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. Indeed, there is anecdotal evidence that this may be the case; for example, a qualitative study of nonabstinence drug treatment in Denmark described a client saying that he would not have presented to abstinence-only treatment due to his goal of moderate use (Järvinen, 2017). Additionally, in the United Kingdom, where there is greater access to nonabstinence treatment (Rosenberg & Melville, 2005; Rosenberg & Phillips, 2003), the proportion of individuals with opioid use disorder engaged abstinence violation effect in treatment is more than twice that of the U.S. (60% vs. 28%; Burkinshaw et al., 2017). 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.
Changes in brain activity in response to problem solving during the abstinence from online game play
Nevertheless, 40 to 60% of people who once were addicted to a substance and achieved sobriety relapse at some point, based on estimates from the National Institute on Drug Abuse (NIDA). A person’s guilt is a difficult emotion to carry, one that can constantly replay in their minds, causing them to use substances again to ease their guilt. Fortunately, professional treatment for addiction can improve outcomes for people experiencing the Abstinence Violation Effect. Twelve-month relapse rates following alcohol or drug cessation attempts can range from 60 to 90 percent, and the AVE can contribute to extended relapses.
- Many people can relate to this feeling of guilt when they use a substance, like alcohol or marijuana, after promising themselves they wouldn’t.
- His work focuses on social, motivational, and spiritual influences in etiology, prevention, and treatment of health and risk behaviors.
- Most often, relapse tends to be construed as a return to pretreatment levels of occurrence of the targeted behavior.
- 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.
- It is for this reason that someone’s tolerance declines following a period of abstinence and that they may overdose if they start using again at the same level as before.
- Marlatt, in particular, became well known for developing nonabstinence treatments, such as BASICS for college drinking (Marlatt et al., 1998) and Relapse Prevention (Marlatt & Gordon, 1985).
Genetic influences on treatment response and relapse
Ultimately, individuals who are struggling with behavior change often find that making the initial change is not as difficult as maintaining behavior changes over time. Many therapies (both behavioral and pharmacological) have been developed to help individuals cease or reduce addictive behaviors and it is critical to refine strategies for helping individuals maintain treatment goals. As noted by McLellan [138] and others [124], it is imperative that policy makers support adoption of treatments that incorporate a continuing care approach, such that addictions treatment is considered from a chronic (rather than acute) care perspective.
- Findings concerning possible genetic moderators of response to acamprosate have been reported [99], but are preliminary.
- In the assessment of addiction, it is not simply an individual’s psychological state while actively engaged in a behavior that is taken into account, but also how they react to situations where they are prevented, whether voluntarily or involuntarily, from engaging in a behavior.
- While withdrawal and craving were investigated to a fair extent across the studies, the study of relapse using abstinence protocols is underutilized within behavioral addiction research.
- Instead of surrendering to the negative spiral, individuals can benefit from reframing the lapse as a learning opportunity and teachable moment.
Craving for internet games? Withdrawal symptoms from an 84-h abstinence from massively multiplayer online gaming
Studies that have examined abstinence as a temporary goal, even if the time frame exceeds the initial 4-week acute withdrawal stage (e.g., a 90-day celibacy contract), are also of interest because they would be especially useful for evaluating temporary abstinence as a potential clinical intervention. The last decade has seen a marked increase in the number of human molecular genetic studies in medical and behavioral research, due largely to rapid technological advances in genotyping platforms, decreasing cost of molecular analyses, and the advent of genome-wide association studies (GWAS). Not surprisingly, molecular genetic approaches have increasingly been incorporated in treatment outcome studies, allowing novel opportunities to study biological influences on relapse. Given the rapid growth in this area, we allocate a portion of this review to discussing initial evidence for genetic associations with relapse.
Journal of Studies on Alcohol
Social pressure may be experienced directly, such as peers trying to convince a person to use, or indirectly through modelling (e.g. a friend ordering a drink at dinner) and/or cue exposure. Outcome expectancies can be defined as an individual’s anticipation or belief of the effects of a behaviour on future experience3. 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. Those who drink the most tend to have higher expectations regarding the positive effects of alcohol9.
Relapse prevention programmes addressing not just the addictive behaviour, but also factors that contribute to it, thereby decreasing the probability of relapse. Addictive behaviours are characterized by a high degree of co-morbidity and these may interfere with treatment response. In the first study to examine relapse in relation to phasic changes in SE [46], researchers reported results that appear consistent with the dynamic model of relapse. During a smoking cessation attempt, participants reported on SE, negative affect and urges at random intervals. Findings indicated nonlinear relationships between SE and urges, such that momentary SE decreased linearly as urges increased but dropped abruptly as urges peaked. Moreover, this finding appeared attributable to individual differences in baseline (tonic) levels of SE.
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. While there is evidence that a subset of individuals who use drugs engage in low-frequency, non-dependent drug use, there is insufficient research on this population to determine the proportion for whom moderation is a feasible treatment goal. However, among individuals with severe SUD and high-risk drug or alcohol use, the urgency of reducing substance-related harms presents a compelling argument for engaging these individuals in harm reduction-oriented treatment and interventions.
Cognitive neuroscience of self-regulation failure
- More recent developments in the area of managing addictions include third wave behaviour therapies.
- Harm reduction therapy has also been applied in group format, mirroring the approach and components of individual harm reduction psychotherapy but with added focus on building social support and receiving feedback and advice from peers (Little, 2006; Little & Franskoviak, 2010).
- Tonic processes include distal risks–stable background factors that determine an individual’s “set point” or initial threshold for relapse [8,31].
- Unlike substance addictions, behavioral addictions do not involve direct contact with brain synapses through the introduction of an exogenous ligand, but instead alter endogenous ligand functions.
- 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.
One study found that momentary coping reduced urges among smokers, suggesting a possible mechanism [76]. Some studies find that the number of coping responses is more predictive of lapses than the specific type of coping used [76,77]. However, despite findings that coping can prevent lapses there is scant evidence to show that skills-based interventions in fact lead to improved coping [75]. Researchers have long posited that offering goal choice (i.e., non-abstinence and abstinence treatment options) may be key to engaging more individuals in SUD treatment, including those earlier in their addictions (Bujarski et al., 2013; Mann et al., 2017; Marlatt, Blume, & Parks, 2001; Sobell & Sobell, 1995). Advocates of nonabstinence approaches often point to indirect evidence, including research examining reasons people with SUD do and do not enter treatment.
