athletes are beginning follow a more balanced diet and continue to perform competitively. We recommend eating well throughout the day with a balance of carbohydrates, protein and fat at each meal.

First, take a look at the micronutrient density of your foods. Are you eating nutrient rich foods or are they many processed and stripped of its vitamins and minerals? Athletes often look past this because they tend to focus on calories and carbohydrates. Bariathletes also tend to forget about this but more due to thinking all their needs are covered in their vitamin and mineral supplements. The supplements cover your bariatric needs, but your nutrient needs increase when you start exercising. And no, we don’t recommend taking more supplements to cover this, we recommend whole foods because your body is able to absorb and utilize these nutrients so much more efficiently from its natural sources.

Because a bariathlete can only eat so much at a given time it is important that meals and snacks do not have more than 4 hours between them. Eating frequently assures your fuel takes are full and can eliminate the need to ‘load’. The key a again is a mix of carbohydrates and protein to meet both your bariatric and athletic needs.

So remember, you are now an athlete and food is the fuel that allows you to live the new and exciting lifestyle you choose. Opt for more mixed meals while still maintaining adequate protein intake. Select more whole, fresh, nutrient rich foods to provide you with the vitamin and minerals you body needs to perform optimally. Good luck and have fun!

*For more specific details for your individual needs, contact us today for a personalized meal plan. [email protected]

30 Points, How Science Has Changed Our Lives

If we look life 100 years ago, and compare that with the today's life, we will notice that Science has dramatically changed human life. With the dawn of the Industrial Revolution in the 18th century, the effect of Science on human life rapidly changed. Today, science has a profound effect on the way we live, largely through technology, the use of scientific knowledge for practical purposes.

Some forms of scientific inventions have changed our lives entirely. For example the refrigerator has played a major role in maintaining public health ever since its invention. The first automobile, dating from the 1880s, made use of many advances in physics, mathematics and engineering; the first electronic computers emerged in the 1940s from simultaneous advances in electronics, physics and mathematics. Today we have extra high- speed super computers with 100% accuracy.

Science has enormous influence on our lives. It provides the basis of much of modern technology – the tools, materials, techniques, and sources of power that make our lives and work easier. The discoveries of scientists also help to shape our views about ourselves and our place in the universe.

Research in food technology has created new ways of preserving and flavoring what we eat. Research in industrial chemistry has created a vast range of plastics and other synthetic materials, which have thousands of uses in the home and in industry. Synthetic materials are easily formed into complex shapes and can be used to make machines, electrical, and automotive parts, scientific, technical and industrial instruments, decorative objects, containers, packing materials and many other items.

1: The use of science in daily life has helped us a good deal in solving problems, dealing with the maintenance of health, production and preservation of food, construction of houses and providing communication and trans-portational (related to transport) facilities. With the help of Science we have controlled epidemics and much other kind of diseases. Now we know the basic structure of DNA and Genetic Engineering is conducting research to find out the right and correct Gene Therapy to overcome all the diseases.

2: Science has changed the people and their living, life style, food habits, sleeping arrangements, earning methods, the way of communication between people and recreational activities. All kinds of music systems, computer games, electronic video games, DVDs, cinema entertainment and communication have been brought to our door with the help of Science. The life of man was very different from what it used to be 100 years back. Science has given ears to the deaf, eyes to the blind and limbs to the crippled. Science has adequately, energetically and productively advanced, changed, civilized, enhanced and progressed human life. Science has brought sophistication to human life.

In short science has changed, improved, enhanced, modified and refined human life in all ways.

3: Today with the help of Science we can explain what was strange and mysterious for the people of the past. The Science of Genetics opening new doors of understanding the human gene and cell.

4: Now human beings have become more critical and less fearful than our fore-fathers and ancestors.

5: Two hundred years ago death rate among children was very high. In those days seven out of eight babies died before their first birthday. Now with the help of vaccines, medications and proper health care system life expectancy has improved. Now people live longer and safe lives as compared to 200 years ago. Biochemical research is responsible for the antibiotics and vaccinations that protect us from infectious diseases, and for a wide range of other drugs used to defeat specific health problems. As a result, the majority of people on the planet now live longer and healthier lives than ever before.

6: After that and up to the age of 12 one used to fall in a prey to diseases like small pox, measles, whooping- cough, scarlet fever and diphtheria. Now Science has defeated these diseases.

7: At a later stage again one was under constant threat of yellow fever, malaria, typhus, cholera, typhoid and influenza. Today we have vaccines and medical aid to cope with these health problems. Further research is underway to find out the causes and treatment of these and other diseases.

8: From one person the disease used to spread among the other people. It is called Epidemics. Now with the help of Vaccines and Medications we have defeated these diseases. But still Science has to do more research and has to fight with other arenas of diseases.

9: Life was uncertain. It was rare to see to somebody thirty years old because due to diseases many people died earlier than the age of thirty. These conditions were prevailing just a short while ago.

