Year: 2020

Learning what one’s triggers are and acquiring an array of techniques for dealing with them should be essential components of any recovery program. Most importantly, 12-step programs tend to be abstinence-based, emphasizing that an authentic or high-quality recovery depends on abstaining completely from drugs and alcohol. Furthermore, 12-step programs often celebrate abstinence milestones and encourage participants to count abstinent days, leading to a perception that someone who resumes substance use is “going back to the beginning” and has not made progress in recovery. Several studies over the past two decades have evaluated the reliability and predictive validity2 of the RP model as well as the efficacy of treatment techniques based on this model. One recent large-scale research effort assessing the RP model was the Relapse Replication and Extension Project (RREP), which was funded by the National Institute on Alcohol Abuse and Alcoholism (Lowman et al. 1996).

2. Established treatment models compatible with nonabstinence goals

Nonabstinence approaches to SUD treatment have a complex and contentious history, and significant social and political barriers have impeded research and implementation of alternatives to abstinence-focused treatment. We summarize historical factors relevant to non-abstinence treatment development to illuminate reasons these approaches are understudied. Global self-management strategy involves encouraging clients to pursue again those previously satisfying, nondrinking recreational activities.

A Lapse Vs. A Relapse

In addition, relaxation training, time management, and having a daily schedule can be used to help clients achieve greater lifestyle balance. Interpersonal relationships and support systems are highly influenced by intrapersonal processes such as emotion, coping, and expectancies18. Inaction has typically been interpreted as the acceptance of substance cues which can be described as “letting go” and not acting on an urge.

Specific Intervention strategies in Relapse Prevention

Olanzapine was found to reduce alcohol-related craving those with the long-repeat VNTR (DRD4 L), but not individuals with the short-repeat version (DRD4 S; [100,101]). Further, a randomized trial of olanzapine led to significantly improved drinking outcomes in DRD4 L but not DRD4 S individuals [100]. The dynamic model of relapse assumes that relapse can take the form of sudden and unexpected returns to the target behavior. This concurs not only with clinical observations, but also with contemporary learning models stipulating that recently modified behavior is inherently unstable and easily swayed by context [32]. 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].

4. Consequences of abstinence-only treatment

Implicit cognitive processes are also being examined as an intervention target, with some potentially promising results [62]. Broadly speaking, there are at least three primary contexts in which genetic variation could influence liability for relapse during or following treatment. First, in the context of pharmacotherapy interventions, relevant genetic variations can impact drug pharmacokinetics or pharmacodynamics, thereby moderating treatment response (pharmacogenetics). Second, the likelihood of abstinence following https://ecosoberhouse.com/ a behavioral or pharmacological intervention can be moderated by genetic influences on metabolic processes, receptor activity/expression, and/or incentive value specific to the addictive substance in question. 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.

Understand The Relapse Process

Such findings have contributed to renewed interest in negative reinforcement models of drug use [63]. Given the abstinence focus of many SUD treatment centers, studies may need to recruit using community outreach, which can yield fewer participants compared to recruiting from treatment (Jaffee et al., 2009). However, this approach is consistent with the goal of increasing treatment utilization by reaching those who may not otherwise present to treatment. Alternatively, researchers who conduct trials in community-based treatment centers will need to obtain buy-in to test nonabstinence approaches, which may necessitate waiving facility policies regarding drug use during treatment – a significant hurdle.

• In a recent review of the literature on relapse precipitants, Dimeff and Marlatt (1998) also concluded that considerable support exists for the notion that an abstinence violation effect can precipitate a relapse.
• Relapse, or the return to heavy alcohol use following a period of abstinence or moderate use, occurs in many drinkers who have undergone alcoholism treatment.
• These choices have been termed “apparently irrelevant decisions” (AIDs), because they may not be overtly recognized as related to relapse but nevertheless help move the person closer to the brink of relapse.

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 abstinence violation effect for AUD in the 1980s and later (Blume, 2012; Sobell & Sobell, 1995). 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). Like the Sobells, Marlatt showed that reductions in drinking and harm were achievable in nonabstinence treatments (Marlatt & Witkiewitz, 2002).

4. Current status of nonabstinence SUD treatment

Lack of consensus around target outcomes also presents a challenge to evaluating the effectiveness of nonabstinence treatment. Experts generally recommend that SUD treatment studies report substance use as well as related consequences, and select primary outcomes based on the study sample and goals (Donovan et al., 2012; Kiluk et al., 2019). While AUD treatment studies commonly rely on guidelines set by government agencies regarding a “low-risk” or “nonhazardous” level of alcohol consumption (e.g., Enggasser et al., 2015), no such guidelines exist for illicit drug use.

Attending or resuming attending meetings of some form of mutual support group can be extremely valuable immediately after a lapse or relapse. Discussing the relapse can yield valuable advice on how to continue recovery without succumbing to the counterproductive feelings of shame or self-pity. Typically, those recovering from addiction are filled with feelings of guilt and shame, two powerful negative emotions. Guilt reflects feelings of responsibility or remorse for actions that negatively affect others; shame reflects deeply painful feelings of self-unworthiness, arising from the belief that one is inherently flawed in some way. As a result, those recovering from addiction can be harsh inner critics of themselves and believe they do not deserve to be healthy or happy. How individuals deal with setbacks plays a major role in recovery—and influences the very prospects for full recovery.