Expanding the continuum of substance use disorder treatment: Nonabstinence approaches PMC

Finally, the results of Miller and colleagues (1996) support the role of the abstinence violation effect in predicting which participants would experience a full-blown relapse following an initial lapse. Specifically, those participants who had a greater belief in the disease model of alcoholism and a higher commitment to absolute abstinence (who were most likely to experience feelings of guilt over their lapse) were most likely to experience relapse in that study. In a recent review of the literature on relapse precipitants, Dimeff and Marlatt (1998) also concluded that considerable support exists for the notion that an abstinence violation effect can precipitate a relapse. Strengthening coping skills is a goal of virtually all cognitive-behavioral interventions for substance use [75].

• Altogether, these thoughts and attributions are frequently driven by strong feelings of personal failure, defeat, and shame.
• It also provides the skills to change your behavior and avoid misusing substances again.
• Based on the classification of relapse determinants and high-risk situations proposed in the RP model, numerous treatment components have been developed that are aimed at helping the recovering alcoholic cope with high-risk situations.
• For example, offering nonabstinence treatment may provide a clearer path forward for those who are ambivalent about or unable to achieve abstinence, while such individuals would be more likely to drop out of abstinence-focused treatment.
• Theoretical constructs such as self-efficacy, appraisal, outcome expectancies related to addictions arising out these models have impacted treatment models considerably.

For instance, the return to substance use can have reciprocal effects on the same cognitive or affective factors (motivation, mood, self-efficacy) that contributed to the lapse. Lapses may also evoke physiological (e.g., alleviation of withdrawal) and/or cognitive (e.g., the AVE) responses that in turn determine whether use escalates or desists. The dynamic model further emphasizes the importance of nonlinear relationships and timing/sequencing of events. For instance, in a high-risk context, a slight and momentary drop in self-efficacy could have a disproportionate impact on other relapse antecedents (negative affect, expectancies) [8]. Furthermore, the strength of proximal influences on relapse may vary based on distal risk factors, with these relationships becoming increasingly nonlinear as distal risk increases [31].

1. Review aims

A critical implication is that rather than signaling a failure in the behavior change process, lapses can be considered temporary setbacks that present opportunities for new learning to occur. In viewing relapse as a common (albeit undesirable) event, emphasizing contextual antecedents over internal causes, and distinguishing relapse from treatment failure, the RP model introduced a comprehensive, flexible and optimistic alternative to traditional approaches. Despite the growth of the harm reduction movement globally, research and implementation of nonabstinence treatment in the U.S. has lagged. Furthermore, abstinence remains a gold standard treatment outcome in pharmacotherapy research for drug use disorders, even after numerous calls for alternative metrics of success (Volkow, 2020). Models of nonabstinence psychosocial treatment for drug use have been developed and promoted by practitioners, but little empirical research has tested their effectiveness. This resistance to nonabstinence treatment persists despite strong theoretical and empirical arguments in favor of harm reduction approaches.

• Here we provide a brief review of existing models of nonabstinence psychosocial treatment, with the goal of summarizing the state of the literature and identifying notable gaps and directions for future research.
• Among social variables, the degree of social support available from the most supportive person in the network may be the best predictor of reducing drinking, and the number of supportive relationships also strongly predicts abstinence.
• Another example is Taylor, who has been doing a wonderful job taking walks and engaging in healthier eating.
• Additionally, lab-based studies will be needed to capture dynamic processes involving cognitive/neurocognitive influences on lapse-related phenomena.

Many advocates of harm reduction believe the SUD treatment field is at a turning point in acceptance of nonabstinence approaches. Indeed, a prominent harm reduction psychotherapist and researcher, Rothschild, argues that the harm reduction approach represents a “third wave of addiction treatment” which follows, and is replacing, the moral and disease models (Rothschild, 2015a). Only a small minority of people with substance use disorders (SUDs) receive treatment. A focus on abstinence is pervasive in SUD treatment, defining success abstinence violation effect in both research and practice, and punitive measures are often imposed on those who do not abstain. Most adults with SUD do not seek treatment because they do not wish to stop using substances, though many also recognize a need for help. This narrative review considers the need for increased research attention on nonabstinence psychosocial treatment of SUD – especially drug use disorders – as a potential way to engage and retain more people in treatment, to engage people in treatment earlier, and to improve treatment effectiveness.

Understanding Relapse: Why it Happens and How to Prevent It

Several behavioural strategies are reported to be effective in the management of factors leading to addiction or substance use, such as anxiety, craving, skill deficits2,7. The first step in planning a cognitive behavioural treatment program is to carry out a functional analysis to identify maintaining antecedents and set treatments targets, select interventions. Ark Behavioral Health offers 100% confidential substance abuse assessment and treatment placement tailored to your individual needs.

For Jim and Taylor, this might involve acknowledging the months of sobriety and healthier lifestyle choices and understanding that a single incident does not erase that progress. “Lapse and relapse following inpatient tr[…]f opiate dependence.” Irish https://ecosoberhouse.com/ Medical Journal, June 2010. We surveyed 2,136 American adults who either wanted to stop drinking alcohol or had already tried to (successfully or not). Remember, reaching out for help and support is vital if you ever feel overwhelmed or struggling.

A strong relapse prevention plan can include:

The wife was involved in therapy, to support his abstinence and help him engage in alternate activities. Rajiv’s problem is an illustration of how various psychological, environmental and situational factors are involved in the acquisition and maintenance of substance use. Withdrawal tendencies can develop early in the course of addiction [25] and symptom profiles can vary based on stable intra-individual factors [63], suggesting the involvement of tonic processes.

• An emotional relapse may occur when a person remembers their last relapse, does not want to repeat it, and is not thinking about using.
• Cue exposure is another behavioural technique based on the classical conditioning theory and theories of cue reactivity and extinction12,13.
• 2The term “reliability” refers to the ability of a test or method to provide stable results (e.g., when different patients are compared or different investigators rate the same patient).
• Preventing relapse or minimizing its extent is therefore a prerequisite for any attempt to facilitate successful, long-term changes in addictive behaviors.