The expected drug effects do not necessarily correspond with the actual effects experienced after consumption. Based on operant conditioning, the motivation to use in a particular situation is based on the expected positive or negative reinforcement value of a specific outcome in that situation5. Both negative and positive expectancies are related to relapse, with negative expectancies being protective against relapse and positive expectancies being a risk factor for relapse4.
Relapse road maps
- 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.
- Following this a decisional matrix can be drawn where pros and cons of continuing or abstaining from substance are elicited and clients’ beliefs may be questioned6.
- According to Beck et al., (2005), “A cognitive therapist could do hundreds of interventions with any patient at any given time”1).
- Together, this suggests a promising degree of alignment between goal selection and probability of success, and it highlights the potential utility of nonabstinence treatment as an “early intervention” approach to prevent SUD escalation.
- About 26% of all U.S. treatment episodes end by individuals leaving the treatment program prior to treatment completion (SAMHSA, 2019b).
- Multiple theories of motivation for behavior change support the importance of self-selection of goals in SUD treatment (Sobell et al., 1992).
- Researchers continue to evaluate the AVE and the efficacy of relapse prevention strategies.
Seemingly irrelevant decisions (SIDs) are those behaviours that are early in the path of decisions that place the client in a high-risk situation. 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. In conclusion, the abstinence violation effect is a psychological effect that impacts those in recovery, as well as those who are focused on making more positive behavioral the abstinence violation effect refers to choices in their lives. By reframing lapses as learning opportunities and teachable moments, cultivating self-compassion, and seeking support, individuals can navigate these challenges more effectively, increasing their chances of leading a healthier lifestyle. Similar to the reward thought, you may have another common thought after a period of sobriety. When you’ve experienced some success in your recovery, you may think that you can return to drug or alcohol use and control it.
Financial support and sponsorship
When the minimal effective response (such as informing friends that “I do not drink”) is not sufficient to bring about change, the individual is instructed to escalate to a stronger response, such as warning, threat, involving others’ support. Role play, behavioural rehearsal and modeling are used to train patients in assertiveness. Patient is instructed not to provide explanations for abstinence so as to avoid counter arguments.
1. Nonabstinence psychosocial treatment models
Others high risk situations include physical states such as hunger, thirst, fatigue, testing personal control, responsivity to substance cues (craving). The RP model highlights the significance of covert antecedents such as lifestyle patterns craving in relapse. Cue exposure is another behavioural technique based on the classical conditioning theory and theories of cue reactivity and extinction12,13. The technique involves exposure to a hierarchy of cues, which signal craving and subsequently substance use.
Abstinence Violation Effect: How Does Relapse Impact Recovery?
Recognizing the factors that contributed to the lapse, such as stressors or triggers, helps individuals to develop strategies and techniques to navigate similar challenges in the future. 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 a full relapse or a return to unhealthy living (Collins & Witkiewitz, 2013; Larimer, Palmer, & Marlatt, 1999).
The article provides an overview of cognitive behavioural approaches to managing addictions. The current review highlights a notable gap in research empirically evaluating the effectiveness of nonabstinence approaches for DUD treatment. While multiple harm reduction-focused treatments for AUD have strong empirical support, there is very little research testing models of nonabstinence treatment for drug use.
Ultimately, nonabstinence treatments may overlap significantly with abstinence-focused treatment models. 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). However, it is also possible that adaptations will be needed for individuals with nonabstinence goals (e.g., additional support with goal setting and monitoring drug use; ongoing care to support maintenance goals), and currently there is a dearth of research in this area. An additional concern is that the lack of research supporting the efficacy of established interventions for achieving nonabstinence goals presents a barrier to implementation. Cognitive behaviour therapy is a structured, time limited, psychological intervention that has is empirically supported across a wide variety of psychological disorders. CBT for addictive behaviours can be traced back to the application of learning theories in understanding addiction and subsequently to social cognitive theories.
