Furnishing And Decor For Your Expat European

Moving from the UK to another home abroad is an energizing prospect yet with numerous functional difficulties and frequently a few boundaries. Obtaining or building another house is one of the greatest difficulties and subsequently the subject of outfitting and stylistic layout is regularly left as an after idea. Be that as it may, in the event that you consider furniture, shades, blinds, carpets, bedding et cetera as a major aspect of your general arrangement you can change your new property into your new home.

The reality of the matter is that you can hold up till you are in living arrangement before you begin hunting neighborhood stores down the important decorations. This without a doubt will enable you to outfit in a comparative way to other nearby homes, yet you will be less comfortable with neighborhood sources and it might require investment and some style mistakes before you figure out how to finish the inside stylistic theme of your home agreeable to you.

We’d generally propose that you ought to drench yourself in the neighborhood condition and group, yet with regards to outfitting and stylistic theme you can get the style you need and spare cash on the off chance that you source things in the UK and afterward send out it you your new home.

Sparing Money

You’ll see that shopping in the UK is currently regularly substantially less expensive than on the Continent. Especially with the parlous condition of the £ versus the Euro and critical VAT differentials you can discover architect textures and home adornments significantly less expensive in the UK. On the off chance that you purchase in the UK and fare to the EU you will pay UK VAT of 17.5% rather than neighborhood VAT which could be as much as 25.5%!

It’s regularly worth influencing a committed outing back to the UK so as to make to huge reserve funds. A few expats will fill a contracted van in the UK with everything required in their vacation investment property or their own “home from home”. Since the UK is a piece of the EU (not at all like the Channel Islands or Gibraltar) you won’t have issues with import obligation to another EU nation. Merchandise can likewise be delivered securely with universal dispatches like FedEx, UPS and DHL.

On the off chance that your house is outside the UK you’ll profit by VAT free fares – however you have to deal with nearby import charges. However, the retail value differentials between the UK and, for instance, Dubai, the Algarve, the Côte d’Azur, effectively exceed the cost of transportation and importation.

Purchasing British

Numerous brands that are accessible in the UK are simply not effortlessly accessible abroad. So on the off chance that you are looking for recognition or selectiveness and a moderate arrangement then it bodes well to source in the UK. For instance numerous fashioner shade textures are half less expensive in the UK than in Europe.

Decision

Contingent upon the area of your new home, you find that you may have extremely restricted decision with regards to furniture for your new home. In significant cosmopolitan urban communities you ought to be ruined for decision however else you’ll see that Britain offers a portion of the vastest decision at all levels of spending plan. So if your new abroad home is in rustic Brittany, for instance, in the event that you need the most ideal decision you could go to Paris or you could source from Britain; which would be less demanding?

Furnished Luxury Homes For Lease

In the event that you need a fantasy home however can’t bear the cost of the cost of getting one or outfitting it, you ought not lose trust as you can simply lease an outfitted extravagance home at a reasonable cost. Nowadays numerous individuals are renting outfitted homes since it spares the time required in the entire procedure of outfitting and furthermore individuals are dependably moving now thus it is more sensible to rent a home than buying a place and offering it. Ensuring that your home is up to the stamp is a challenging task when you have quite recently moved into another house. Extraordinary compared to other things that numerous individuals frequently do is to approach renting their home. They find this is a substantially more financially savvy way and it is a win-win circumstance for the two gatherings included.

By having extravagance outfitted homes for rent, the accompanying are a portion of the advantages:-

1. Efficient You don’t need to burn through cash on outfitting your home subsequent to moving in to your recently leased home.

2. Spares TIME-The time required for first acquiring and after that outfitting your new house is spared and you now have more opportunity to make the most of your new home without trying.

3. Advantageous You don’t need to move your furniture with your assets while moving into your new home. As you just need to move your assets you don’t need to employ additional individuals.

4. It is most appropriate to individuals who move around a great deal due to their activity.

Due to the above components, outfitted homes have turned out to be in vogue living spots for a figure of individuals due to the practicality that it offers. In the event that you are a landowner of an outfitted house and need to lease it out to individuals who are occupied with letting out extravagance outfitted homes then you require not stress yourself. There are numerous land specialists who are constantly prepared to help you during the time spent searching for planned purchasers. Another approach to this is by posting your home in notices in daily papers and magazines. You can likewise post blurbs on house rental sites to snatch the consideration of various individuals associated with renting your habitation. You can take the assistance of a mediator to get into manages the general population fascinated in renting your home. This would be gainful as it can enable you to make the most reasonable arrangements.

Operations and Supply Chain Management in Manufacturing

Tourism is a tremendous and dynamic industry that is contained a wide assortment of administration organizations that mirror similar progression and needs that a maker would have for tasks arranging (OP) and production network administration (SCM). One such administration business is the journey deliver part in which vacationers travel by means of these sorts of vessels to different goals.

