Against this backdrop, both tonic (stable) and phasic (transient) influences interact to determine relapse likelihood. Tonic processes include distal risks–stable background factors that determine an individual’s “set point” or initial threshold for relapse 8,31. Personality, genetic or familial risk factors, drug sensitivity/metabolism and physical withdrawal profiles are examples of distal variables that could influence relapse liability a priori.
1. Nonabstinence goals among people with SUD
- Overall, the RP model is characterized by a highly ideographic treatment approach, a contrast to the “one size fits all” approach typical of certain traditional treatments.
- Therapeutic strategies such as contingency management, differential reinforcement of incompatible and alternate behaviours and rearrangement of environmental cues that set the occasion for addictive behaviour, including emotional triggers are used in this approach.
- Relative to the TAU group, the VM group reported significantly lower levels of substance use and alcohol-related consequences and improved psychosocial functioning at follow-up 116.
- An abstinence violation can also occur in individuals with low self-efficacy, since they do not feel very confident in their ability to carry out their goal of abstinence.
- Harm reduction psychotherapies, for example, incorporate multiple modalities that have been most extensively studied as abstinence-focused SUD treatments (e.g., cognitive-behavioral therapy; mindfulness).
One critical goal will be to integrate empirically supported substance use interventions in the context of continuing care models of treatment delivery, which in many cases requires adapting existing treatments to facilitate sustained delivery 140. Given its focus on long-term maintenance of treatment gains, RP is a behavioral intervention that is particularly well suited for implementation in continuing care contexts. However, it is imperative that insurance providers and funding entities support these efforts by providing financial support for aftercare services.
Normalize Relapse
- A more recent development in the area of managing addictive behaviours is the application of the construct of mindfulness to managing experiences related to craving, negative affect and other emotional states that are believed to impact the process of relapse34.
- However, the review also showed that there is still insufficient evidence for most predictors of relapse.
- The evolution of cognitive-behavioral theories of substance use brought notable changes in the conceptualization of relapse, many of which departed from traditional (e.g., disease-based) models of addiction.
- Unconscious cravings may turn into the conscious thought that it is the only way you can cope with your current situation.
Planning coping responses to anticipated, personal, high-risk situations helps an individual to cope with difficult situations, such as negative emotions or being tempted by their social or physical environment (Sniehotta, Schwarzer, Scholz, & Schüz, 2005). Coping planning has been shown to be an efficacious technique to promote health behavior change, especially when individuals receive support when forming coping plans (Kwasnicka, Presseau, White, & Sniehotta, 2013). Therefore, we advise health practitioners to support their clients by helping them to identify personal risk situations and formulating corresponding coping plans. The relationship between specific risk factors and drinking in this sample of individuals who received three unique treatments (CBT, MET, and TSF) is of particular interest to treatment providers and clinical researchers.
III.D. Abstinence Violation Effect
The past 20 years has seen growing acceptance of harm reduction, evidenced in U.S. public health policy as well as SUD treatment research. Thirty-two states now have legally authorized SSPs, a number which has https://ecosoberhouse.com/ doubled since 2014 (Fernández-Viña et al., 2020). Regarding SUD treatment, there has been a significant increase in availability of medication for opioid use disorder, especially buprenorphine, over the past two decades (opioid agonist therapies including buprenorphine are often placed under the “umbrella” of harm reduction treatments; Alderks, 2013).
However, the review also showed that there is still insufficient evidence for most predictors of relapse. As of yet, current literature still lacks an in-depth understanding of key stakeholders’ personal perspectives on relapse after weight loss. A number of studies have examined psychosocial risk reduction interventions for individuals with high-risk drug use, especially people who inject drugs. In contrast to the holistic approach of harm reduction psychotherapy, risk reduction interventions are generally designed to target specific HIV risk behaviors (e.g., injection or sexual risk behaviors) without directly addressing mechanisms of SUD, and thus are quite limited in scope. However, these interventions also typically lack an abstinence focus and sometimes result in reductions in drug use.
Develop Coping Skills
Given this limitation, the National Institutes on Alcohol Abuse and Alcoholism (NIAAA) sponsored the Relapse Replication and Extension Project (RREP), a multi-site study aiming to test the reliability and validity of Marlatt’s original relapse taxonomy. Efforts to evaluate the validity 119 and predictive validity 120 of the taxonomy failed to generate supportive data. It was noted that in focusing on Marlatt’s relapse taxonomy the RREP did not comprehensive evaluation of the full RP model 121. Nevertheless, these studies were useful in identifying limitations and qualifications of the RP taxonomy and generated valuable suggestions 121. Addressing the AVE in the context of addiction treatment involves helping people develop healthier coping strategies and challenging negative beliefs that contribute to addiction. The Abstinence Violation Effect is a psychological phenomenon that occurs when a person experiences relapse after attempting to abstain from drug or alcohol use.
In this study incarcerated individuals were offered the chance to participate in an intensive 10-day course in Vipassana meditation (VM). Those participating in VM were compared to a treatment as usual (TAU) group on measures of post-incarceration substance use and psychosocial functioning. Relative to the TAU group, the VM group reported significantly lower levels of substance use and alcohol-related consequences and improved psychosocial functioning at follow-up 116. Additionally, the support of a solid social network and professional help can play a pivotal role.
Related terms:
The client may be taught to monitor their proximal risks in conjunction with continuous monitoring of drinking, and be provided with skills for seeking support when proximal risks are on the rise. Multiple versions of harm reduction psychotherapy for alcohol and drug use have been described in detail but not yet studied empirically. However, to date there have been no published empirical trials testing the effectiveness of the approach. The RP model proposed by Marlatt and Gordon suggests that both immediate determinants (e.g., high-risk situations, coping skills, outcome expectancies, and the abstinence violation effect) and covert antecedents (e.g., lifestyle factors and urges abstinence violation effect and cravings) can contribute to relapse. The RP model also incorporates numerous specific and global intervention strategies that allow therapist and client to address each step of the relapse process.
This false sense of control can often lead us to put ourselves in highly tempting situations, such as going to our favorite bar, mistakenly thinking the urge to drink is now behind us. However, the temptation from a familiar setting, coupled with the thought “one drink won’t hurt,” makes resisting the drink extra hard. If you are worried that you might be headed for a relapse, you don’t have to wait until it happens to reach out for help.
Mechanisms of treatment effects
- This suggests that individuals with nonabstinence goals are retained as well as, if not better than, those working toward abstinence, though additional research is needed to confirm these results and examine the effect of goal-matching on retention.
- Rajiv’s unsuccessful attempts at abstinence lead to a low sense of self-confidence and a belief that he would not be able help himself (low perceived self- efficacy) setting up a vicious cycle.
- Further, a randomized trial of olanzapine led to significantly improved drinking outcomes in DRD4 L but not DRD4 S individuals 100.
- Based on more than 2,000 data points analyses revealed a periodic cycle in which sudden shifts in drinking behavior were observed after periods of stability.
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. Multimodality and inaccessibility are characteristics of a catastrophe model that are most consistent with observed drinking behavior following treatment. Multimodality is indicated by the presence of more than one mode of the behavior based on specific values of the control parameters.