- Using a wave metaphor, urge surfing is an imagery technique to help clients gain control over impulses to use drugs or alcohol.
- Despite these obstacles, SSPs and their advocates grew into a national and international harm reduction movement (Des Jarlais, 2017; Friedman, Southwell, Bueno, & Paone, 2001).
- Interpersonal relationships and support systems are highly influenced by intrapersonal processes such as emotion, coping, and expectancies18.
More Commonly Misspelled Words
- Given data demonstrating a clear link between abstinence goals and treatment engagement in a primarily abstinence-based SUD treatment system, it is reasonable to hypothesize that offering nonabstinence treatment would increase overall engagement by appealing to those with nonabstinence goals.
- The abstinence violation effect (AVE) occurs when an individual, having made a personal commitment to abstain from using a substance or to cease engaging in some other unwanted behavior, has an initial lapse whereby the substance or behavior is engaged in at least once.
- Relapse prevention initially evolved as a calculated response to the longer-term treatment failures of other therapies.
- Only a small minority of people with substance use disorders (SUDs) receive treatment.
- More recent versions of RP have included mindfulness-based techniques (Bowen, Chawla, & Marlatt, 2010; Witkiewitz et al., 2014).
- The hallmark of CBT is collaborative empiricism and describes the nature of therapeutic relationship.
Mindfulness, is drawn from Zen Buddhist teachings and refers to viewing things in a special way. The mechanisms of mindfulness include being non-judgemental, acceptance, habituation and extinction, relaxation and cognitive change35. These variables are essential in developing distress tolerance and reducing impulsivity, which are important variables in relapse process. Various psychological factors were significant in initiating and maintaining Rajiv’s dependence on alcohol. At the start of treatment, Rajiv was not keen engage to in the process of recovery, having failed at multiple attempts over the years (motivation to change, influence of past learning experiences with abstinence).
Planning a cognitive behavioural programme
- An additional concern is that the lack of research supporting the efficacy of established interventions for achieving nonabstinence goals presents a barrier to implementation.
- The expected drug effects do not necessarily correspond with the actual effects experienced after consumption.
- Negative social support in the form of interpersonal conflict and social pressure to use substances has been related to an increased risk for relapse.
- Approach coping may involve attempts to accept, confront, or reframe as a means of coping, whereas avoidance coping may include distraction from cues or engaging in other activities.
- Advocates of nonabstinence approaches often point to indirect evidence, including research examining reasons people with SUD do and do not enter treatment.
Publications about harm reduction psychotherapy have included numerous case studies and client examples that highlight the utility of the approach for helping clients achieve reductions in drug and alcohol use and related problems, moderate/controlled use, and abstinence (Rothschild, 2015b; Tatarsky, 2002; Tatarsky & Kellogg, 2010). However, to date there have been no published empirical trials testing the effectiveness of the approach. Only a small minority of people with substance use disorders (SUDs) receive treatment. A focus on abstinence is pervasive in SUD treatment, defining success in both research and practice, and punitive measures are often imposed on those who do not abstain. Most adults with SUD do not seek treatment because they do not wish to stop using substances, though many also recognize a need for help.
Relapse prevention
Lifestyle factors have been proposed as the covert antecedents most strongly related to the risk of relapse. It involves the degree of balance in the person’s life between perceived external demands and internally fulfilling or enjoyable activities. Urges and cravings precipitated by psychological or environmental stimuli are also important6. A high-risk situation is defined as a circumstance in which an individual’s attempt to refrain from a particular behaviour is threatened. While analysing high-risk situations the client is asked to generate a list of situations that are low-risk, and to determine what aspects of those situations differentiate them from the high-risk situations. High-risk situations are determined by an analysis of previous lapses and by reports of situations in which the client feels or felt “tempted.” Appropriate responses are those behaviours that lead to avoidance of high-risk situations, or behaviours that foster adaptive responses.