Next, we review other established SUD treatment models that are compatible with non-abstinence goals. We focus our review on two well-studied approaches that were initially conceptualized – and have been frequently discussed in the empirical literature – as client-centered alternatives to abstinence-based treatment. Of note, other SUD treatment approaches that could be adapted to target nonabstinence goals (e.g., contingency management, behavioral activation) are excluded from the current review due to lack of relevant empirical evidence.
In particular, cognitive restructuring is a critical component of interventions to lessen the abstinence violation effect. Thus, clients are taught to reframe their perception of lapses—to view them not as failures or indicators of a lack of willpower but as mistakes or errors in learning that signal the need for increased planning to cope more effectively in similar situations in the future. This perspective considers lapses key learning opportunities resulting from an interaction between coping and situational determinants, both of which can be modified in the future. 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.
Models of nonabstinence psychosocial treatment for SUD
Two publications, Cognitive Behavioral Coping Skills Training for Alcohol Dependence (Kadden et al., 1994; Monti, Kadden, Rohsenow, Cooney, & Abrams, 2002) and Cognitive Behavioral Therapy for Cocaine Addiction (Carroll, 1998), are based on the RP model and techniques. Although specific CBT interventions may focus more or less on particular techniques or skills, the primary goal of CBT for addictions is to assist clients in mastering skills that will allow them to become and remain abstinent from alcohol and/or drugs (Kadden et al., 1994). CBT treatments are usually guided by a manual, are relatively short term (12 to 16 weeks) in duration, and focus on the present and future. Clients are expected to monitor substance use (see Table 8.1) and complete homework exercises between sessions. The https://accountingcoaching.online/tips-for-treating-and-living-with-essential-tremor/ involves a high degree of negative emotions that accompany a relapse, which can create further conditions for continued substance use (i.e., relapses lead to emotion dysregulation, which leads to further substance use). A major advantage of harm-reduction approaches is that people can get back to sobriety more quickly when they relapse because they have planned for how to be effective when they have lapses (i.e., they help people prepare for the abstinence violation effect).
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. The verdict is strongest for interventions focused on identifying and resolving tempting situations, as most studies were concerned with these24. In the 1980s and 1990s, the HIV/AIDS epidemic prompted recognition of the role of drug use in disease transmission, generating new urgency around the adoption of a public health-focused approach to researching and treating drug use problems (Sobell & Sobell, 1995). The realization that HIV had been spreading widely among people who injected drugs in the mid-1980s led to the first syringe services programs (SSPs) in the U.S. (Des Jarlais, 2017). Early attempts to establish pilot SSPs were met with public outcry and were blocked by politicians (Anderson, 1991).
Specific Intervention strategies in Relapse Prevention
At least 74.8% of those deaths involved opioids, 14% involved Tips for Treating and Living With Essential Tremor Cleveland Clinic heroin, 26% involved psychostimulants, primarily…
This resistance to nonabstinence treatment persists despite strong theoretical and empirical arguments in favor of harm reduction approaches. These strategies also focus on enhancing the client’s awareness of cognitive, emotional, and behavioral reactions in order to prevent a lapse from escalating into a relapse. The first step in this process is to teach clients the RP model and to give them a “big picture” view of the relapse process. For example, the therapist can use the metaphor of behavior change as a journey that includes both easy and difficult stretches of highway and for which various “road signs” (e.g., “warning signals”) are available to provide guidance. According to this metaphor, learning to anticipate and plan for high-risk situations during recovery from alcoholism is equivalent to having a good road map, a well-equipped tool box, a full tank of gas, and a spare tire in good condition for the journey. Marlatt and Gordon (1980, 1985) have described a type of reaction by the drinker to a lapse called the abstinence violation effect, which may influence whether a lapse leads to relapse.
Does Abstinence Work?
While he considered 12-Step programs and other similar approaches to recovery to be useful, he also believed that the notions of a lapse and relapse were not realistically conceived by many recovery programs. An individual progresses through various stages of changes and the movement is influenced by several factors. Stages imply a readiness to change and therefore the TTM has been particularly relevant in the timing of interventions.
- According to these models, the relapse process begins prior to the first posttreatment alcohol use and continues after the initial use.
- Although reducing practical barriers to treatment is essential, evidence suggests that these barriers do not fully account for low rates of treatment utilization.
- But in cases in which a person is prone to this cognitive distortion, abstinence may not be the healthiest approach to take.
- For instance, one interesting manifestation of a lapse is something termed the abstinence violation effect.
A verbal or written contract will increase the chance that gamblers will recontact at an appropriate stage and therefore minimise the likelihood of a full blown relapse. DBT-SUD is a treatment for individuals with co-occurring disorders, that is, those who have both a SUD and a mental health diagnosis. Most research on DBT-SUD is with individuals who have SUD and Borderline Personality Disorder (BPD), although some research has been conducted with individuals with other mental health diagnoses that involve severe emotion dysregulation. This feature by Nick Salsman, PhD, ABPP is Part 1 of 2 in a series about DBT for substance use disorders. In this first part, Nick describes how DBT-SUD utilizes the approach of dialectical abstinence in the assessment and treatment of SUDs and how DBT-SUD utilizes the hierarchy of targets in Pretreatment and Stage 1. It was at these meetings that he finally decided that he was an alcoholic and that he needed to stop drinking.
4. Consequences of abstinence-only treatment
We summarize historical factors relevant to non-abstinence treatment development to illuminate reasons these approaches are understudied. Meanwhile, a study published in the Journal of Family Planning and Reproductive Health Care found adult women who engaged in voluntary sexual abstinence were less likely to have used illicit drugs, misused alcohol, or be unemployed. While this does not necessarily mean abstinence caused these women to make certain lifestyle choices, it may be that women who make these https://accountingcoaching.online/what-is-a-halfway-house-what-to-expect-in-halfway/ choices are more likely to go through periods of sexual abstinence. One helpful cognitive strategy in the initial phase of CBT includes using the Advantage/disadvantage technique with the patient29. The therapist and patient collaboratively review the advantages/disadvantages of engaging in substance use or addictive behaviour. Several behavioural strategies are reported to be effective in the management of factors leading to addiction or substance use, such as anxiety, craving, skill deficits2,7.
- A more recent development in the area of managing addictive behaviours is the application of the construct of mindfulness to managing experiences related to craving, negative affect and other emotional states that are believed to impact the process of relapse34.
- Inaction has typically been interpreted as the acceptance of substance cues which can be described as “letting go” and not acting on an urge.
- In addition to this, booster sessions over at least a 12 month period are advisable to ensure that a safety net is available since gamblers are renown for not recontacting sufficiently hastily when difficulties arise.
- Cue exposure is another behavioural technique based on the classical conditioning theory and theories of cue reactivity and extinction12,13.