Expanding the continuum of substance use disorder treatment: Nonabstinence approaches PMC
The RP model views relapse not as a failure, but as part of the recovery process and an opportunity for learning. Marlatt (1985) describes an abstinence violation effect (AVE) that leads people to respond to any return to drug or alcohol use after a period of abstinence with despair and a sense of failure. By undermining confidence, these negative thoughts and feelings increase the likelihood that an isolated “lapse” will lead to a full-blown relapse. If, however, individuals view lapses as temporary setbacks or errors in the process of learning a new skill, they can renew their efforts to remain abstinent. Cognitions—specifically, thoughts and expectations about drinking behavior and sobriety—contribute importantly to the process of relapse. These alcohol-related cognitions are placed in the relapse prevention model within the overlap of the tonic stable processes and the phasic fluid responses.
A better understanding of one’s motives, one’s vulnerabilities, and one’s strengths helps to overcome addiction. Experts in the recovery process believe that relapse is a process and that identifying its stages can help people take preventative action. The dynamic model of relapse takes many of the RREP criticisms into account. Ecological momentary assessment, either via electronic device or interactive voice response methodology, could provide the data necessary to fully test the dynamic model of relapse19.
Does 12-Step Contribute to the AVE?
Research shows that those who forgive themselves for backsliding into old behavior perform better in the future. Reflect on what triggered the relapse—the emotional, physical, situational, or relational experiences that immediately preceded abstinence violation effect definition the lapse. Inventory not only the feelings you had just before it occurred but examine the environment you were in when you decided to use again. Sometimes nothing was going on—boredom can be a significant trigger of relapse.
For example, despite being widely cited as a primary rationale for nonabstinence treatment, the extent to which offering nonabstinence options increases treatment utilization (or retention) is unknown. In addition to evaluating nonabstinence treatments specifically, researchers could help move the field forward by increased attention to nonabstinence goals more broadly. There is also a need for updated research examining standards of practice in community SUD treatment, including acceptance of non-abstinence goals and facility policies such as administrative discharge. Harm reduction therapy has also been applied in group format, mirroring the approach and components of individual harm reduction psychotherapy but with added focus on building social support and receiving feedback and advice from peers (Little, 2006; Little & Franskoviak, 2010). These groups tend to include individuals who use a range of substances and who endorse a range of goals, including reducing substance use and/or substance-related harms, controlled/moderate use, and abstinence (Little, 2006). Additionally, some groups target individuals with co-occurring psychiatric disorders (Little, Hodari, Lavender, & Berg, 2008).
Overcoming Abstinence Violation Effect
John’s goal is to monitor every department to ensure proper policies and procedures are in place and client care is carried out effortlessly. John joined Amethyst as a behavioral health technician where he quickly developed strong personal relationships with the clients through support and guidance. John understands first hand the struggles of addiction and strives to provide a safe environment for clients. Marlatt’s technique keeps us focused on the present rather than on the past.
Unfortunately, there has been little empirical research evaluating this approach among individuals with DUD; evidence of effectiveness comes primarily from observational research. Marlatt and Gordon’s (1985) model of the relapse process in addictive disorders has had a major impact in the field of relapse prevention since the late 1980s. Marlatt and Gordon postulate that newly abstinent patients experience a sense of perceived control up to the point at which they encounter a high-risk situation, which most commonly entails a negative emotional state, an interpersonal conflict, or an experience of social pressure. If individuals cope effectively in the high-risk situation, perceived control and self-efficacy increase, which in turn makes the probability of relapse decrease. Conversely, the hypothesized result of a failure to cope with a high-risk situation is a decrease in a sense of self-efficacy, which in turn increases the probability of relapse.
Cognitive Behavioral Therapy for Substance use Disorders
The model incorporates the stages of change proposed by Procahska, DiClement and Norcross (1992) and treatment principles are based on social-cognitive theories11,29,30. Lack of consensus around target outcomes also presents a challenge to evaluating the effectiveness of nonabstinence treatment. Experts generally recommend that SUD treatment studies report substance use as well as related consequences, and select primary outcomes based on the study sample and goals (Donovan et al., 2012; Kiluk et al., 2019). While AUD treatment studies commonly rely on guidelines set by government agencies regarding a “low-risk” or “nonhazardous” level of alcohol consumption (e.g., Enggasser et al., 2015), no such guidelines exist for illicit drug use. Thus, studies will need to emphasize measures of substance-related problems in addition to reporting the degree of substance use (e.g., frequency, quantity). Although the RP model considers the high-risk situation the immediate relapse trigger, it is actually the person’s response to the situation that determines whether he or she will experience a lapse (i.e., begin using alcohol).
- There has been little research on the goals of non-treatment-seeking individuals; however, research suggests that nonabstinence goals are common even among individuals presenting to SUD treatment.
- The relapse prevention programme combines a variety of cognitive behavioural strategies33.
- MET adopts several social cognitive as well as Rogerian principles in its approach and in keeping with the social cognitive theory, personal agency is emphasized.
- For example, Bandura, who developed Social Cognitive Theory, posited that perceived choice is key to goal adherence, and that individuals may feel less motivation when goals are imposed by others (Bandura, 1986).
Thus, this perspective considers only a dichotomous treatment outcome—that is, a person is either abstinent or relapsed. In contrast, several models of relapse that are based on social-cognitive or behavioral theories emphasize relapse as a transitional process, a series of events that unfold over time (Annis 1986; Litman et al. 1979; Marlatt and Gordon 1985). According to these models, the relapse process begins prior to the first posttreatment alcohol use and continues after the initial use.
Helping people understand whether emotional pain or some other unacknowledged problem is the cause of addition is the province of psychotherapy and a primary reason why it is considered so important in recovery. Therapy not only gives people insight into their vulnerabilities but teaches them healthy tools for handling emotional distress. The power to resist cravings rests on the ability to summon and interpose judgment between a craving and its intense motivational command to seek the substance.