Such findings have contributed to renewed interest in negative reinforcement models of drug use . 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 policies regarding drug use during treatment – a significant hurdle.
- This model both accelerated the spread of AA and NA and helped establish the abstinence-focused 12-Step program at the core of mainstream addiction treatment.
- The use of functional magnetic resonance imaging (fMRI) techniques in addictions research has increased dramatically in the last decade  and many of these studies have been instrumental in providing initial evidence on neural correlates of substance use and relapse.
- Among those seeking treatment for alcohol use disorder (AUD), studies with large samples have cited rates of nonabstinence goals ranging from 17% (Berglund et al., 2019) to 87% (Enggasser et al., 2015).
- Studies show that those who detour back to substance use are responding to drug-related cues in their surroundings—perhaps seeing a hypodermic needle or a whiskey bottle or a person or a place where they once obtained or used drugs.
- The more ACEs children have, the greater the possibility of poor school performance, unemployment, and high-risk health behaviors including smoking and drug use.
Such studies have shown that both positive and negative moods show close temporal links to alcohol use . One study  found evidence suggesting a feedback cycle of mood and drinking whereby elevated daily levels of NA predicted alcohol use, which in turn predicted spikes in NA. Other studies have similarly found that relationships between daily events and/or mood and drinking can vary based on intraindividual or situational factors , suggesting dynamic interplay between these influences. Harm reduction may also be well-suited for people with high-risk drug use and severe, treatment-resistant SUDs (Finney & Moos, 2006; Ivsins, Pauly, Brown, & Evans, 2019). These individuals are considered good candidates for harm reduction interventions because of the severity of substance-related negative consequences, and thus the urgency of reducing these harms. Indeed, this argument has been central to advocacy around harm reduction interventions for people who inject drugs, such as SSPs and safe injection facilities (Barry et al., 2019; Kulikowski & Linder, 2018).
Theoretical and Practical Support for the RP Model
For example, one could imagine a situation whereby a client who is relatively committed to abstinence from alcohol encounters a neighbor who invites the client into his home for a drink. Feeling somewhat uncomfortable with the offer the client might experience a slight decrease in self-efficacy, which cascades into positive outcome expectancies about the potential effects of having a drink as well as feelings of shame or guilt about saying no to his neighbor’s offer. Importantly, this client might not have ever considered such an invitation as a high-risk situation, yet various contextual factors may interact to predict a lapse. Unfortunately, there has been little empirical research evaluating this approach among individuals with DUD; evidence of effectiveness comes primarily from observational research. Marlatt and Gordon’s (1985) model of the relapse process in addictive disorders has had a major impact in the field of relapse prevention since the late 1980s.
Nonabstinence approaches to SUD treatment have a complex and contentious history, and significant social and political barriers have impeded research and implementation of alternatives to abstinence-focused treatment. We summarize historical factors relevant to non-abstinence treatment development to illuminate reasons these approaches are understudied. Additionally, the support of a solid social network and professional help can play a pivotal role.
2. Relationship between goal choice and treatment outcomes
Stress and sleeplessness weaken the prefrontal cortex, the executive control center of the brain. Ecological momentary assessment, either via electronic device or interactive voice response methodology, could provide the data necessary to fully test the dynamic model of relapse19. Helping clients develop positive addictions or substitute indulgences (e.g. jogging, meditation, relaxation, exercise, hobbies, or creative tasks) also help to balance their lifestyle6. Global self-management strategy involves encouraging clients to pursue again those previously satisfying, nondrinking recreational activities. In addition, relaxation training, time management, and having a daily schedule can be used to help clients achieve greater lifestyle balance. The myths related to substance use can be elicited by exploring the outcome expectancies as well as the cultural background of the client.
This article discusses the concepts of relapse prevention, relapse determinants and the specific interventional strategies. Thus, while it is vital to empirically test nonabstinence treatments, implementation research examining strategies to obtain buy-in from agency https://ecosoberhouse.com/ leadership may be just as impactful. 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.