10: In everyday life, we have to communicate with different friends and relatives, various official people and for general purposes. And many people to be contacted can be at very far off distances. However, time and distance both have been conquered by Science. Whether we want to communicate or travel, both are possible quickly, briskly and expeditiously.

11: These days there are very little chances of babies catching diseases, because births normally take place in hospitals under the supervision of a team of specialist doctors. Science has invented vaccines for young babies to protect them against future life illnesses.

12: Young people are also given medical treatment in time and these days the man lives for about seventy years.

13: Science and scientific methods have helped in finding out the cause of disease and its prevention.

14: Sanitary condition in the past was deplorable. Now we have better sanitary systems.

15: The city streets were unpaved; there was no proper drainage system. Garbage and other refuse was seen everywhere. Pigs were seen wandering through the streets. People got water from filthy wells. Now filtered mineral water is available to overcome diseases. Solid waste management is not a problem now a days, it is the duty of the city municipal committees to manage and dump it with the latest machinery and equipments

16: Now all these defects have gone. There is cleanliness everywhere. It is illegal to throw garbage into the streets. There is a proper drainage system and new and improved methods for solid waste management as it has been told earlier. There are separate departments that bother about sanitary condition of the towns.

17: A century ago for house hold purposes water was carried from wells outside in buckets. It sometimes proved injurious to human health. Moreover, it was insufficient for the daily needs. But now water filters have become a thing of common usage.

18: Now there is sufficient supply of water in cities. For example Los Angeles gets water through pipes from Colorado River, which is 340 miles away. This water is supplied to Los Angeles after the proper water filtration process.

19: With the help of science there is change in our food also. We get varieties of food. In the past, food could not be preserved. But now the quick freezing methods have made possible preservation possible. Due to modern technologies like dehydration and sterilization there is no chance of food poisoning. We get all kinds of fruits, meats and vegetables. Even those fruits and vegetables which are out of season.

20: Not only our eating habits are changed, but also there are improvements in our houses. Means of transport has also undergone a big improvement and change.

21: Science has also changed our attitudes. Superstitions have been discarded, because there is no scientific basis for them. Now people do not fear cloud thunders.

22: Now people no more believe that diseases are caused by evil spirits.

23: Astrology and fortune- telling have lost popularity as compared to 100 years ago. Nobody now fears black cats, broken mirrors and the number 13. Because science has proved that these kinds of fears are un-scientific and illogical.

24: Science has changed the longstanding false notions of the people, which are not supported by Scientific Facts.

25: Research in the field of science and technology has made people open-minded and cosmopolitan, because the Scientist does not like to travel on the beaten track and he always tries to find out new things, new explorations, new discoveries and new inventions.

26: Science has also brought medical equipments that help to save human life. The kidney dialysis machine facilitates many people to survive kidney diseases that would once have proved fatal, and artificial valves allow sufferers of coronary heart disease to return to active living. Since the 1980s, lasers have been used in the treatment of painful kidney stones. Lasers are used when kidney stones fail to pass through the body after several days, it provides a quick and low-pain way to break up the stone and allow the stones to be easily passed through the body. This technique is called Lithotripsy.

27: Arthroscopic surgery is a technique using fiber optics to probe complex joints such as knee, shoulder, ankle and wrist to evaluate injury. It is a minimally invasive operation to repair a damaged joint; the surgeon examines the joint with an "arthroscopy" while making repairs through a small incision.

28: 200 years ago nobody even knows that human body parts can be replaced or transplanted. Now kidney transplant is widely used to save human lives around the globe. Dr. Christian Bernard first of all invented the method of heart transplant. Eye transplant techniques are used in these days to see again this beautiful world, for those who have lost their eyes. These all are the blessings of Science.

29: Ultra-high-frequency (UHF) waves are allocated for variety of uses, including television, cellular phones, public safety radios, business radios, military aircraft communications, military radar, cordless phones, baby monitors, etc. So, whether someone is watching over-the-air TV, talking on cell phone, having police / fire / ambulance dispatched to an emergency they are experiencing, or having national airspace protected by military aircraft, they all are benefitting from the science that has allowed the use of UHF waves. Even it is used to treat some illnesses.

30: For communication, now we have fixed wire telephones, moveable wireless phone sets, cordless phones, mobile phones, wireless, video conferencing, Internet, Broad Band Internet, E-mail, Social Networks, Satellite Communication and many other ways to communicate. These all are blessings of Science. Today we are better aware of what is happening around the globe due to satellite television channels. The benign and benefits of science for human life are endless.

The Importance of Physical Fitness

In its most general meaning, physical fitness is a general state of good physical health. Obtaining and maintaining physical fitness is a result of physical activity, proper diet and nutrition and of course proper rest for physical recovery. In its simplest terms, physical fitness is to the human body what fine-tuning is to an engine. It enables people to perform up to their potential. Regardless of age, fitness can be described as a condition that helps individuals look, feel and do their best. Thus, physical fitness trainers, describe it as the ability to perform daily tasks vigorously and alertly, with left over energy to enjoy leisure-time activities and meet emergency demands. Specifically true for senior citizens, physical fitness is the ability to endure, bear up, withstand stress and carry on in circumstances where an unfit person could not continue.

