If I asked you about your past drinking experiences, you’d likely recall the bonding moments or numbing relaxation rather than the drunk argument and frequent blackouts. AVE also involves cognitive dissonance, a distressing experience people go through when their internal thoughts, beliefs, actions, or identities are put in conflict with one another. Set realistic expectations for your recovery journey, understanding that progress may not always be linear. Rather than only focusing on the end goal, celebrate small victories and all positive steps you’ve taken thus far. Learning healthy coping mechanisms can help you manage stress, cravings, and triggers without resorting to substance use. There are several factors that can contribute to the development of the AVE in people recovering from addiction.
- Although some high-risk situations appear nearly universal across addictive behaviors (e.g., negative affect; [25]), high-risk situations are likely to vary across behaviors, across individuals, and within the same individual over time [10].
- With the right help, preparation, and support, you and your loved ones can still continue to build a long-lasting recovery from substance abuse.
Katie Witkiewitz
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. Thus, while it is vital to empirically test nonabstinence treatments, implementation research examining strategies to obtain buy-in from agency leadership may be just as impactful. Harm reduction therapy has also been applied in group format, mirroring the approach and components of individual harm reduction psychotherapy but with added focus on building social support and receiving feedback and advice from peers (Little, 2006; Little & Franskoviak, 2010).
Genetic influences on treatment response and relapse
Given the abstinence focus of many SUD treatment centers, studies may need to recruit using community outreach, which can yield fewer participants compared to recruiting from treatment (Jaffee et al., 2009). However, this approach is consistent with the goal of increasing treatment utilization by reaching those who may not otherwise present to treatment. Alternatively, researchers who conduct trials in community-based treatment centers will need to obtain buy-in to test nonabstinence approaches, which may necessitate waiving facility https://ecosoberhouse.com/ policies regarding drug use during treatment – a significant hurdle. In sum, research suggests that achieving and sustaining moderate substance use after treatment is feasible for between one-quarter to one-half of individuals with AUD when defining moderation as nonhazardous drinking. While there is evidence that a subset of individuals who use drugs engage in low-frequency, non-dependent drug use, there is insufficient research on this population to determine the proportion for whom moderation is a feasible treatment goal.
Empirical findings relevant to the RP model
Not surprisingly, molecular genetic approaches have increasingly been incorporated in treatment outcome studies, allowing novel opportunities to study biological influences on relapse. Given the rapid growth in this area, we allocate a portion of this review to discussing initial evidence for genetic associations with relapse. Specifically, we focus on recent, representative findings from studies evaluating candidate single nucleotide polymorphisms (SNPs) as moderators of response to substance use interventions. It is important to note that these studies were not designed to evaluate specific components of the RP model, nor do these studies explicitly espouse the RP model.
2. Controlled drinking
Additionally, other findings suggest the influence of a DRD4 variable number of tandem repeats (VNTR) polymorphism on response to olanzapine, a dopamine antagonist that has been studied as an experimental treatment for alcohol problems. Olanzapine was found to reduce alcohol-related craving those with the long-repeat VNTR (DRD4 L), but not individuals with the short-repeat version (DRD4 S; [100,101]). Further, a randomized trial of olanzapine led to significantly improved drinking outcomes in DRD4 L but not DRD4 S individuals [100]. A common pattern of self-regulation failure occurs for addicts and chronic dieters when they ‘fall off the wagon’ by consuming the addictive substance or violating their diets [5]. Marlatt coined the term abstinence violation effect to refer to situations in which addicts respond to an initial indulgence by consuming even more of the forbidden substance [11].
Definitions of relapse and relapse prevention
Viewing a lapse as a personal failure may lead to feelings of guilt and abandonment of the behavior change goal [24]. This reaction, termed the Abstinence Violation Effect (AVE; [16]), is considered more likely when one holds a dichotomous view of relapse and/or neglects to consider situational explanations for lapsing. In sum, the RP framework emphasizes high-risk contexts, coping responses, self-efficacy, affect, expectancies and the AVE as primary relapse antecedents. Researchers have long posited that offering goal choice (i.e., nonabstinence and abstinence treatment options) may be key to engaging more individuals in SUD treatment, including those earlier in their addictions (Bujarski et al., 2013; Mann et al., 2017; Marlatt, Blume, & Parks, 2001; Sobell & Sobell, 1995).
1. Nonabstinence psychosocial treatment models
Those who wish to become sober—and stay that way—must therefore learn to identify abstinence violation effect and the dangerous ways in which it might impact our recovery. Jeanette Hu, AMFT, based in California, is a former daily drinker, psychotherapist, and Sober Curiosity Guide. She supports individuals who long for a better relationship with alcohol, helping them learn to drink less without living less.
- The second is assessing coping skills of the client and imparting general skills such as relaxation, meditation or positive self-talk or dealing with the situation using drink refusal skills in social contexts when under peer pressure through assertive communication6.
- Still, some have criticized the model for not emphasizing interpersonal factors as proximal or phasic influences [122,123].
- It doesn’t seem logical that we would still experience cravings when we were only just recently hurt by a relapse.
- How one defines relapse may be an important influence on determining what happens when one suffers a lapse or slip.
Related terms:
One study found that momentary coping reduced urges among smokers, suggesting a possible mechanism [76]. Some studies find that the number of coping responses is more predictive of lapses than the specific type of coping used [76,77]. However, despite findings that coping can prevent abstinence violation effect lapses there is scant evidence to show that skills-based interventions in fact lead to improved coping [75]. In the first study to examine relapse in relation to phasic changes in SE [46], researchers reported results that appear consistent with the dynamic model of relapse.
Relapse prevention
While attesting to the influence and durability of the RP model, the tendency to subsume RP within various treatment modalities can also complicate efforts to systematically evaluate intervention effects across studies (e.g., [21]). 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 & 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.
Perhaps the most notable gap identified by this review is the dearth of research empirically evaluating the effectiveness of nonabstinence approaches for DUD treatment. Given low treatment engagement and high rates of health-related harms among individuals who use drugs, combined with evidence of nonabstinence goals among a substantial portion of treatment-seekers, testing nonabstinence treatment for drug use is a clear next step for the field. Ultimately, nonabstinence treatments may overlap significantly with abstinence-focused treatment models.