Integral Model |

Ken Wilber, in Integral Psychology (2000) stated that all the diverse theories about human development could not be wrong, they were just incomplete. He put them together in a model that blends eastern and western psychology and philosophy, offering a much more inclusive and broad theory about how humans develop. We have applied this to substance abuse treatment.

The upper left quadrant is individual development-our thoughts, ideas, opinions, and beliefs. These grow and change over time from infancy into our old age in some predictable patterns. Many psychological interventions are based only on the upper left quadrant, such as behaviorism, cognitive behavioral theory, Twelve Step, motivational interviewing and psychoanalysis. Ken Wilber places spirituality in this quadrant

The upper right quadrant is the individual biological systems, including hormones, neurotransmitters, and organ systems, and the outward symptoms of diseases. We are made up of biological matter from molecules to cells to systems that can be objectively studied. In the field of addiction, this means studies of the genetics of drug addiction, the role of neurotransmitters in creating symptoms of depression or anxiety, and studies of brain activity while under the influence of a drug. Medical interventions such as medications to treat addiction or mental illness stem from this quadrant.

The lower left quadrant is our social and cultural environment, including the influence of family, neighborhoods, local churches, peers, and other immediate social influences. It is the “we” of development whereas the upper left is the “I “and the upper right is the “It.” Cultural competence means learning ways to bridge the upper and lower left quadrants.

Finally, the lower right quadrant contains the larger social structures and institutions that affect us all–the legal system, the economic system (such as capitalism), public policies, the media, and so on. Addiction treatment is greatly influenced by these larger social structures, including payment systems. Why does insurance cover treatment for diabetes, but not drug treatment?

Every human behavior has its roots in all four quadrants. To make real changes in behavior, we have to take into account all aspects of the behavior. We believe, like Ken Wilber, that all the experts in the field of addiction cannot be wrong–the 12 step approach, cognitive behavioral models, motivational interviewing, methadone treatments, and many other treatments that are considered to be research-based treatments. The problem is that no one approach alone captures all four quadrants, therefore, they are incomplete.

The diagram shows how an Integral Approach to Substance Abuse would look.

This diagram shows our adaptation of Ken Wilber’s work to the field of substance abuse treatment.

An Integral Model of Substance Abuse Treatment:

Inner Substance®

INTERIOR: INDIVIDUAL	EXTERIOR: INDIVIDUAL
(Individual lines of development, such as cognitive, affective, moral, spiritual)	(cells, matter, organs, hormones, neurotransmitters, body systems)
Etiological Factors: Emotional distress Individual experiences of trauma/abuse	Etiological Factors: Genetic predisposition Biochemical factors Psychiatric/Medical illnesses
Treatment Components: Twelve-Step Cognitive Behavioral Psychodynamic Religiously based treatments	Treatment Components: Addiction Medicine (psychiatry, internal medicine, other) Primary Care
Specific Treatment Methods: Individual counseling Group counseling/psycho-educational Individual spiritual practices	Specific Treatment Methods: Medications Detoxification Nutrition Fitness
INTERIOR: COLLECTIVE	EXTERIOR: COLLECTIVE
(social and cultural factors)	(geopolitical formations, material circumstances)
Etiological Factors: Poverty Effects of Oppression Cultural Attitudes about Substances Role of drugs/alcohol in culture	Etiological Factors: Economic Circumstances Drug Policies & Laws Political Agendas
Treatment Components: Culturally competent services Gender/age specific services Broader social context Attention to social/cultural norms	Treatment Components: Third Party Payers Reimbursement issues Dominant Philosophies of Treatment
Specific Treatment Methods: Culturally specific treatments Family Therapies Life skills training Education	Specific Treatment Methods: Access to treatment Payment options/plans Treatment on demand options Incarceration

Ken Wilber (2000) suggests that there are five common definitions of the nature of spirituality in human consciousness. These definitions place spirituality as the highest level of some or most lines of development (cognitive, affective, moral, etc), the sum total of development, as a separate line of development itself, as an attitude that a person can have at any level of development, or as peak or mystical experiences. At this point in time, there is no one widely accepted definition of spirituality.

Table: Spirituality from a broader, four quadrant perspectives

UPPER LEFT	UPPER RIGHT
• Individual inner development (cognitive, moral, affective, perceptual, social, spiritual, etc).	• Individual physical development (physical health, body systems, neurotransmitters, hormones, etc).
• Spirituality as a separate line of development vs dependent on other lines of development, vs peak experience or attitude	• Effect of physical health on spirituality. • Diagnosis of “Spiritual emergency” versus psychiatric illness.
LOWER LEFT	LOWER RIGHT
• Socio-cultural influences (family, community, culture).	• Societal institutions (political, economic, media, etc).
• Specific religious, cultural worldviews influence on spirituality.	• Dominant societal messages about spirituality. Access to spiritual institutions, knowledge, practices.