While makers deliver unmistakable items and squanders, benefit organizations likewise create squander, however their items are elusive. For instance, the item that a fitness coach may create is a more advantageous customer. Activities Managers (OM) in the two enterprises share comparative interests in wiping out waste and conveying quality items.

The two primary elusive items that the vacationer (end client) purchases, and a journey send organization “produces” and conveys, are delight and unwinding – the aggregate experience that enables vacationers to “suspend” their ordinary reality for a timeframe and inundate themselves in pleasurable encounters. The mission of the journey dispatch industry is to convey this experience to them in a way that outperforms their clients’ desires, and it depends an incredible arrangement on the assembling business to make this conceivable.

Practically identical Dynamics and Priorities in Manufacturing and Service

The development and association of merchandise and ventures from the purpose of birthplace, or the first source, to the end client is alluded to as “the inventory network”. Production network Management is a piece of the Operations Management that includes the successful administration of numerous between firm procedures, for example,

Provider/Vendor relationship administration

Request Processing

Data Systems administration

Sourcing and Procurement

Creation Scheduling

Stock Management

Warehousing and Distribution

Client Services

Earth feasible practices

Similarly as in the assembling business, in the journey deliver industry it takes the coordination of an assortment of assets – money related, material and human – cooperating to deal with these procedures keeping in mind the end goal to accomplish authoritative objectives.

Tasks Management includes the administration of the considerable number of exercises that create a yield (an item). In activities administration a huge number of procedures must be overseen with a specific end goal to create and disperse items and administrations. Strategies must be planned; day by day tasks must be overseen, thus should the utilization of human and material assets. OM likewise requests the successful usage of innovation and interchanges frameworks to take into account auspicious requesting and conveyance of materials and items, and the overhauling of clients and partners.

Creating An Effectively Furnished House

The craft of providing your home while utilizing the ideal home furniture that coordinates all around truly is urgent as this is the spot of your home that you basically invest about all your energy. Which implies you should mellow and put in a great deal of push to be seen and adorn your home.

Along these lines you can make your own optimal home and it is essential that you outfit the house by injecting your unmistakable character and endeavors inside redesigning your property. Many individuals enjoy providing their home as it’s an imaginative snag and give people the chance to improve and give their property as illustrated by their preferences. A large portion of the general population feel that buying exorbitant home furniture and furthermore improvements may help their home stylistic theme all things considered is the place people get the definitely wrong thought being a perfect decorations doesn’t need to end up costly in light of the fact that minimal effort item likewise can switch your home in to a pleasant looking alongside legitimately designed a solitary.

Taking your home decorated making it accessible from utilizing the administrations of an inside adorn costs cash truth your home shot turning out to are the flawlessly adorned and prepared one specific however the majority of this may likewise cost you cash hence the greatly improved that you basically hold fast to your individual choice alongside senses so you can never squander cash by just procuring a specialist in the event that you have the most minimal spending plan.

The most ideal approach to purchase your home decorated is essentially by picking a topic alongside thinking about your way of life and tastes you can choose the one that meets your home. You can really adorn your premises any way you require by choosing from the National, France or maybe great styles.

Individuals that adoration to adorn their home with a Tiongkok touch will get Paper lights and cookware screens just on the grounds that all tingles have a tendency to be a piece of the Persian culture and may give your home a nearby look.

Vintage individuals love to finish their homes utilizing a set up contact and furthermore incline toward the Victorian created family unit furniture to light up and supply their homes. The genuine Victorian floor coverings alongside love seats create polish for that home and furthermore help to influence your home to resemble your Classical One specific.

A few people also like to join coordinate their own topics and practice the ultra present day sprucing up and furniture alongside to a great degree refined sorts.

Be that as it may, before necessities to design your home you ought to consider all through the measure of value extend you can stop as you have to arrange a financial plan all together that things are used in a sorted out approach and you don’t stall out up-wards being insufficient cash. Whenever every one of these things are cleared up then you can surely begin additional money and purchase the specific household item on your appealing house appropriately.

You can really gain the differing home adorning merchandise from a home furniture store in your general vicinity or even acquire associated with online stores that offer lessened rates in addition to convey the refurbishing things to the house in skip forward approach.

Furnishing and Organizing Your Garden Shed

In this way, you simply wrapped up a delightful garden shed for your terrace and are presently prepared to move in all your planting actualizes before the frosty climate arrives. By what means would it be advisable for you to best compose the garden shed so you can appreciate and utilize the space generally successfully? Here are some awesome plans to enable you to outfit and sort out your new (or old) plant shed.

