When working with those who wish to change addictive behavior I am often struck by how many issues require attention after conducting an evaluation. Not only do most struggle with multiple addictions, but there are often mental health, legal, financial, social, housing, and employment issues to grapple with as well. Combined, these problems can easily seem overwhelming, particularly if you are of a mindset that every issue needs some specific intervention.

Here is where systems thinking plays a key role in successful treatment and long term management. In short, systems thinking helps us to understand that addictive behavior is an outcome of a complex system of interacting issues, for example:

In this diagram, mutliple mental health, addiction, physical and environmental problems combine to create many problems for this individual. In treatment, we identified the different issues, and then spent time drawing arrows between them and talking about how they all relate. We then uncovered a key leverage point for change that in all prior treatment episodes had been missed – an undiagnosed sleep apnea. Turns out it is hard to make progress on much in life if you are constantly in a daze. After a night at the sleep disorders lab and a confirmed diagnosis, we started  treating the sleep problem and within days were making progress on the other issues.

Of all the problems listed for this patient, would you have thought the key to making significant progress was a sleep issue? The most powerful leverage points are most often not obvious.