The following section reviews selected empirical findings that support or coincide with tenets of the RP model. Because the scope of this literature precludes an exhaustive review, we highlight select findings that are relevant to the main tenets of the RP model, in particular those that coincide with predictions of the reformulated model of relapse. Understanding the AVE is crucial for individuals in recovery and those focused on healthier lifestyle choices. Instead of surrendering to the negative spiral, individuals can benefit from reframing the lapse as a learning opportunity and teachable moment. Recognizing the factors that contributed to the lapse, such as stressors or triggers, helps individuals to develop strategies and techniques to navigate similar challenges in the future. We calculated the relative risk (i.e. risk ratios (RRs)) for dichotomous variables (e.g. proportion of patients completely abstinent) and standardized mean differences (SMDs) for continuous variables (e.g. PDA) using 95% confidence intervals (CIs) to express the uncertainty of the estimate.
Models of nonabstinence psychosocial treatment for SUD
In focusing exclusively on addictive behaviors (for which the RP model was initially conceived) we forego a discussion of RP as it relates to various other behavioral domains (e.g., sexual offending, depression, diet and exercise) and refer readers to other sources for updates on the growing range of RP applications [8,11]. Researchers have long posited that offering goal choice (i.e., nonabstinence 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). Because relapse is the most common outcome of treatment for addictions, it must be addressed, anticipated, and prepared for during treatment. The RP model views relapse not as a failure, but as part of the recovery process and an opportunity for learning. Marlatt (1985) describes an abstinence violation effect (AVE) that leads people to respond to any return to drug or alcohol use after a period of abstinence with despair and a sense of failure. By undermining confidence, these negative thoughts and feelings increase the likelihood that an isolated “lapse” will lead to a full-blown relapse.
1. Nonabstinence psychosocial treatment models
They assume a distinction between stress coping skills, which are responses intended to deal with general life stress, and temptation coping skills, which are coping responses specific to situations in which there are temptations for substance which could contribute to relapse13. Despite findings like these, many studies of treatment mechanisms have failed to show that theoretical mediators account for salutary effects of CBT-based interventions. Also, many studies that have examined potential mediators of outcomes have not provided a rigorous test [129] of mechanisms of change. These results suggest that researchers should strive to consider alternative mechanisms, improve assessment methods and/or revise theories about how CBT-based interventions work [77,130]. Although withdrawal is usually viewed as a physiological process, recent theory emphasizes the importance of behavioral withdrawal processes [66]. Whereas physiological withdrawal symptoms tend to abate in the days or weeks following drug cessation, the unavailability of a conditioned behavioral coping response (e.g., the ritual of drug administration) may leave the former user ill-equipped to cope with ongoing stressors, thus exacerbating and/or prolonging symptoms [66].
- Set realistic expectations for your recovery journey, understanding that progress may not always be linear.
- This disinhibition of dietary restraint has been replicated numerous times [20,28] and demonstrates that dieters often eat a great deal after they perceive their diets to be broken.
- They assume a distinction between stress coping skills, which are responses intended to deal with general life stress, and temptation coping skills, which are coping responses specific to situations in which there are temptations for substance which could contribute to relapse13.
- If we can keep others from making the same mistakes, our experiences will serve a wonderful purpose.
- Moderation analyses suggested that RP was consistently efficacious across treatment modalities (individual vs. group) and settings (inpatient vs. outpatient)22.
Psychological Theories of Alcohol Consumption
Such findings have contributed to renewed interest in negative reinforcement models of drug use [63]. Administrative discharge due to substance use is not a necessary practice even within abstinence-focused treatment (Futterman, Lorente, & Silverman, 2004), and is likely linked to the assumption that continued use indicates lack of readiness for treatment, and that abstinence is the sole marker of treatment success. 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.
While maintaining its footing in cognitive-behavioral theory, the revised model also draws from nonlinear dynamical systems theory (NDST) and catastrophe theory, both approaches for understanding the operation of complex systems [10,33]. Detailed discussions of relapse in relation to NDST and catastrophe theory are available elsewhere [10,31,34]. The RP model developed by Marlatt [7,16] provides both a conceptual framework for understanding relapse and a set of treatment strategies designed to limit relapse likelihood and severity. Because detailed accounts of the model’s historical background and theoretical underpinnings have been published elsewhere (e.g., [16,22,23]), we limit the current discussion to a concise review of the model’s history, core concepts and clinical applications.
Empirical findings relevant to the RP model
Abstinence violation effect can be overcome, but it is far better to avoid suffering AVE in the first place. Enroll in Amethyst Recovery, and you’ll learn the skills you need to practice effective relapse prevention. Looking back does have its benefits in that it helps us identify weaknesses in our program. The problem is that abstinence violation effect magnifies these weaknesses and prevents us from seeking solutions.
- Shiffman and colleagues describe stress coping where substance use is viewed as a coping response to life stress that can function to reduce negative affect or increase positive affect.
- We remember that our urges do not control us, that we have power over our own decisions.
- 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].
2. Controlled drinking
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). In addition to shaping mainstream addiction treatment, the abstinence-only 12-Step model also had an indelible effect on the field of SUD treatment research. Most scientists who studied SUD treatment believed that abstinence was the only acceptable treatment goal until at least the 1980s (Des Jarlais, 2017).
About 10% of individuals who report cannabis use in the past year meet criteria for a cannabis use disorder, while this proportion increases to 18%, 19%, 58%, and 65% of those with past year use of cocaine, opioids (misuse), methamphetamine, and heroin, respectively. These data suggest https://ecosoberhouse.com/ that non-disordered drug use is possible, even for a substantial portion of individuals who use drugs such as heroin (about 45%). However, they do not elucidate patterns of non-disordered use over time, nor the likelihood of maintaining drug use without developing a DUD.
- Among social variables, the degree of social support available from the most supportive person in the network may be the best predictor of reducing drinking, and the number of supportive relationships also strongly predicts abstinence.
- Third, variants implicated in broad traits relevant for addictive behaviors–for instance, executive cognitive functioning (e.g., COMT) or externalizing traits (e.g., GABRA2, DRD4)–could influence relapse proneness via general neurobehavioral mechanisms, irrespective of drug class or treatment modality.
- She hopes to continue investigating implicit and explicit measures of substance abuse in the future.
- In addition to these areas, which already have initial empirical data, we predict that we could learn significantly more about the relapse process using experimental manipulation to test specific aspects of the cognitive-behavioral model of relapse.
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).
Most notably, we provide a recent update of the RP literature by focusing primarily on studies conducted within the last decade. We also provide updated reviews of research areas that have seen notable growth in the last few years; in particular, the application of advanced statistical modeling techniques to large treatment outcome datasets and the development of mindfulness-based relapse prevention. Additionally, we review the nascent but rapidly growing literature on genetic predictors of relapse following substance use interventions.