In order for one to be considered physically fit, the heart, lungs, and muscles have to perform at a certain level for the individual to continue feeling capable of performing an activity. At the same time, since what humans do with their bodies directly affects the state of mind, fitness influences to some degree qualities such as mental alertness and emotional expression.

Physical fitness is often divided into the following categories in order for people to be able examine its components or parts. Particularly, physical fitness is judged by:

1. Cardiovascular endurance: This is the ability of the body to deliver oxygen and nutrients to tissues and to remove wastes over sustained periods of time.

2. Muscular strength & endurance: Strength deals with the ability of the muscle to exert force for a brief time period, while endurance is the ability of a muscle, or group of muscles, to sustain repeated contractions or to continue to apply force against an inert object.

3. Flexibility: This denotes the ability to move joints and use muscles through their full range of motion.

4. Body composition: Considered as one of the components of fitness, composition refers to the body in terms of lean mass (muscle, bone, vital tissue, and organs) and fat mass. Actually, the optimal ratio of fat to lean mass is an indication of fitness. Performing the right set of exercises can help people get rid off body fat and increase or maintain muscle mass.

Pathological Eating Disorders and Poly-Behavioral Addiction

When considering that pathological eating disorders and their related diseases now afflict more people globally than malnutrition, some experts in the medical field are presently purporting that the world’s number one health problem is no longer heart disease or cancer, but obesity. According to the World Health Organization (June, 2005), “obesity has reached epidemic proportions globally, with more than 1 billion adults overweight – at least 300 million of them clinically obese – and is a major contributor to the global burden of chronic disease and disability. Often coexisting in developing countries with under-nutrition, obesity is a complex condition, with serious social and psychological dimensions, affecting virtually all ages and socioeconomic groups.” The U.S. Centers for Disease Control and Prevention (June, 2005), reports that “during the past 20 years, obesity among adults has risen significantly in the United States. The latest data from the National Center for Health Statistics show that 30 percent of U.S. adults 20 years of age and older – over 60 million people – are obese. This increase is not limited to adults. The percentage of young people who are overweight has more than tripled since 1980. Among children and teens aged 6-19 years, 16 percent (over 9 million young people) are considered overweight.”

Morbid obesity is a condition that is described as being 100lbs. or more above ideal weight, or having a Body Mass Index (BMI) equal to or greater than 30. Being obese alone puts one at a much greater risk of suffering from a combination of several other metabolic factors such as having high blood pressure, being insulin resistant, and/ or having abnormal cholesterol levels that are all related to a poor diet and a lack of exercise. The sum is greater than the parts. Each metabolic problem is a risk for other diseases separately, but together they multiply the chances of life-threatening illness such as heart disease, cancer, diabetes, and stroke, etc. Up to 30.5% of our Nations’ adults suffer from morbid obesity, and two thirds or 66% of adults are overweight measured by having a Body Mass Index (BMI) greater than 25. Considering that the U.S. population is now over 290,000,000, some estimate that up to 73,000,000 Americans could benefit from some type of education awareness and/ or treatment for a pathological eating disorder or food addiction. Typically, eating patterns are considered pathological problems when issues concerning weight and/ or eating habits, (e.g., overeating, under eating, binging, purging, and/ or obsessing over diets and calories, etc.) become the focus of a persons’ life, causing them to feel shame, guilt, and embarrassment with related symptoms of depression and anxiety that cause significant maladaptive social and/ or occupational impairment in functioning.

We must consider that some people develop dependencies on certain life-functioning activities such as eating that can be just as life threatening as drug addiction and just as socially and psychologically damaging as alcoholism. Some do suffer from hormonal or metabolic disorders, but most obese individuals simply consume more calories than they burn due to an out of control overeating Food Addiction. Hyper-obesity resulting from gross, habitual overeating is considered to be more like the problems found in those ingrained personality disorders that involve loss of control over appetite of some kind (Orford, 1985). Binge-eating Disorder episodes are characterized in part by a feeling that one cannot stop or control how much or what one is eating (DSM-IV-TR, 2000). Lienard and Vamecq (2004) have proposed an “auto-addictive” hypothesis for pathological eating disorders. They report that, “eating disorders are associated with abnormal levels of endorphins and share clinical similarities with psychoactive drug abuse. The key role of endorphins has recently been demonstrated in animals with regard to certain aspects of normal, pathological and experimental eating habits (food restriction combined with stress, loco-motor hyperactivity).” They report that the “pathological management of eating disorders may lead to two extreme situations: the absence of ingestion (anorexia) and excessive ingestion (bulimia).”

