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

There are many relapse prevention models used in substance abuse treatment to counter AVE and give those in recovery important tools and coping skills. Not all addictions can be treated with abstinence, and it is not always possible or healthy to avoid certain behaviors for the long term. Sometimes, “abstinence-based treatment” is used to refer to “drug free” treatment, with the ultimate goal of transitioning a person with substance misuse issues to stop using any drug. In extreme cases and in many cases of opioid addiction, this method has proven unreliable, as drugs such as Buprenorphine may be prescribed to help people abstain from the drug they misuse, allowing them to maintain a functional lifestyle. Altogether, these thoughts and attributions are frequently driven by strong feelings of personal failure, defeat, and shame. These negative emotions are, unfortunately, often temporarily placated by a renewed pattern of substance abuse.

• Relapse Prevention (RP) is another well-studied model used in both AUD and DUD treatment (Marlatt & Gordon, 1985).
• 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.
• John joined Amethyst as a behavioral health technician where he quickly developed strong personal relationships with the clients through support and guidance.
• Ongoing cravings, in turn, may erode the client’s commitment to maintaining abstinence as his or her desire for immediate gratification increases.
• Third wave behaviour therapies are focused on improving building awareness, and distress tolerance skills using mindfulness practices.
• Oxford English Dictionary defines motivation as “the conscious or unconscious stimulus for action towards a desired goal provided by psychological or social factors; that which gives purpose or direction to behaviour.
• Patterns of movement through the various stages are categorized as stable, progressive or unstable11.

Therapists also can enhance self-efficacy by providing clients with feedback concerning their performance on other new tasks, even those that appear unrelated to alcohol use. In general, success in accomplishing even simple tasks (e.g., showing up for appointments on time) can greatly enhance a client’s feelings of self-efficacy. This success can then motivate the client’s effort to change his or her pattern of alcohol use and increase the client’s confidence that he or she will be able to successfully master the skills needed to change. Abstinence violation effect can be overcome, but it is far better to avoid suffering AVE in the first place.

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This reaction focuses on the drinker’s emotional response to an initial lapse and on the causes to which he or she attributes the lapse. People who attribute the lapse to their own personal failure are likely to experience guilt and negative emotions that can, in turn, lead to increased drinking https://ecosoberhouse.com/ as a further attempt to avoid or escape the feelings of guilt or failure. In contrast to the former group of people, the latter group realizes that one needs to “learn from one’s mistakes” and, thus, they may develop more effective ways to cope with similar trigger situations in the future.

• Quite frankly, studies that have attempted to look at lapse and relapse rates across different substances have discrepant findings because the terms are often defined differently.
• Nonabstinence goals have become more widely accepted in SUD treatment in much of Europe, and evidence suggests that acceptance of controlled drinking has increased among U.S. treatment providers since the 1980s and 1990s (Rosenberg, Grant, & Davis, 2020).
• However, evidence regarding its superiority relative to other active treatments has been less consistent.
• Nevertheless, the study provides relatively good support for other aspects of the RP model.

To increase the likelihood that a client can and will utilize his or her skills when the need arises, the therapist can use approaches such as role plays and the development and modeling of specific coping plans for managing potential high-risk situations. The desire for immediate gratification can take many forms, and some people may experience it as a craving or urge to use alcohol. Although many researchers and clinicians consider urges and cravings primarily physiological states, the RP model proposes that both urges and cravings are precipitated by psychological or environmental stimuli. Ongoing cravings, in turn, may erode the client’s commitment to maintaining abstinence as his or her desire for immediate gratification increases. This process may lead to a relapse setup or increase the client’s vulnerability to unanticipated high-risk situations. This article presents one influential model of the antecedents of relapse and the treatment measures that can be taken to prevent or limit relapse after treatment completion.

Relapse prevention

Thirty-two states now have legally authorized SSPs, a number which has doubled since 2014 (Fernández-Viña et al., 2020). Nonabstinence goals have become more widely accepted in SUD treatment in much of Europe, and evidence suggests that acceptance of controlled drinking has increased among U.S. treatment providers since the 1980s and 1990s (Rosenberg, Grant, & Davis, 2020). Importantly, there has also been increasing acceptance of non-abstinence outcomes as a metric for assessing treatment effectiveness in SUD research, even at the highest levels of scientific leadership (Volkow, 2020). Many advocates of harm reduction believe the SUD treatment field is at a turning point in acceptance of nonabstinence approaches.

Distal risks, which are thought to increase the probability of relapse, include background variables (e.g. severity of alcohol dependence) and relatively stable pretreatment characteristics (e.g. expectancies). Proximal risks actualize, or complete, the distal predispositions and include transient lapse precipitants (e.g. stressful situations) and dynamic individual characteristics (e.g. negative affect, self-efficacy). Combinations of precipitating and predisposing risk factors are innumerable for any abstinence violation effect particular individual and may create a complex system in which the probability of relapse is greatly increased. Quite frankly, studies that have attempted to look at lapse and relapse rates across different substances have discrepant findings because the terms are often defined differently. In addition, many individuals in recovery consider a single slip as a full-blown relapse. In CBT for addictive behaviours cognitive strategies are supported by several behavioural strategies such as coping skills.

Overview of the RP Model

Although non-dieters ate less after consuming the milkshakes, presumably because they were full, dieters paradoxically ate more after having the milkshake (Figure 1a). This disinhibition of dietary restraint has been replicated numerous times [20,28] and demonstrates that dieters often eat a great deal after they perceive their diets to be broken. It is currently not clear, however, how a small indulgence, which itself might not be problematic, escalates into a full-blown binge [29].

• Future research must test the effectiveness of nonabstinence treatments for drug use and address barriers to implementation.
• At this stage, a person might not even think about using substances, but there is a lack of attention to self-care, the person is isolating from others, and they may be attending therapy sessions or group meetings only intermittently.
• Lastly, we review existing models of nonabstinence psychosocial treatment for SUD among adults, with a special focus on interventions for drug use, to identify gaps in the literature and directions for future research.
• The onset of bulimia nervosa is often preceded by extended periods of recurrent dieting occurring in the context of other psychosocial stressors.

Going to the front of the room to grab a new one-day chip after months or years of sobriety makes us feel like complete failures. We feel ashamed of ourselves, and fear that everybody else must be ashamed of us as well. Relapsing isn’t a matter of one’s lack of willpower, and it isn’t the end of the road.