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

In 1990, Marlatt was introduced to the philosophy of harm reduction during a 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). Marlatt’s work inspired the development of multiple nonabstinence treatment models, including harm reduction psychotherapy (Blume, 2012; Denning, 2000; Tatarsky, 2002). Additionally, while https://ecosoberhouse.com/ early studies of SUD treatment used abstinence as the single measure of treatment effectiveness, by the late 1980s and early 1990s researchers were increasingly incorporating psychosocial, health, and quality of life measures (Miller, 1994). Only a small minority of people with substance use disorders (SUDs) receive treatment. A focus on abstinence is pervasive in SUD treatment, defining success in both research and practice, and punitive measures are often imposed on those who do not abstain.

Access to aftercare support and programs can also help you to avoid and recover from the AVE. The abstinence violation effect is also considered an immediate factor of relapse. In the meantime, by keeping AVE in mind, perhaps Oprah and the rest of us will have a better chance of sticking with our 2009 resolutions.

Does 12-Step Contribute to the AVE?

This resistance to nonabstinence treatment persists despite strong theoretical and empirical arguments in favor of harm reduction approaches. 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. Traditional alcoholism treatment approaches often conceptualize relapse as an end-state, a negative outcome equivalent to treatment failure. Thus, this perspective considers only a dichotomous treatment outcome—that is, a person is either abstinent or relapsed.

According to drug and alcohol research, negative emotions after relapsing can increase your risk of another relapse in the future. If you relapse on drugs or alcohol, relapsing can also be seen as a personal failure or a lack of willpower, which can lead to feelings of guilt, shame, and an increased risk of relapsing again. If you see a relapse as an opportunity to learn, and not a failure, your chances of managing your addiction can improve.

2. Established treatment models compatible with nonabstinence goals

Little attention was given to whether people in abstinence-focused treatments endorsed abstinence goals themselves, or whether treatment could help reduce substance use and related problems for those who did not desire (or were not ready for) abstinence. There are many relapse prevention models used in substance abuse treatment to counter AVE and give those in recovery important tools and coping skills. The AVE was introduced into the substance abuse literature within the context of the “relapse process” (Marlatt and Gordon 1985, p. 37).

• Because of heightened overdose risk, treatment providers can offer naloxone and overdose prevention training to all clients, even those whose “drug of choice” does not include opioids.
• One of the most important efficacy-enhancing strategies employed in RP is the emphasis on collaboration between the client and therapist instead of a more typical “top down” doctor-patient relationship.
• This resistance to nonabstinence treatment persists despite strong theoretical and empirical arguments in favor of harm reduction approaches.
• Therefore, we advise health practitioners to support their clients by helping them to identify personal risk situations and formulating corresponding coping plans.
• Conversely, people with ineffective coping responses will experience decreased self-efficacy, which, together with the expectation that alcohol use will have a positive effect (i.e., positive outcome expectancies), can result in an initial lapse.
• Relapse triggers a sense of failure, shame, and a slew of other negative feelings.
• For the health practitioners, all new statements were directly entered into the online software.

Cravings can be dealt with in a great variety of ways, and each person needs as array of coping strategies to discover which ones work best and under what circumstances. Another is to carefully plan days so that they are filled with healthy, absorbing activities that give little time for rumination to run wild. Exercise, listening to music, getting sufficient rest—all can have a role in taking the focus off cravings. And all strategies boil down to getting comfortable with being uncomfortable. Changing bad habits of any kind takes time, and thinking about success and failure as all-or-nothing is counterproductive.

Future research

Relapse has been variously defined, depending on theoretical orientation, treatment goals, cultural context, and target substance (Miller 1996; White 2007). It is, however, most commonly used to refer to a resumption of substance use behavior after a period of abstinence from substances (Miller 1996). The term relapse may be used to describe a prolonged return to substance use, whereas lapsemay be used to describe discrete, circumscribed… The results reported in the RREP study indicate that the original relapse taxonomy of the RP model has only moderate inter-rater reliability at the highest level of specificity, although reliability of the more general categories (e.g., negative affect and social pressure) was better.

Amanda completed her Doctor of Nursing Practice and Post Masters Certification in Psychiatry at Florida Atlantic University. She is a current member of the Golden Key International Honor Society and the Delta Epsilon Iota Honor Society. Regard Healthcare offers 100% confidential substance abuse assessment and treatment placement tailored to your individual needs.

They are particularly prone to relapse because they spent their formative years engaged with substances rather than developing a strong social support network, learning basic life skills, or gaining academic achievement—all positive predictors of success. Learning what one’s triggers are and acquiring an array of techniques for dealing with them should be essential components of any recovery program. There is an important distinction to be made between a lapse, or slipup, and a relapse.