What is more, it can alter the sensitivity of the stress response system so that it overresponds to low levels of threat, making people feel easily overwhelmed by life’s normal difficulties. Research shows a strong link between ACEs and opioid drug abuse as well as alcoholism. Craving is an overwhelming desire to seek a substance, and cravings focus all one’s attention on that goal, shoving aside all reasoning ability. Perhaps the most important thing to know about cravings is that they do not last forever.
Most scientists who studied SUD treatment believed that abstinence was the only acceptable treatment goal until at least the 1980s (Des Jarlais, 2017). Abstinence rates became the primary outcome for determining SUD treatment effectiveness (Finney, Moyer, & Swearingen, 2003; Kiluk, Fitzmaurice, Strain, & Weiss, 2019; Miller, 1994; Volkow, 2020), a standard which persisted well into the 1990s (Finney et al., 2003). Little attention was given to whether people in abstinence-focused treatments endorsed abstinence goals themselves, or whether treatment could help reduce substance use and related problems for those who did not desire (or were not ready for) abstinence.
The results reported in the RREP study indicate that the original relapse taxonomy of the RP model has only moderate inter-rater reliability at the highest level of specificity, although reliability of the more general categories (e.g., negative affect and social pressure) was better. Therefore, the RREP studies do not represent a good test of the predictive validity of the taxonomy. Questionnaires such as the situational confidence test (Annis 1982b) can assess the amount of self-efficacy a person has in coping with drinking-risk situations. Those measures do not necessarily indicate, however, whether a client is actually able or willing to use his or her coping skills in a high-risk situation. To increase the likelihood that a client can and will utilize his or her skills when the need arises, the therapist can use approaches such as role plays and the development and modeling of specific coping plans for managing potential high-risk situations. In many cases, initial lapses occur in high-risk situations that are completely unexpected and for which the drinker is often unprepared.
- Because the volume and scope of this work precludes an exhaustive review, the following section summarizes a select body of findings reflective of the literature and relevant to RP theory.
- For example, Bandura, who developed Social Cognitive Theory, posited that perceived choice is key to goal adherence, and that individuals may feel less motivation when goals are imposed by others (Bandura, 1986).
- If you are at a gathering where provocation arises because alcohol or other substances are available, leave.
- We suggest an ecological momentary assessment (EMA) study to track experiences over time and get insight into the process of behavior change, among which lapsing and relapsing (Shiffman, Stone, & Hufford, 2008).
- According to these models, the relapse process begins prior to the first posttreatment alcohol use and continues after the initial use.
- Consistent with the broader literature, it can be anticipated that most genetic associations with relapse outcomes will be small in magnitude and potentially difficult to replicate.
Such reflection helps you understand your vulnerabilities—different for every person. Armed with such knowledge, you can develop a contingency plan to help you avoid or cope with such situations in the future. Some people arrange a tight network of friends to call on in an emergency, such as when they are experiencing cravings. Since cravings do not last forever, engaging in conversation about the feelings as they occur with someone who understands their nature can help a person ride out the craving.
Adults: Clinical Formulation & Treatment
When urge and negative affect were low, individuals with low, intermediate or high baseline SE were similar in their momentary SE ratings. However, these groups’ momentary ratings diverged significantly at high levels of urges and negative affect, such that those with low baseline SE had large drops in momentary SE in the face of increasingly challenging situations. These findings support that higher distal risk can result in bifurcations (divergent patterns) of behavior as the level of proximal risk factors increase, consistent with predictions from nonlinear dynamic systems theory . Lack of consensus around target outcomes also presents a challenge to evaluating the effectiveness of nonabstinence treatment.
This is especially true if we are involved in a twelve-step program, as we now realize we must reset our chips. Going to the front of the room to grab a new one-day chip after months or years of sobriety makes us feel like complete failures. We feel ashamed of ourselves, and fear that everybody else must be ashamed of us as well. Getting through the holidays while maintaining recovery, especially for people newer to this abstinence violation effect life-changing process, is an accomplishment worthy of celebration in its own right. One way of ensuring recovery from addiction is to remember the acronym DEADS, shorthand for an array of skills to deploy when faced with a difficult situation—delay, escape, avoid, distract, and substitute. They are typically triggered by people, places, paraphernalia, and passing thoughts in some way related to previous drug use.