آرشیو ماهانه: ژوئن 2020

Expanding the continuum of substance use disorder treatment: Nonabstinence approaches PMC

Client is taught that overcoming the problem behaviour is not about will power rather it has to do with skills acquisition. Another technique is that the road to abstinence is broken down to smaller achievable targets so that client can easily master the task enhancing self-efficacy. Also, therapists can provide positive feedback of achievements that the client has been able to make in other facets of life6. Critical for craving and relapse is the process of associative learning, whereby environmental stimuli repeatedly paired with drug consumption acquire incentive-motivational value, evoking expectation of drug availability and memories of past drug euphoria15. 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. Approach oriented participants may see themselves as more responsible for their actions, including lapse, while avoidance-based coping may focus more on their environment than on their own actions14.

Global Lifestyle Self-Control Strategies

• This lapse, in turn, can result in feelings of guilt and failure (i.e., an abstinence violation effect).
• In this context, a critical question will concern the predictive and clinical utility of brain-based measures with respect to predicting treatment outcome.
• Still, some have criticized the model for not emphasizing interpersonal factors as proximal or phasic influences [122,123].

First characterized as an important ingredient in the relapse process in the mid-1980s, the AVE has profound relevance for addiction professionals today. In our era of heightened overdose risk, the AVE is more likely than ever to have tragic effects. Lapses are, however, a major risk factor for relapse as well as overdose and other potential social, personal, and legal consequences of drug or alcohol abuse.

• Recent reviews provide a convincing rationale for the putative role of implicit processes in addictive behaviors and relapse [54,56,57].
• 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.
• It’s fine to acknowledge them, but not to dwell on them, because they could hinder the most important action to take immediately—seeking help.
• High-risk situations include both internal experiences—positive memories of using or negative thoughts about the difficulty of resisting impulses—and situational cues.
• Furthermore, the use of FDA-approved medications (which not all clients will view as “abstinence”) has been shown to produce the best health and recovery outcomes for people with opioid use disorders.

Relapse road maps

• Finally, an intriguing direction is to evaluate whether providing clients with personalized genetic information can facilitate reductions in substance use or improve treatment adherence [110,111].
• Lapses may also evoke physiological (e.g., alleviation of withdrawal) and/or cognitive (e.g., the AVE) responses that in turn determine whether use escalates or desists.
• There has been little research on the goals of non-treatment-seeking individuals; however, research suggests that nonabstinence goals are common even among individuals presenting to SUD treatment.
• They found that their controlled drinking intervention produced significantly better outcomes compared to usual treatment, and that about a quarter of the individuals in this condition maintained controlled drinking for one year post treatment (Sobell & Sobell, 1973).

Relapse in addiction is of particular concern because it poses the risk of overdose if someone uses as much of the substance as they did before quitting. More and more, behavioral health organizations are moving away from “kicking people out of treatment” if they return to substance use. This type of policy is increasingly recognized as scientifically un-sound, given that continued substance use despite consequences is a hallmark symptom of the disease of addiction. Although it may be helpful for treatment centers to incorporate small penalties or rewards for specific client behaviors (for example, as part of a contingency management program), enforcing harsh consequences when clients do not maintain total abstinence will only exacerbate the AVE.

A Lapse Vs. A Relapse

The term relapse may be used to describe a prolonged return to substance use, whereas lapsemay be used to describe discrete, circumscribed… Many factors play a role in a person’s decision to misuse legal or illegal psychoactive substances, and different schools of thinking https://ecosoberhouse.com/ assign different weight to the role each factor plays. Recovery benefits from a detailed relapse prevention plan kept in a handy place—next to your phone charger, taped to the refrigerator door or the inside of a medicine cabinet—for immediate access when cravings hit.

Cognitive Dissonance

However, broadly speaking, there are clear features of 12-step programs that can contribute to the AVE. For instance, a person recovering from alcohol use disorder who has a drink may feel a sense of confusion or a lack of control and they may make unhealthy abstinence violation effect attributions or rationalizations to try to define and understand what they’re doing. Rather than labeling oneself as a failure, weak, or a loser, recognizing the effort and progress made before the lapse can provide a more balanced perspective.

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 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. Oxford English Dictionary defines motivation as “the conscious or unconscious stimulus for action towards a desired goal provided by psychological or social factors; that which gives purpose or direction to behaviour. Motivation may relate to the relapse process in two distinct ways, the motivation for positive behaviour change and the motivation to engage in the problematic behaviour.

Consistent with the RP model, changes in coping skills, self-efficacy and/or outcome expectancies are the primary putative mechanisms by which CBT-based interventions work [126]. One study, in which substance-abusing individuals were randomly assigned to RP or twelve-step (TS) treatments, found that RP participants showed increased self-efficacy, which accounted for unique variance in outcomes [69]. Further, there was strong support that increases in self-efficacy following drink-refusal skills training was the primary mechanism of change. In another study examining the behavioral intervention arm of the COMBINE study [128], individuals who received a skills training module focused on coping with craving and urges had significantly better drinking outcomes via decreases in negative mood and craving that occurred after receiving the module.

Models of nonabstinence psychosocial treatment for SUD

This does not mean that 12-step is an ineffective or counterproductive source of recovery support, but that clinicians should be aware that 12-step participation may make a client’s AVE more pronounced. Therapists also can enhance self-efficacy by providing clients with feedback concerning their performance on other new tasks, even those that appear unrelated to alcohol use. In general, success in accomplishing even simple tasks (e.g., showing up for appointments on time) can greatly enhance a client’s feelings of self-efficacy.