1) For seeds, make or buy a seed box. Nothing is all the more baffling come late-winter going through heaps of scattered seed bundles. Exploit end of the year scrounge deals and insect markets to locate a decent excited steel box that you can use as a seed box. Or on the other hand, look online at well known garden retailers. You ought to have the capacity to locate a reasonable seed box for well under $20, and it will be justified regardless of each penny you pay.

2) You can never have enough holders. Indeed, perhaps you can, however your garden shed is an incredible place to store some wonderful earthenware or ceramics compartments (avoid the plastic ones, in the event that you can). Since numerous garden supply shops have extraordinary rebates on these in the fall, endeavor to gobble up no less than a couple in the event that you can. You won’t think twice about it.

3) Install pegs and snares, everywhere. You will enormously value having snares on the dividers of your garden shed to hang everything, from cultivating devices, to gloves, caps, frocks and a whole lot more.

4) Get some wicker bins. On the off chance that you are a cultivator, you know how helpful these can be to gather create and blooms. These are another of those things that you will appear to be never to have enough of in your shed, so stock up now in the event that you can. Thrift stores are regularly an extraordinary place to get great arrangements on utilized wicker containers, frequently for under $1 each.

5) A preparing seat. In the event that you consider your cultivating important, at that point your shed will be an awesome place to put a preparing seat. The compartments on the seat will enable you to additionally sort out things in your shed, and it will make the time spent in your garden shed significantly more pleasant.

6) Shelving. In the event that you can locate some delightful rescued racking, it will add significantly more character to your garden shed. Or on the other hand, in the event that you are convenient with a sledge, you can take a stab at building your own racks to particular, to guarantee they fit your new shed flawlessly.

Web Designing And Seo

Technologies are improving day by day. The days were gone where a new brand went through a lot of troubles to be famous and well-known. It needed a lot of advertisement to come to the attraction of folks. Televisions, newspapers, and magazines are some mediums to promote a brand. But it was really tiresome as it takes a long time and process. A brand could be lost easily in the crowd of competitors. Reaching people was tough and complicated. But those days were gone and today a new item does not face many troubles for its promotion. It is because of the invention of the internet. This highly advanced technology has made everything easy and fast. From booking a flight ticket to communicating one far away from a place becomes easy and it is by the influence of the internet. The internet has entered in everyone’s home very casually and has made lives more comfortable and swift.
Now business promotion is not a big matter to the businesspersons and they have got many useful and effective ways to make brands popular and well-known. One of the easiest and effective ways is website making. You can call that it is an imperative task for every business and by using this skill a business can reach its highest level of success. When a new brand is marketed it needs to be popular for increasing its sell and profit. And it is the best option to create an innovative and informative website for the brand. Website making is a tough task also as it needs the highest efficiency. You can get many assurances about the services as there are many designers but it is a challenge to find an innovative and experienced designing team for the purpose.
Your website is the face of what you provide to the people. It can say everything about your taste, choice, and eminence. Thus, it should be created sincerely and in an efficient manner that it can attract a huge number of visitors easily with its first glimpse. When a visitor visits your website he leaves it immediately if there is no interesting issue in it. And making your website interesting and attractive, you need a good and experienced website designer or a designing team that is efficient, creative, and resourceful. Searching on the internet, you will be able to find out the best Web Design Adelaide that can support you from the initial stage. A creative designer inputs all your essential data and images to your website that visitors get the total familiarity about your business.
A creative website making does not work fruitfully if it is not promoted on the internet. And it is called SEO, the service that gives your brand a higher rank on the search engines like Google. When a visitor searches a product he will be impressive by your position if it has a higher position. He is more likely want to choose a business that has a good and reputed position. And a good and skilled Adelaide SEO team can create the miracle by the most innovative and advanced process. SEO is an imperative task to increase your business and brand name. Chose the team carefully and enjoy a gainful business.

Vitamins Are Organic Compounds That Are Necessary In Small Amounts To Sustain Life And Health

Vitamins are nutrients essential for health. Vitamins are organic compounds that are necessary in small amounts in animal and human diets to sustain life and health. Vitamins are organic compounds which are needed in small quantities to sustain life. Vitamins are organic substances, essential for maintaining life functions and preventing disease among humans and animals and even some plants. Vitamins are complex organic compounds that occur naturally in plants and animals.

Vitamins are named by letters – vitamin A, vitamin C, D, E, K, and the group of B vitamins. Vitamins are organic components in food that are needed in very small amounts for growth and for maintaining good health. Vitamins are compounds that are essential in small amounts for proper body function and growth. Vitamins are organic substances that are required in small amounts for normal functioning of the body. Vitamins are substances that the human body requires but is unable to synthesize and therefore, must obtain externally.

