In the U.S., about 25% of patients seeking treatment for AUD endorsed nonabstinence goals in the early 2010s (Dunn & Strain, 2013), while more recent clinical trials have found between 82 and 91% of those seeking treatment for AUD prefer nonabstinence goals (Falk et al., 2019; Witkiewitz et al., 2019). Unfortunately, a single lapse can cause you to fall into a full relapse because of something called the https://ecosoberhouse.com/ (AVE). It is not necessarily a failure of self-control nor a permanent failure to abstain from using a substance of abuse. Those in addiction treatment or contemplating treatment can benefit from this aspect of relapse prevention. There are many relapse prevention models used in substance abuse treatment to counter AVE and give those in recovery important tools and coping skills. As the foregoing review suggests, validation of the reformulated RP model will likely progress slowly at first because researchers are only beginning to evaluate dynamic relapse processes.

Cognitive Behavioural model of relapse

In response to these criticisms, Witkiewitz and Marlatt proposed a revision of the cognitive-behavioral model of relapse that incorporated both static and dynamic factors that are believed to be influential in the relapse process. The “dynamic model of relapse” builds on several previous studies of relapse risk factors by incorporating the characterization of distal and proximal risk factors. Distal risks, which are thought to increase the probability of relapse, include background variables (e.g. severity of alcohol dependence) and relatively stable pretreatment characteristics (e.g. expectancies). Proximal risks actualize, or complete, the distal predispositions and include transient lapse precipitants (e.g. stressful situations) and dynamic individual characteristics (e.g. negative affect, self-efficacy).

Decoupling Goal Striving From Resource Depletion by Forming Implementation Intentions

This reframing of lapse episodes can help decrease the clients’ tendency to view lapses as the result of a personal failing or moral weakness and remove the self-fulfilling prophecy that a lapse will inevitably lead to relapse. Although high-risk situations can be conceptualized as the immediate determinants of relapse episodes, a number of less obvious factors also influence the relapse process. These covert antecedents include lifestyle factors, such as overall stress level, as well as cognitive factors that may serve to “set up” a relapse, such as rationalization, denial, and a desire for immediate gratification (i.e., urges and cravings) (see figure 2). These factors can increase a person’s vulnerability to relapse both by increasing his or her exposure to high-risk situations and by decreasing motivation to resist drinking in high-risk situations. 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 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).

Ecological momentary assessment in the investigation of craving and substance use in daily life: A systematic review

A recent report indicated that gamers might engage in compensatory behaviors (e.g., searching for gaming-related pornography) during periods of ‘forced abstinence’ from gaming (Castro-Calvo, Ballester-Arnal, Potenza, King, & Billieux, 2018). It is entirely possible that across different behaviors, individuals respond to the unpleasant experience of withdrawal by engaging in compensatory behaviors that might sometimes cause equal or more harm (e.g., binge drinking to cope with gambling cravings). Not knowing how to deal adaptively with lapses or slips during periods of abstinence might also lead to counterproductive consequences – for example, the phenomenon of the abstinence violation effect (Marlatt & Gordon, 1985) might cause a lapse to progress to a full-blown relapse (e.g., Sharma & Anand, 2019).

Other more general strategies include helping the person develop positive addictions and employing stimulus-control and urge-management techniques. Here we provide a brief review of existing models of nonabstinence psychosocial treatment, with the goal of summarizing the state of the literature and identifying notable gaps and directions for future research. Previous reviews have described nonabstinence pharmacological approaches (e.g., Connery, 2015; Palpacuer et al., 2018), which are outside the scope of the current review. While there are multiple such intervention approaches for treating AUD with strong empirical support, we highlight a dearth of research testing models of harm reduction treatment for DUD.

Importantly, there has also been increasing acceptance of non-abstinence outcomes as a metric for assessing treatment effectiveness in SUD research, even at the highest levels of scientific leadership (Volkow, 2020). Many advocates of harm reduction believe the SUD treatment field is at a turning point in acceptance of nonabstinence approaches. Indeed, a prominent harm reduction psychotherapist and researcher, Rothschild, argues that the harm reduction approach represents a “third wave of addiction treatment” which follows, and is replacing, the moral and disease models (Rothschild, 2015a). The cognitive-behavioral model of the relapse process posits a central role for high-risk situations and for the drinker’s response to those situations.

The neurocognitive correlates of non-substance addictive behaviors

While abstinence is the only guaranteed method for avoiding disease and pregnancy, current discourse generally considers abstinence-only programs to be ineffective. Some educators advocate instead for emphasizing the benefits of abstinence and abstinence violation effect then teaching strategies for avoiding disease, promoting healthy sexuality, and ensuring emotional needs are met. Abstinence is commonly used to refer to complete avoidance of sexual behaviors, particularly among children and adolescents.

Based on the cognitive-behavioral model of relapse, RP was initially conceived as an outgrowth and augmentation of traditional behavioral approaches to studying and treating addictions. The evolution of cognitive-behavioral theories of substance use brought notable changes in the conceptualization of relapse, many of which departed from traditional (e.g., disease-based) models of addiction. For instance, whereas traditional models often attribute relapse to endogenous factors like cravings or withdrawal–construed as symptoms of an underlying disease state–cognitive-behavioral theories emphasize contextual factors (e.g., environmental stimuli and cognitive processes) as proximal relapse antecedents. Cognitive-behavioral theories also diverged from disease models in rejecting the notion of relapse as a dichotomous outcome. Rather than being viewed as a state or endpoint signaling treatment failure, relapse is considered a fluctuating process that begins prior to and extends beyond the return to the target behavior [8,24].

Develop Coping Skills

In a subsequent meta-analysis by Irwin, twenty-six published and unpublished studies representing a sample of 9,504 participants were included. Specifically, RP was most effective when applied to alcohol or polysubstance use disorders, combined with the adjunctive use of medication, and when evaluated immediately following treatment. Moderation analyses suggested that RP was consistently efficacious across treatment modalities (individual vs. group) and settings (inpatient vs. outpatient)22. Using a wave metaphor, urge surfing is an imagery technique to help clients gain control over impulses to use drugs or alcohol. In this technique, the client is first taught to label internal sensations and cognitive preoccupations as an urge, and to foster an attitude of detachment from that urge.

• A significant proportion (40–80%) of patients receiving treatment for alcohol use disorders have at least one drink, a “lapse,” within the first year of after treatment, whereas around 20% of patients return to pre-treatment levels of alcohol use3.
• In a 2013 Cochrane review which also discussed regarding relapse prevention in smokers the authors concluded that there is insufficient evidence to support the use of any specific behavioural intervention to help smokers who have successfully quit for a short time to avoid relapse.
• Emotional relapses can be incredibly difficult to recognize because they occur so deeply below the surface in your mind.
• This can include abstinence from substance abuse, overeating, gambling, smoking, or other behaviors a person has been working to avoid.
• Individuals with fewer years of addiction and lower severity SUDs generally have the highest likelihood of achieving moderate, low-consequence substance use after treatment (Öjehagen & Berglund, 1989; Witkiewitz, 2008).