Unfortunately, there has been little empirical research evaluating this approach among individuals with DUD; evidence of effectiveness comes primarily from observational research. Participants with controlled use goals in this center are typically able to achieve less problematic (38%) or non-problematic (32%) use, while a minority achieve abstinence with (8%) or without (6%) incidental relapse (outcomes were not separately assessed for those with AUD vs. DUD; Schippers https://ecosoberhouse.com/ & Nelissen, 2006). This paper presents a narrative review of the literature and a call for increased research attention on the development of empirically supported nonabstinence treatments for SUD to engage and treat more people with SUD. We define nonabstinence treatments as those without an explicit goal of abstinence from psychoactive substance use, including treatment aimed at achieving moderation, reductions in use, and/or reductions in substance-related harms.
The AVE was introduced into the substance abuse literature within the context of the “relapse process” (Marlatt and Gordon 1985, p. 37). Relapse has been variously defined, depending on theoretical orientation, treatment goals, cultural context, and target substance (Miller 1996; White 2007). It is, however, most commonly used to refer to a resumption of substance use behavior after a period of abstinence from substances (Miller 1996). The term relapse may be used to describe a prolonged return to substance use, whereas lapsemay be used to describe discrete, circumscribed… 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. With regard to addictive behaviours Cognitive Therapy emphasizes psychoeducation and relapse prevention.
Treatment strategies in the relapse prevention
This model notes that those who have the latter mindset are proactive and strive to learn from their mistakes. To do so, they adapt their coping strategies to better deal with future triggers should they arise. This protects their sobriety and enhances their ability to protect themselves from future threats of relapse. Cori’s key responsibilities include supervising financial operations, and daily financial reporting and account management. Cori’s goal is to ensure all patient’s needs are met in an accurate and timely manner.
- An individual progresses through various stages of changes and the movement is influenced by several factors.
- According to AVE research, those who do chose to respond to their behavior with blame and a sense of lost perceived control are more likely to relapse than those who respond by attributing lapse to preventable events and not feeling as though they failed completely.
- Social pressure may be experienced directly, such as peers trying to convince a person to use, or indirectly through modelling (e.g. a friend ordering a drink at dinner) and/or cue exposure.
- The AVE occurs when a client is in a high-risk situation and views the potential lapse as so severe, that he or she may as well relapse.
This model has received a good deal of empirical support and has the merit of dismantling the process of relapse and exploring subjective and cognitive variables in a manner that has important treatment implications. 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.
Clinical perfectionism: A cognitive-behavioural analysis
This is a likely predecessor of giving into temptation in the initial use of a substance. While a person may physically abstain from using drugs or alcohol, their thoughts and emotions may have already returned to substance abuse. This model asserts that full-blown relapse is a transitional process based on a combination of factors. Problem solving therapy (PST) is a cognitive behavioural program that addresses interpersonal problems and other problem situations that may trigger stress and thereby increase probability of the addictive behaviour. The four key elements of PST are problem identification, generating alternatives, decision making, implementing solutions, reviewing outcomes and revising steps where needed.
- 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.
- Administrative discharge due to substance use is not a necessary practice even within abstinence-focused treatment (Futterman, Lorente, & Silverman, 2004), and is likely linked to the assumption that continued use indicates lack of readiness for treatment, and that abstinence is the sole marker of treatment success.
- For example, in AUD treatment, individuals with both goal choices demonstrate significant improvements in drinking-related outcomes (e.g., lower percent drinking days, fewer heavy drinking days), alcohol-related problems, and psychosocial functioning (Dunn & Strain, 2013).
- The AVE occurs when the person attributes the cause of the initial lapse (the first violation of abstinence) to internal, stable, and global factors within (e.g., lack of willpower or the underlying addiction or disease).
- A recent qualitative study found that concern about missing substances was significantly correlated with not completing treatment (Zemore, Ware, Gilbert, & Pinedo, 2021).
Marlatt and Gordon (1985) contend that individuals’ reactions to the initial slip and their attributions regarding the cause of the slip are the determining factors in the escalation of a lapse or setback into a full-blown relapse. The transition from slip or lapse to relapse involves the “abstinence violation abstinence violation effect effect,” which results from a state of cognitive dissonance regarding the nonabstinent behavior and the individual’s image of being abstinent. This dissonance can be reduced by either changing the behavior or changing the image, and characteristically in this population is resolved by the latter.