Cooper

Level

1

2

3

TABLE 2

Treatment Commonalities of Chemical Dependency and Eating Disorders

Description

Outpatient

Intensive

Inpatient

Components

Individual therapy

Individual, group, and family Hospitalization plus

Through the assessment process, the counselor or psychologist has a wealth of information that is extremely useful in arranging appropriate referral or tailor-making intervention plans. In addition, the client has the opportunity to make important gains through this process as well. Usually, there is a much better understanding of the disorder with its likely consequences and causes, and the client is more aware of the specific areas that will need work if he or she is going to be I successful in reducing or eliminating these problematic behavior patterns.

SELECTING THE LEVEL OF INTERVENTION

The research in both alcohol and drug abuse and eating disorders suggests that there are three levels of treatment, each of which is better suited for specific clients (Armor, Polich, & Stambul, 1978; Hall, 1982; Miller & Hester, 1986). This fits with Paul's (1967) historic statement of which treatment works best with which client with what specific problem, as well as with the work by Nerviana and Gross (1983) and Morey and Blashfield (1981), which support differential treatments for subgroups of persons with self-destructive compulsive disorders. Table 2 presents the treatment components and target populations for this differential intervention.

The first level of treatment relies upon outpatient counseling, with an emphasis on dealing with underlying problems that contributed to the appearance of some chemical abuse or eating disordered actions. This level of treatment is appropriate only for those who have a short history of these patterns when there appears to be specific trigger situations that have occurred in their lives.

The second level of treatment is much more probably for a client who is referred by family or friends for a problem in either of these areas. Specifically, level two treatment involves intensive individual outpatient work with group support and family counselng if it seems appropriate, that is, other family members are also involved in the disorder. This second level of treatment is usually necessary for those with moderate problematic abuse or disorder because of the intensity of the compulsiveness that persons with each of these problem areas experiences. Level two treatment can also be used in a contract fashion for a client who is motivated to work hard and does not want inpatient treatment. Continuation of intensive outpatient interventions should continue as long as gains are made, but hospitalization becomes necessary if a client continues to decline despite treatment. The contract approach makes it more likely that resistant clients will accept and benefit from an inpatient program, if that becomes necessary.

The third level of treatment is usually necessary for those with either severe or chronic patterns of eating disorders or addictions. It consists of an inpatient program of stabilization, a forced breakage of negative behavioral patterns, and preparation for the work to be done after hospitalization. When it is most productive, it prepares the client for level two-type inter-

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Target Population Acute, situational patterns Moderate involvement patterns Severe or chronic patterns

ventions and for the adjustment of leaving a structured, secure environment. Education for possible lapses may be very important in preventing a relapse (Brownell, Marlatt, Lichenstein, & Wilson, 1986).

EVALUATION OF PROGRESS

The two main goals for clients with these disorders is elimination or reduction of destructive patterns of functioning and the acquisition of skills, beliefs, self-esteem, and networking leading to a new level of personal and environmental adjustment (Duke & Nowicki, 1986). The speed and degree of work required for any given individual will be highly idiosyncratic. The counselor who uses this biopsychosocial perspective relies upon four components for evaluation that are identical to those of assessment. This provides the data necessary to reliably and validly evaluate treatment outcomes (Gottman & Markman, 1978). As depicted in Table 3, progress on the behavioral component would consist of a substantial decrease or absence of self-defeating behavior. Affectively, there would be a decrease in negative feelings and an enhanced snese of selfefficacy. The client who has improved significantly wil show marked changes in the beliefs and perceptions, and finally his or her personal and interpersonal relationships will be more productive and satisfying.

CONCLUSION

This article advocates the adoption of a common biopsychosocial perspective for integrating the etiology and treament of eating disorders and chemical dependency. The model would also be useful as a foundation for integrating future research on these often recalcitrant clinical syndromes. The inclusion of genetic, disease, psychological, and sociocultural factors offers both a comprehensive framework and a greater range of treatment options for those who work with clients who manifest symptoms in these areas and who are seeking help in changing their lives.

TABLE 3

Treatment Evaluation Commonalities of Chemical Dependency and Eating Disorders

Component Behavioral Affective

Cognitive

Specifics

Decrease or absence of self-defeating behaviors Decreased negative feelings, increased

self-efficacy

Adaptation of productive beliefs and values. Environmental Enhanced social and vocational functioning

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Stewart E. Cooper is the director and an associate professor, Student Counseling and Development Center, and a part-time associate professor of psychology, Valparaiso University, Valparaiso, Indiana. Correspondence regarding this article should be sent to Stewart E. Cooper, Director, Student Counseling and Development Center, Valparaiso University, Valparaiso, IN

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