Vitamins are not individual molecular compounds. Vitamins were not discovered until early in the twentieth century. Vitamins are of two type’s water soluble and fat soluble. Vitamins are required in the diet in only tiny amounts, in contrast to the energy components of the diet. Supplements can be beneficial, but the key to vitamin and mineral success is eating a balanced diet.

Vitamins cannot be synthesized by the cells of an animal but are vital for normal cell function. Vitamins cannot be isolated from their complexes and still perform their specific life functions within the cells.

Persons already experiencing coronary health issues should consider having their vitamin D levels checked and take action if a lack of vitamin D detected. I’ve cited the review, “Is US Health Really the Best in the world?”, by Dr. Barbara Starfield (Journal of the American Medical Association, July 26, 2000), in which Starfield reveals the American medical system kills 225,000 people per year–106,000 as a direct result of pharmacological drugs. Berries come in many shapes and sizes, but they are all healthy sources of fiber, potassium and vitamin C. Strawberries, blueberries and blackberries are low in fat and calories, and contain compounds that might protect you from certain health conditions. B 12 deficiencies cause a host of health problems, including potentially irreversible nerve damage that can occur before symptoms are noticed. The easiest way for most people to avoid a deficiency is to take a B 12 supplement containing at least 1000 micro grams of B 12 two or three times a week. The Health Organization Founded by Dr. Rath is Unique in the world: All the Profits it Makes Go to a Non-profit Foundation. Vitamins and minerals are essential to life-and we mean essential. The early human diet was largely vegetarian, humans have adapted to utilize nutrients and vitamins from plant sou.

3 Foods to Avoid While Constipated

Most people have bowel movements every day or every second day depending on their diet and lifestyle. Constipation is having difficulty trying to empty your bowels for more than 3 or 4 days, or having extremely hard stools that cause pain when you try to expel them from your body. You must eat food that softens your stools to relieve constipation. Eating food that makes them harden will make the condition worse.

Heavy foods like red meat, deep-fried foods like battered fish and chips, bakery products with like pastries, cakes and bread generally take a long time to digest. Food must pass through the stomach, large intestine, small intestine, colon then the bowels before the waste products are passed out of the body as waste. Along the way different nutrients and water are extracted and delivered to the part of the body that requires it. The longer the process takes the more water is extracted, the drier or harder the stools become. Also if food is relatively dry to start with or inadequate liquid (excluding caffine products and alcohol which may be dyhydrating) is consumed the end product (the stools) will subsequently be dry or hard. [“Water is the best drink for a wise man.” said the French philosopher Henry David Thoreau.]

Red meat comes from large strong animals so it’s meat is tougher compared with the animals that white meat comes from. Therefore its meat takes longer to break down in our bodies because the muscles are stronger. White meat is easier to digest because fish and poultry have smaller muscles compared with cattle and pigs.

Fried food is generally oily. Oil makes the food tasty and softer in most cases but it is something the body doesn’t really need. The body must work harder to extract oil and fats from food so that they can be expelled. If the body’s digestive system is busy trying to neutralise other toxins that have entered the system the fat will be placed in “storage areas” around the body until it has resources to process it. When these “store rooms” are too crowded we feel bloated and uncomfortable.

Products which contain a lot of wheat flour and oil which have little nutritional value. Flour is basically a carrier for other foods. For example, the pastry shell of a pie is a “bag” or edible packaging for the meat, vegetables or fruit inside it, bread is what holds a sandwich together. The crust or bread simply make the filling more palatable and easier to digest. But most breads and pastries are simply flour, oil and air which contain no nutrients. Consuming more of the pastry rather than the filling will just clog up your digestive system, especially if you are constipated.

As my title promised I need to nominate the 3 top foods to avoid that someone with constipation should avoid. To narrow down the candidates we should consider foods that fall into two or all of the above three categories then pick out the ones that are consumed the most. The nominations are:

  • Meat pies and sausage rolls contain red meat and flour.
  • Fish and Chips are fried and the batter contains flour.
  • Barbecued or grilled steak – meat that is cooked relatively quickly doesn’t break down the fatty tissue and muscles as well as slow cooked meat so when it enters your stomach it has to be broken down more by your digestive juices.
  • Potato chips or crisps are fried and very dry. Your body must use more water to digest this so your stools will become harder if you are already constipated.
  • Hard cheeses as they have most of their moisture content pressed out in their production process. As well they contain fat and protein from a large animal.
  • Deep fried meat like schnitzel, sweet and sour pork, fried chicken.
  • Bacon and eggs or sausages and eggs.
  • Salami and other processed meats.

My pick for the top three are meat pies, deep-fried battered fish ‘n chips and potato crisps. What are yours?

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

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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/

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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

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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.

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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.

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