The Discovery Behind The Blindspot

The Cause of Any Substance Use Disorder is Development.

All Substance Use Disorder research, prevention and treatment programs suffer from the same blindspot - selection bias. The reason is simple. In order to research, prevent and treat we must study those afflicted with the condition. By necessity, selection for study, comes from the extreme end of the SUD continuum. This selection bias is the blindspot hiding the cause of any SUD. I made the exact same mistake in my stage model assessment for high school and college students called MAPP as seen above. Can you see it? I couldn't. Never the less it is right there - plain as day. Behind the blindspot is the cause of any SUD.

The blind spot is the 4th column. The 4th column attributes are universal. That's why I chose them. Here's the thing. The pattern shown in the The MAPP model is accurate as evidenced by MAPP scores - for 5% of the population (stages 0-4). It is accurate enough to identify and intervene on the high risk 20% of the population (stages 0-3) in a random sample - a real break through. It is not accurate but never the less educational for the low risk 75% (stages 0-1) - another significant breakthrough. The methods, measurements and analysis can be seen in published literature, research poster and video at www.prehabmapp.com.

Naturally I was thrilled with the positive results and ignored questionable results. Finally, the other shoe dropped by asking a new question. How were the low risk using risk response attributes? They simply are not represented in my model - due to selection bias. I did have their data. They were telling me, but I simply was not listening.

Fortunately, the same data and risk response principles that brought me this far took me a little further into a new model. Then and only then could the difference between those students at high to severe risk be seen in bold relief to those at low risk. Here's the difference which explains the necessary and sufficient condition for any SUD.

75% of the sample uses the 4th column attributes in a high benefit, low risk pattern. All of the attributes used by the severe risk over 5 stages is compressed into 2 MAPP stages. Everyday. They are always changing, growing and developing, yet never go above stage 1. This group habituates in stage 0. This direction results in autonomy - the capacity to make an informed, uncoerced decision.

For the 25% high to severe risk population, the pattern feels low risk and high benefit to them, but in fact is high risk and low benefit over time and leads to dependence - the state of relying on or being controlled by someone or something else. These attributes are scattered over 5 MAPP stages. Without intervention, this group habituates in stage 4. Many of these people will find the autonomous pattern eventually - sometimes at great cost. As time and development continue the probability of changing patterns becomes less and less.

Without understanding the cause, we leave development to trial and error. Some of the high risk population will drift back into the low risk population, some of the low risk people will drift into the following high risk pattern. This is an inefficient, deadly and costly process.

The strange outcome is that more deaths and hospitalizations will happen among the low risk. The acute consequences from low risk impairment kill more than all high risk fatalities. The simple explanation is the low risk group is by far the largest group. I believe the other reason is lack of a causal variable. We preach caution to the low risk. Caution is a poor substitute for judgment based risk response development. In this way we are promoting perception to perceptive people when judgment is most needed.

The two attributes that determine the cause of either autonomy or dependence is Benefit/Risk and New/Familiar. The formula for the cause of SUDs is Y=f(X). In this model the Y axis is the outcome of Benefit and Risk choices. The X axis represents New to the Familiar. Four other risk response attributes affect how we perceive Benefit and Risk and thus outcomes. Therefore, Benefit/Risk outcomes (Y) are a (=) function (f) of New/Familiar (X) over time.

Control seems to be the fulcrum attribute in stage 1 that determines which pattern will develop. Controlling outcomes rather than process is an easy mistake in the fog of war that is life for the developing human being who happens to to be a brilliant perceiver but not a very good interpreter. In this model the simple definition for addiction is mistaking dependence for autonomy.

Awareness of these attributes and patterns encourages responsibility at a very basic level. Changing these patterns early on is much easier than waiting for tragedies or symptoms. Change after years of hardened habituation proves we live in the age of miracles but far too many die trying to change everything except what really matters.

Collaboration between education, criminal justice, prevention and treatment professionals can eradicate Substance Abuse Disorders by intervening at every risk level by replacing trial and error development with risk response development models. Anyone can rent or buy the Prehab presentation at https://vimeo.com/ondemand/prehabknowyourpattern. The Prehab presentation can easily integrate with any existing intervention. The author welcomes any comments or questions by Linkedin or [email protected].