Co-morbidity & Mortality

Addictions and other mental disorders as a rule do not develop in isolation. The National Co-morbidity Survey (NCS) that sampled the entire U.S. population in 1994, found that among non-institutionalized American male and female adolescents and adults (ages 15-54), roughly 50% had a diagnosable Axis I mental disorder at some time in their lives. This survey’s results indicated that 35% of males will at some time in their lives have abused substances to the point of qualifying for a mental disorder diagnosis, and nearly 25% of women will have qualified for a serious mood disorder (mostly major depression). A significant finding of note from the NCS study was the widespread occurrence of co-morbidity among diagnosed disorders. It specifically found that 56% of the respondents with a history of at least one disorder also had two or more additional disorders. These persons with a history of three or more co-morbid disorders were estimated to be one-sixth of the U.S. population, or some 43 million people (Kessler, 1994).

McGinnis and Foege, (1994) report that, “the most prominent contributors to mortality in the United States in 1990 were tobacco (an estimated 400,000 deaths), diet and activity patterns (300,000), alcohol (100,000), microbial agents (90,000), toxic agents (60,000), firearms (35,000), sexual behavior (30,000), motor vehicles (25,000), and illicit use of drugs (20,000). Acknowledging that the leading cause of preventable morbidity and mortality was risky behavior lifestyles, the U.S. Prevention Services Task Force set out to research behavioral counseling interventions in health care settings (Williams & Wilkins, 1996).

Poor Prognosis

We have come to realize today more than any other time in history that the treatment of lifestyle diseases and addictions are often a difficult and frustrating task for all concerned. Repeated failures abound with all of the addictions, even with utilizing the most effective treatment strategies. But why do 47% of patients treated in private treatment programs (for example) relapse within the first year following treatment (Gorski,T., 2001)? Have addiction specialists become conditioned to accept failure as the norm? There are many reasons for this poor prognosis. Some would proclaim that addictions are psychosomatically- induced and maintained in a semi-balanced force field of driving and restraining multidimensional forces. Others would say that failures are due simply to a lack of self-motivation or will power. Most would agree that lifestyle behavioral addictions are serious health risks that deserve our attention, but could it possibly be that patients with multiple addictions are being under diagnosed (with a single dependence) simply due to a lack of diagnostic tools and resources that are incapable of resolving the complexity of assessing and treating a patient with multiple addictions?

Diagnostic Delineation

Thus far, the DSM-IV-TR has not delineated a diagnosis for the complexity of multiple behavioral and substance addictions. It has reserved the Poly-substance Dependence diagnosis for a person who is repeatedly using at least three groups of substances during the same 12-month period, but the criteria for this diagnosis do not involve any behavioral addiction symptoms. In the Psychological Factors Affecting Medical Condition’s section (DSM-IV-TR, 2000); maladaptive health behaviors (e.g., overeating, unsafe sexual practices, excessive alcohol and drug use, etc.) may be listed on Axis I only if they are significantly affecting the course of treatment of a medical or mental condition.

Since successful treatment outcomes are dependent on thorough assessments, accurate diagnoses, and comprehensive individualized treatment planning, it is no wonder that repeated rehabilitation failures and low success rates are the norm instead of the exception in the addictions field, when the latest DSM-IV-TR does not even include a diagnosis for multiple addictive behavioral disorders. Treatment clinics need to have a treatment planning system and referral network that is equipped to thoroughly assess multiple addictive and mental health disorders and related treatment needs and comprehensively provide education/ awareness, prevention strategy groups, and/ or specific addictions treatment services for individuals diagnosed with multiple addictions. Written treatment goals and objectives should be specified for each separate addiction and dimension of an individuals’ life, and the desired performance outcome or completion criteria should be specifically stated, behaviorally based (a visible activity), and measurable.

New Proposed Diagnosis

To assist in resolving the limited DSM-IV-TRs’ diagnostic capability, a multidimensional diagnosis of “Poly-behavioral Addiction,” is proposed for more accurate diagnosis leading to more effective treatment planning. This diagnosis encompasses the broadest category of addictive disorders that would include an individual manifesting a combination of substance abuse addictions, and other obsessively-compulsive behavioral addictive behavioral patterns to pathological gambling, religion, and/ or sex / pornography, etc.). Behavioral addictions are just as damaging – psychologically and socially as alcohol and drug abuse. They are comparative to other life-style diseases such as diabetes, hypertension, and heart disease in their behavioral manifestations, their etiologies, and their resistance to treatments. They are progressive disorders that involve obsessive thinking and compulsive behaviors. They are also characterized by a preoccupation with a continuous or periodic loss of control, and continuous irrational behavior in spite of adverse consequences.

