Content
Currently, the dynamic model can be viewed as a hypothetical, theory-driven framework that awaits empirical evaluation. Testing the model’s components will require that researchers avail themselves of innovative assessment techniques (such as EMA) and pursue cross-disciplinary collaboration in order to integrate appropriate statistical methods. Irrespective of study design, greater integration of distal and proximal variables will aid in modeling the interplay of tonic and phasic influences on relapse outcomes. As was the case for Marlatt’s original RP model, efforts are needed to systematically evaluate specific theoretical components of the reformulated model [1]. Withdrawal tendencies can develop early in the course of addiction [25] and symptom profiles can vary based on stable intra-individual factors [63], suggesting the involvement of tonic processes. Despite serving as a chief diagnostic criterion, withdrawal often does not predict relapse, perhaps partly explaining its de-emphasis in contemporary motivational models of addiction [64].
A “controlled drinking controversy” followed, in which the Sobells as well as those who supported them were publicly criticized due to their claims about controlled drinking, and the validity of their research called into question (Blume, 2012; Pendery, Maltzman, & West, 1982). Despite the intense controversy, the Sobell’s high-profile research paved the way for additional studies of nonabstinence treatment for AUD in the 1980s and later (Blume, 2012; Sobell & Sobell, 1995). Marlatt, in particular, became abstinence violation effect well known for developing nonabstinence treatments, such as BASICS for college drinking (Marlatt et al., 1998) and Relapse Prevention (Marlatt & Gordon, 1985). Like the Sobells, Marlatt showed that reductions in drinking and harm were achievable in nonabstinence treatments (Marlatt & Witkiewitz, 2002). The abstinence violation effect (AVE) highlights the distinction between a lapse and relapse. Put simply, the AVE occurs when a client perceives no intermediary step between a lapse and a relapse.
Outcome expectancies
While a lapse might prompt a full-blown relapse, another possible outcome is that the problem behavior is corrected and the desired behavior re-instantiated–an event referred to as prolapse. A critical implication is that rather than signaling a failure in the behavior change process, lapses can be considered temporary setbacks that present opportunities for new learning to occur. In viewing relapse as a common (albeit undesirable) event, emphasizing contextual antecedents over internal causes, and distinguishing relapse from treatment failure, the RP model introduced a comprehensive, flexible and optimistic alternative to traditional approaches.
The harm reduction movement, and the wider shift toward addressing public health impacts of drug use, had both specific and diffuse effects on SUD treatment research. In 1990, Marlatt was introduced to the philosophy of harm reduction during a https://ecosoberhouse.com/article/why-alcohol-makes-you-feel-hot-and-sweat-after-drinking/ trip to the Netherlands (Marlatt, 1998). He adopted the language and framework of harm reduction in his own research, and in 1998 published a seminal book on harm reduction strategies for a range of substances and behaviors (Marlatt, 1998).
AVE and the 12-Step Approach
In another recent study, researchers trained participants in attentional bias modification (ABM) during inpatient treatment for alcohol dependence and measured relapse over the course of three months post-treatment [62]. Relative to a control condition, ABM resulted in significantly improved ability to disengage from alcohol-related stimuli during attentional bias tasks. While incidence of relapse did not differ between groups, the ABM group showed a significantly longer time to first heavy drinking day compared to the control group. Additionally, the intervention had no effect on subjective measures of craving, suggesting the possibility that intervention effects may have been specific to implicit cognitive processes [62].
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. 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).
What Is The Difference Between A Lapse And Relapse?
In contrast, individuals with greater SUD severity, who are more likely to have abstinence goals, generally have the best outcomes when working toward abstinence (Witkiewitz, 2008). Together, this suggests a promising degree of alignment between goal selection and probability of success, and it highlights the potential utility of nonabstinence treatment as an “early intervention” approach to prevent SUD escalation. The past 20 years has seen growing acceptance of harm reduction, evidenced in U.S. public health policy as well as SUD treatment research. Thirty-two states now have legally authorized SSPs, a number which has doubled since 2014 (Fernández-Viña et al., 2020).
- 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 therapist therefore planned to improve his motivation for seeking help and changing his perspective about his confidence (motivational interviewing).
- Social-cognitive and behavioral theories believe relapse begins before the person actually returns to substance abuse.
- Although reducing practical barriers to treatment is essential, evidence suggests that these barriers do not fully account for low rates of treatment utilization.
- As such, these cognitive constructs have both a stable and enduring effect emanating from the individual’s general cognitive beliefs as well as a malleable and plastic effect emanating from upon the individual’s moment-to-moment experiences.
- 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).
This protects their sobriety and enhances their ability to protect themselves from future threats of relapse. There is a large literature on self-efficacy and its predictive relation to relapse or the maintenance of abstinence. Before any substance use even occurs, clinicians can talk to clients about the AVE and the cognitive distortions that can accompany it. This preparation can empower a client to avoid relapse altogether or to lessen the impact of relapse if it occurs. Abstinence may have varying levels of effectiveness depending on the context in which it’s applied.
2. Controlled drinking
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. The Institute for Research, Education and Training in Addictions (IRETA) is an independent 501(c)3 nonprofit located in Pittsburgh, PA. As with all things 12-step, the emphasis on accumulating “time” and community reaction to a lapse varies profoundly from group to group, which makes generalizations somewhat unhelpful. However, broadly speaking, there are clear features of 12-step programs that can contribute to the AVE.
- The recently introduced dynamic model of relapse [8] takes many of the RREP criticisms into account.
- However, to date there have been no published empirical trials testing the effectiveness of the approach.
- Additionally, the intervention had no effect on subjective measures of craving, suggesting the possibility that intervention effects may have been specific to implicit cognitive processes [62].
- Overall, a large volume of research has yielded no consensus operational definition of the term [14,15].
Cognitive behavioural therapies are empirically supported interventions in the management of addictive behaviours. CBT comprises of heterogeneous treatment components that allow the therapist to use this approach across a variety of addictive behaviours, including behavioural addictions. Relapse prevention programmes addressing not just the addictive behaviour, but also factors that contribute to it, thereby decreasing the probability of relapse.
The use of functional magnetic resonance imaging (fMRI) techniques in addictions research has increased dramatically in the last decade [131] and many of these studies have been instrumental in providing initial evidence on neural correlates of substance use and relapse. In one study of treatment-seeking methamphetamine users [132], researchers examined fMRI activation during a decision-making task and obtained information on relapse over one year later. Based on activation patterns in several cortical regions they were able to correctly identify 17 of 18 participants who relapsed and 20 of 22 who did not.
