The Gate Model is a comprehensive approach to assessing and treating addictions, developed over 20 years of clinical practice and focusing on the multidimensional aspects of addiction including trauma, genetics, and environmental factors. It provides a framework for evaluating an individual's risk of addictive illness, emphasizing the importance of diverse treatment modalities and the role of trauma in addiction. The model aims to enhance treatment planning and resource allocation to better address the complexities of addiction recovery.

1. The GATE ModelA Systemic Approach to Addictions Assessment and Treatment PlanningTab Ballis LCSW, LCASUNCW School of Social Work

2. Seeing “the forest and the trees”

3. Development of the GATE ModelDeveloped over twenty years of clinical practiceIntegration of hundreds of casesConceptualized for universal applicationField-tested with UNCW social work students

4. The GATE RationaleAddresses the diversity of needs/strengths“Real world” view of addictionIdentifies variations within groupsTranscends artificial barriers of addiction treatmentAlcohol/drug/food/sex/work etc.

5. The GATE RationaleTargets the role of Trauma in the etiology of addictive illness80% of female alcoholics are survivors of sexual traumaChild abuse and neglect is endemic in families that are suffering from addictionAddiction is operative in the incidence of sexual assault, and other violent crime

6. The GATE RationaleCaptures the complexity of addictive illnessMultidimensional modelMacro view of addictionSupported by “Syndrome Model” of addictionHoward Shaffer, PhD, CAS, et al, 2004“Addiction should be understood as a syndrome, with multiple opportunistic manifestations.”

7. The GATE RationaleIncludes “Process Addictions” on same scaleOften co-occur with substance abuse and dependenceTypically overlooked in treatment settingsMay trigger relapse of substance abuseMay emerge during substance abuse recovery

8. Theoretical FrameworkGATEGeneticsAccessTraumaEnvironment

9. Theoretical FrameworkGeneticsFamily history of addictionFamily history of mental illnessActive symptoms of MH/SAMedical conditionsChronic pain

10. Theoretical FrameworkAccessNegativeAddictive agent at homeAddictive agent at workAddictive agent in social networkPositiveTreatment resourcesSelf help groups

11. Theoretical FrameworkTraumaEmotional traumaPhysical traumaSexual traumaSeverityMultiple events

12. Theoretical FrameworkEnvironmentHomeWorkplaceFinancial/material resourcesLegal consequencesSupport systemPositive/negative factors

13. The GATE Model in PracticeFour-dimensional axisEach dimension (GATE), plotted on 10-point scaleThe GATE (square or rectangle) encompasses the points on each dimension.The total area of the GATE measures the risk of addictive illnessThe location of the GATE defines the risk and suggests the focus of intervention

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19. The GATE Model in PracticeThe following pattern is typical of A person at low-risk of addiction Total of 25 pointsBalanced

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21. The GATE Model in PracticeThe following pattern is typical ofA person at moderate-risk of addictionTotal of 100 pointsBalanced

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23. The GATE Model in PracticeThe following pattern is typical ofA person from a family with multigenerational addiction and traumaTotal of 200 pointsSkewed towards Genetics and Trauma

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25. The GATE Model in PracticeThe following pattern is typical ofA trauma survivor exposed to a substance abusing peer groupTotal of 225 pointsSkewed towards Access and Trauma

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27. The GATE Model in PracticeThe following pattern is typical ofA person with a family history of addiction and depression, with a high-stress living/working environmentTotal of 150 pointsSkewed towards Genetic and Environment

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29. The GATE Model in PracticeThe following pattern is typical ofA combat veteran, with family history of addiction, low socioeconomic status, and substance-abusing social networkTotal of 400 pointsBalanced risk

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31. The GATE Model in PracticeThe following pattern is typical of A young adult engaged in binge drinkingTotal of 200 pointsSkewed towards Access and Environment

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33. The GATE Model in PracticeThe GATE Model illustrates the impact of trauma on the risk of addictionIn this example, a person with moderate risk of addiction experiences a traumatic eventThe risk of addictive illness immediately increases, from 100 points to 150 points

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36. The GATE Model in PracticeThe GATE Model illustrates the treatment value of a potential clinical intervention In this example, an opiate addict initiates treatment with Buprenorphine (Suboxone)The risk of addictive illness immediately decreases, from 200 points to 130 points.

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39. Applications of the GATE ModelTreatment planningAllocation of diminishing resourcesEducation of clientInvolvement of family/support systemCase managementProgram developmentGrant/funding applications

40. The GATE ModelFor more information, contact:Tab Ballis LCSW, LCASInsight Wellness Services 311 N. 2nd St., Suite One Wilmington, NC 28401 910/251-2106 www.insightwellnessservices.com info@insightwellnessservices.com

41. Developed byTab Ballis LCSW, LCASSchool of Social WorkUniversity of North Carolina at Wilmingtonballist@uncw.eduwww.insightwellnessservices.com

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