Poly-behavioral addiction would be described as a state of periodic or chronic physical, mental, emotional, cultural, sexual and/ or spiritual/ religious intoxication. These various types of intoxication are produced by repeated obsessive thoughts and compulsive practices involved in pathological relationships to any mood-altering substance, person, organization, belief system, and/ or activity. The individual has an overpowering desire, need or compulsion with the presence of a tendency to intensify their adherence to these practices, and evidence of phenomena of tolerance, abstinence and withdrawal, in which there is always physical and/ or psychic dependence on the effects of this pathological relationship. In addition, there is a 12 – month period in which an individual is pathologically involved with three or more behavioral and/ or substance use addictions simultaneously, but the criteria are not met for dependence for any one addiction in particular (Slobodzien, J., 2005). In essence, Poly-behavioral addiction is the synergistically integrated chronic dependence on multiple physiologically addictive substances and behaviors (e.g., using/ abusing substances – nicotine, alcohol, & drugs, and/or acting impulsively or obsessively compulsive in regards to gambling, food binging, sex, and/ or religion, etc.) simultaneously.

New Proposed Theory

The Addictions Recovery Measurement System’s (ARMS) theory is a nonlinear, dynamical, non-hierarchical model that focuses on interactions between multiple risk factors and situational determinants similar to catastrophe and chaos theories in predicting and explaining addictive behaviors and relapse. Multiple influences trigger and operate within high-risk situations and influence the global multidimensional functioning of an individual. The process of relapse incorporates the interaction between background factors (e.g., family history, social support, years of possible dependence, and co-morbid psychopathology), physiological states (e.g., physical withdrawal), cognitive processes (e.g., self-efficacy, cravings, motivation, the abstinence violation effect, outcome expectancies), and coping skills (Brownell et al., 1986; Marlatt & Gordon, 1985). To put it simply, small changes in an individual’s behavior can result in large qualitative changes at the global level and patterns at the global level of a system emerge solely from numerous little interactions.

The ARMS hypothesis purports that there is a multidimensional synergistically negative resistance that individual’s develop to any one form of treatment to a single dimension of their lives, because the effects of an individual’s addiction have dynamically interacted multi-dimensionally. Having the primary focus on one dimension is insufficient. Traditionally, addiction treatment programs have failed to accommodate for the multidimensional synergistically negative effects of an individual having multiple addictions, (e.g. nicotine, alcohol, and obesity, etc.). Behavioral addictions interact negatively with each other and with strategies to improve overall functioning. They tend to encourage the use of tobacco, alcohol and other drugs, help increase violence, decrease functional capacity, and promote social isolation. Most treatment theories today involve assessing other dimensions to identify dual diagnosis or co-morbidity diagnoses, or to assess contributing factors that may play a role in the individual’s primary addiction. The ARMS’ theory proclaims that a multidimensional treatment plan must be devised addressing the possible multiple addictions identified for each one of an individual’s life dimensions in addition to developing specific goals and objectives for each dimension.

The ARMS acknowledges the complexity and unpredictable nature of lifestyle addictions following the commitment of an individual to accept assistance with changing their lifestyles. The Stages of Change model (Prochaska & DiClemente, 1984) is supported as a model of motivation, incorporating five stages of readiness to change: pre-contemplation, contemplation, preparation, action, and maintenance. The ARMS theory supports the constructs of self-efficacy and social networking as outcome predictors of future behavior across a wide variety of lifestyle risk factors (Bandura, 1977). The Relapse Prevention cognitive-behavioral approach (Marlatt, 1985) with the goal of identifying and preventing high-risk situations for relapse is also supported within the ARMS theory.

The ARMS continues to promote Twelve Step Recovery Groups such as Food Addicts and Alcoholics Anonymous along with spiritual and religious recovery activities as a necessary means to maintain outcome effectiveness. The beneficial effects of AA may be attributable in part to the replacement of the participant’s social network of drinking friends with a fellowship of AA members who can provide motivation and support for maintaining abstinence (Humphreys, K.; Mankowski, E.S, 1999) and (Morgenstern, J.; Labouvie, E.; McCrady, B.S.; Kahler, C.W.; and Frey, R.M., 1997). In addition, AA’s approach often results in the development of coping skills, many of which are similar to those taught in more structured psychosocial treatment settings, thereby leading to reductions in alcohol consumption (NIAAA, June 2005).

Treatment Progress Dimensions

The American Society of Addiction Medicine’s (2003), “Patient Placement Criteria for the Treatment of Substance-Related Disorders, 3rd Edition”, has set the standard in the field of addiction treatment for recognizing the totality of the individual in his or her life situation. This includes the internal interconnection of multiple dimensions from biomedical to spiritual, as well as external relationships of the individual to the family and larger social groups. Life-style addictions may affect many domains of an individual’s functioning and frequently require multi-modal treatment. Real progress however, requires appropriate interventions and motivating strategies for every dimension of an individual’s life.

