Expanding the continuum of substance use disorder treatment: Nonabstinence approaches

Additionally, in the United Kingdom, where there is greater access to nonabstinence treatment (Rosenberg & Melville, 2005; Rosenberg & Phillips, 2003), the proportion of individuals with opioid use disorder engaged in treatment is more than twice that of the U.S. (60% vs. 28%; Burkinshaw et al., 2017). In a meta-analysis by Carroll, more than 24 RCT’s have been evaluated for the effectiveness of RP on substance use outcomes. Review of this body of literature suggests that, across substances of abuse but most strongly for smoking cessation, there is evidence for the effectiveness of relapse prevention compared with no treatment controls. However, evidence regarding its superiority relative to other active treatments has been less consistent. Outcomes in which relapse prevention may hold particular promise include reducing severity of relapses, enhanced durability of effects, and particularly for patients at higher levels of impairment along dimensions such as psychopathology or dependence severity21. An important part of RP is the notion of Abstinence violation effect (AVE), which refers to an individual’s response to a relapse where often the client blames himself/herself, with a subsequent loss of perceived control4.

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It occurs when the client perceives no intermediary step between a lapse and relapse i.e. since they have violated the rule of abstinence, “they may get most out” of the lapse5. 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 as a further attempt to avoid or escape the feelings of guilt or failure7. Addiction and related disorders are chronic lapsing and relapsing disorders where the combination of long term pharmacological and psychosocial managements are the mainstay approaches of management.

Relapse Prevention

• The model’s predictive validity also was modest; however, the definition of the key relapse episodes utilized in these studies failed to clarify whether these were voluntary change episodes or simply a return to drinking following a short period of abstinence that did not represent a serious attempt to quit drinking.
• When people don’t have the proper tools to navigate the challenges of recovery, the AVE is more likely to occur, which can make it difficult to achieve long-term sobriety.
• Models of nonabstinence psychosocial treatment for drug use have been developed and promoted by practitioners, but little empirical research has tested their effectiveness.
• These properties of the abstinence violation effect also apply to individuals who do not have a goal to abstain, but instead have a goal to restrict their use within certain self-determined limits.
• One of the most important efficacy-enhancing strategies employed in RP is the emphasis on collaboration between the client and therapist instead of a more typical “top down” doctor-patient relationship.

Like the conceptualization of urges and cravings as the result of an external stimulus, this imagery fosters detachment from the urges and cravings and reinforces the temporary and external nature of these phenomena. In the multifaceted journey of overcoming addiction and living a healthier life, individuals often encounter a psychological phenomenon known as the abstinence violation effect (AVE). It sheds light on the challenges individuals face when attempting to maintain abstinence and how a single lapse can trigger a surge of negative emotions, potentially leading to abstinence violation effect a full relapse or a return to unhealthy living (Collins & Witkiewitz, 2013; Larimer, Palmer, & Marlatt, 1999). As a result of stress, high-risk situations, or inborn anxieties, you are experiencing negative emotional responses. Emotional relapses can be incredibly difficult to recognize because they occur so deeply below the surface in your mind.

2. Relationship between goal choice and treatment outcomes

For example, if the client understands that using alcohol in the day time triggers a binge, agreeing for a meeting in the afternoon in a restaurant that serves alcohol would be a SID5. The AVE describes the negative emotional response that often accompanies a failure to maintain abstinence from drugs or alcohol. In such a matrix, the client lists both the positive and negative immediate and delayed consequences of remaining abstinent versus resuming drinking. This list can facilitate the client’s decisionmaking process regarding his or her future alcohol consumption. One day, when he was faced with a stressful situation, he felt overwhelmed, gave in to the urge, and had a drink.

• The 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).
• Also, the client is asked to keep a current record where s/he can self-monitor thoughts, emotions or behaviours prior to a binge.
• In its original form, RP aims to reduce risk of relapse by teaching participants cognitive and behavioral skills for coping in high-risk situations (Marlatt & Gordon, 1985).
• Kristen P. Lindgren is an assistant professor and licensed clinical psychologist in the University of Washington’s Department of Psychiatry and Behavioral Sciences.
• A high-risk situation is defined as a circumstance in which an individual’s attempt to refrain from a particular behaviour is threatened.

There may be an internal conflict between resisting thoughts about drugs and compulsions to use them. There is a possibility that you might rationalize why you might not experience the same consequences if you continue to use. It is not necessarily these natural emotions that cause emotional relapse, but how you cope with them, that does. In a study by McCrady evaluating the effectiveness of psychological interventions for alcohol use disorder such as Brief Interventions and Relapse Prevention was classified as efficacious23. The myths related to substance use can be elicited by exploring the outcome expectancies as well as the cultural background of the client.