The Addictions Recovery Measurement System (ARMS) has identified the following seven treatment progress areas (dimensions) in an effort to: (1) assist clinicians with identifying additional motivational techniques that can increase an individual’s awareness to make progress: (2) measure within treatment progress, and (3) measure after treatment outcome effectiveness:

PD- 1. Abstinence/ Relapse: Progress Dimension

PD- 2. Bio-medical/ Physical: Progress Dimension

PD- 3. Mental/ Emotional: Progress Dimension

PD- 4. Social/ Cultural: Progress Dimension

PD- 5. Educational/ Occupational: Progress Dimension

PD- 6. Attitude/ Behavioral: Progress Dimension

PD- 7. Spirituality/ Religious: Progress Dimension

Considering that addictions involve unbalanced life-styles operating within semi-stable equilibrium force fields, the ARMS philosophy promotes that positive treatment effectiveness and successful outcomes are the result of a synergistic relationship with “The Higher Power,” that spiritually elevates and connects an individuals’ multiple life functioning dimensions by reducing chaos and increasing resilience to bring an individual harmony, wellness, and productivity.

Addictions Recovery Measurement – Subsystems

Since chronic lifestyle diseases and disorders such as diabetes, hypertension, alcoholism, drug and behavioral addictions cannot be cured, but only managed – how should we effectively manage poly-behavioral addiction?

The Addiction Recovery Measurement System (ARMS) is proposed utilizing a multidimensional integrative assessment, treatment planning, treatment progress, and treatment outcome measurement tracking system that facilitates rapid and accurate recognition and evaluation of an individual’s comprehensive life-functioning progress dimensions. The “ARMS”- systematically, methodically, interactively, & spiritually combines the following five versatile subsystems that may be utilized individually or incorporated together:

1) The Prognostication System – composed of twelve screening instruments developed to evaluate an individual’s total life-functioning dimensions for a comprehensive bio-psychosocial assessment for an objective 5-Axis diagnosis with a point-based Global Assessment of Functioning score;

2) The Target Intervention System – that includes the Target Intervention Measure (TIM) and Target Progress Reports (A) & (B), for individualized goal-specific treatment planning;

3) The Progress Point System – a standardized performance-based motivational recovery point system utilized to produce in-treatment progress reports on six life-functioning individual dimensions;

4) The Multidimensional Tracking System – with its Tracking Team Surveys (A) & (B), along with the ARMS Discharge criteria guidelines utilizes a multidisciplinary tracking team to assist with discharge planning; and

5) The Treatment Outcome Measurement System – that utilizes the following two measurement instruments: (a) The Treatment Outcome Measure (TOM); and (b) the Global Assessment of Progress (GAP), to assist with aftercare treatment planning.

National Movement

With the end of the Cold War, the threat of a world nuclear war has diminished considerably. It may be hard to imagine that in the end, comedians may be exploiting the humor in the fact that it wasn’t nuclear warheads, but “French fries” that annihilated the human race. On a more serious note, lifestyle diseases and addictions are the leading cause of preventable morbidity and mortality, yet brief preventive behavioral assessments and counseling interventions are under-utilized in health care settings (Whitlock, 2002).

The U.S. Preventive Services Task Force concluded that effective behavioral counseling interventions that address personal health practices hold greater promise for improving overall health than many secondary preventive measures, such as routine screening for early disease (USPSTF, 1996). Common health-promoting behaviors include healthy diet, regular physical exercise, smoking cessation, appropriate alcohol/ medication use, and responsible sexual practices to include use of condoms and contraceptives.

350 national organizations and 250 State public health, mental health, substance abuse, and environmental agencies support the U.S. Department of Health and Human Services, “Healthy People 2010” program. This national initiative recommends that primary care clinicians utilize clinical preventive assessments and brief behavioral counseling for early detection, prevention, and treatment of lifestyle disease and addiction indicators for all patients’ upon every healthcare visit.

Partnerships and coordination among service providers, government departments, and community organizations in providing treatment programs are a necessity in addressing the multi-task solution to poly-behavioral addiction. I encourage you to support the mental health and addiction programs in America, and hope that the (ARMS) resources can assist you to personally fight the War on pathological eating disorders within poly-behavioral addiction.

For more info see:

Poly-Behavioral Addiction and the Addictions Recovery Measurement System,

By James Slobodzien, Psy.D., CSAC at:

[http://www.geocities.com/drslbdzn/Behavioral-Addictions.html]

Food Addicts Anonymous: http://www.foodaddictsanonymous.org/

Alcoholics Anonymous: http://www.alcoholics-anonymous.org/

References

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition,

Text Revision. Washington, DC, American Psychiatric Association, 2000, p. 787 & p. 731.

American Society of Addiction Medicine’s (2003), “Patient Placement Criteria for the

Treatment of Substance-Related Disorders, 3rd Edition,. Retrieved, June 18, 2005, from:

http://www.asam.org/

Bandura, A. (1977), Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review,

84, 191-215.

Brownell, K. D., Marlatt, G. A., Lichtenstein, E., & Wilson, G. T. (1986). Understanding and preventing relapse. American Psychologist, 41, 765-782.

Centers for Disease Control and Prevention (CDC). Retrieved June 18, 2005, from: http://www.cdc.gov/nccdphp/dnpa/obesity/

Gorski, T. (2001), Relapse Prevention In The Managed Care Environment. GORSKI-CENAPS Web

Healthy People 2010. Retrieved June 20, 2005, from: http://www.healthypeople.gov/

Publications. Retrieved June 20, 2005, from: http://www.tgorski.com

Lienard, J. & Vamecq, J. (2004), Presse Med, Oct 23;33(18 Suppl):33-40.

Marlatt, G. A. (1985). Relapse prevention: Theoretical rationale and overview of the model. In G. A.

Marlatt & J. R. Gordon (Eds.), Relapse prevention (pp. 250-280). New York: Guilford Press.

McGinnis JM, Foege WH (1994). Actual causes of death in the United States. US Department of Health and Human Services, Washington, DC 20201

Humphreys, K.; Mankowski, E.S.; Moos, R.H.; and Finney, J.W (1999). Do enhanced friendship networks and active coping mediate the effect of self-help groups on substance abuse? Ann Behav Med 21(1):54-60.

Kessler, R.C., McGonagle, K.A., Zhao, S., Nelson, C.B., Hughes, M., Eshleman, S., Wittchen, H. H,-U, & Kendler, K.S. (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United

States: Results from the national co morbidity survey. Arch. Gen. Psychiat., 51, 8-19.

Morgenstern, J.; Labouvie, E.; McCrady, B.S.; Kahler, C.W.; and Frey, R.M (1997). Affiliation with Alcoholics Anonymous after treatment: A study of its therapeutic effects and mechanisms of action. J Consult Clin Psychol 65(5):768-777.

Orford, J. (1985). Excessive appetites: A psychological view of addiction. New York: Wiley.

Prochaska, J. O., & DiClemente, C. C. (1984). The transtheoretical approach: Crossing the boundaries of therapy. Malabar, FL: Krieger.

Slobodzien, J. (2005). Poly-behavioral Addiction and the Addictions Recovery Measurement System (ARMS), Booklocker.com, Inc., p. 5.

Whitlock, E.P. (1996). Evaluating Primary Care Behavioral Counseling Interventions: An Evidence-based Approach. Am J Prev Med 2002;22(4): 267-84.Williams & Wilkins. U.S. Preventive Services Task Force. Guide to Clinical Preventive Services. 2nd ed. Alexandria, VA.

U.S. Department of Health and Human Services. Healthy People 2010 (Conference Edition). Washington, DC: U.S. Government Printing Office; 2000.

World Health Organization, (WHO). Retrieved June 18, 2005, from: http://www.who.int/topics/obesity/en/

Advantages to Computers in the Food & Beverage Industry

Computers have revolutionized the food and beverage industry as they have nearly every other industry. Computers have had positive, measurable effects on the front end and back end of hospitality operations. Computers systems have improved employee performance, and food and beverage quality and consistency. Within the food and beverage industry there is no longer a question of should technology be used, but rather a question of which technology to use? In the food and beverage business, computers are here to stay.

In the hospitality industry, customer service is an absolute critical factor for success. Computers are helping in this area in several ways. In many restaurants, the wait staff can process various forms of payment at guest tables, which allows guest to leave directly from their table without the need to stop at a centralized checkout station. This has removed long unsightly lines, which annoy customers, and disrupt the flow of traffic in food and beverage businesses. This service is made possible by either small hand held computers which handle credit card transactions using wireless technology, or via remote point of sale systems that interact with a central computer system. This improves the customers dining experience, which should be the goal of any food service business.

A key management concern of any food and beverage business is the profit margin. In this vital area of business, computers have also proven to be an indispensable tool. Computer systems help manage the entire food service process from ordering the ingredients needed to produce menu items, to forecasting the amount of items to prepare for each dining period based on historical patterns. This helps to reduce wasted food, which is very expensive and comes out of the businesses profit. It also helps in preparing menu items before hand, which reduces customer wait time. Computer can also forecast with high accuracy rates the volume of business to be expected which allows managers to properly staff their business. This is vital because having too much staff on hand can consume unnecessary amounts of payroll, and not having enough staff on hand will cause customer service problems.

Computers are also being used in very innovative ways by some food and beverage businesses. For instance, Darden Restaurants that owns and operates the Red lobster and Olive Garden chains uses computers to help choose new building sites. This computer system uses a software program called the Darden Site Analyzer. The software gathers critical information needed to select a site, such as demographics, distance to other restaurants and customer information specific to the Darden business model. The program then analyzes the site and provides a series of reports to help Darden make the final decision. Darden plans to improve the software so that it can evaluate things such as whether a new Darden restaurant will negatively effect other Darden restaurants in the same area.

Computer systems have become a vital part of all aspects of the food and beverage industry, they help with purchasing decisions, inventory control, employee scheduling and training, and customer acquisition and retention. A leading indicator of this growing trend is the fact that many hospitality training programs now include computer and technology courses in the curriculum.

Each year innovators are creating more unique ways that technology can be used to enhance the overall commercial dining experience. Computers make out of home dining a more enjoyable experience for the consumer and a more profitable manageable experience for business managers and owners.

(c) 2006, Marcus Barber

Role Of Food Service Consultants

If you have ever received bad service in a restaurant, you know that it can be a sales killer for any restaurant business. However, if you desire to have your restaurant be among the better restaurants in town and you aspire to be the best in your niche, then, providing great service is one of the best ways to earn a strong reputation. And one person that can help you deliver great is a professional food service consultant. The professional food service consultant can advise and give you the guidance you on the proper service techniques for your concept and assist in training how to deliver great service.

Providing great service is complex and needs all departments to coordinate their training and to achieve great service. It effects each food service departments such as banqueting, catering, room service and kitchen. Good food and beverage managers learn how to organize each of these departments to achieve great service.

Providing great service in hotels is even more complicated because there are so many departments involved. Every department imaginable including housekeeping, human resources and purchasing can have an impact on service. Different types of hotels have different food service needs as well. Little wonder that providing great service is so complicated. Food service consultants are the experts who know exactly what is needed by different restaurants.

Food service consultants play an active role in recipe development. They take on a number of services like:

– Development of food products

– Compilation and preparation of recipes

– Developing new ideas for recipes

– Innovating new product range

– Product management from planning to cooking and presentation

– Analyses of the market

– Analyses of competitors

– Recipe development

– Menu development advice and planning

– Catering

– Product tasting and evaluation

– Food styling and presentation

– Food recommendations

In addition to the above, food service consultants also focus on the nutritive value of foods so that the restaurant can serve foods that appeal to a large number of customers. Food consultants can even provide food specific nutrient analysis to show the exact number of calories, protein, carbs and vitamins in particular foods. This is important as many people are becoming more health conscious. A well trained food consultant can help you modify your recipes so that they are flavorful, visually appealing and nutritious.

Along with recipe development, good food consultants also can support the training of your people.

Therefore, if your restaurant business seems to be lagging behind and you just don’t know what to do, consider contacting a professional food consultant to assist in supporting your needs. You could also depend on food and beverage consultants to produce attractive pictures and sales materials for the restaurant.

Great food and service is an integral component to your restaurant business. A restaurant with excellent food service is the foundation for popular.

5 Advantages of a Home Made Ice Cream Maker

Ice cream is one of the worlds’ favorite comfort foods. It just seems to make everything better, don’t you agree? You can mix it with fruits, custard, wafers, chocolates, nuts, brownies, cheeses and other stuff that people like, to give it different wonderful flavors. There are even eccentric flavors such as squid, wasabi, chicken, and bacon! Ice cream has been enjoyed by the elite from as early as second century B.C., and as its goodness became known, more and more people hungered after it which gave birth to its massive production in the 1800s.

Surprisingly, not a lot of people know that you don’t have to look for a gelateria or sherbet shop every time you want some dessert. Through developments in technology, you can now make your own frozen dessert according to your tastes. Ice cream makers are available in the market and can be purchased in almost any appliance shops or online store. Some think that these machines are expensive but the truth is they have many advantages that can outweigh their prices.

  1. One of the main advantages of having a homemade ice cream maker is the ability to create healthy desserts anytime. Unexpected guests may always visit one’s home and it can be a real treat to serve them delicious homemade desserts such as sorbets, sherbert and yogurt. You can always lug one of these over to a friend’s house to have an impromptu party, as most of them can be easily cleaned and stored after without hassle.
  2. Another good thing about these machines is that they can be used to make different ice cream flavors effortlessly. Right after you create one mix, you can go ahead and pour it into a freezer bowl and make another one. Even a cheaper model can make tons of flavors since most of these machines can create desserts in as little as 20 minutes.
  3. Aside from portability and ease of use, the homemade stuff is healthier than most frozen desserts bought in the store. You may not be so sure whether the ice cream that you are about to buy from the grocery has been defrosted and frozen back several times which can lose its flavor and health benefits. Having a homemade ice cream maker gives you the option to create your own flavor and to put ingredients which you think are beneficial to you.
  4. If you are looking for a quality machine for a fraction of the price, you may also look into buying a durable ice cream maker online. A durable one can last a long time and it can be very good investment if you are planning to use it very often. Some of the trusted brands in the market are Cuisinart, Hamilton Beach, Lello and KitchenAid. They can be easily purchased online where you can also read feedback from users so you can assess if their features are apt for your needs.
  5. Last but not the least, having a homemade ice cream maker saves you time than going out and looking for the flavor that you want. You do not need to be a professional to create new flavors. All you need to do is to look for a recipe and gather all the ingredients and you can make as much ice cream as you want.

Making healthy desserts should not be too hard if you have all the things that you need. Whether you have a pricey ice cream maker or a cheaper model, enjoying healthy desserts is always possible at the comfort of your own home.