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- Miller and Hester reviewed more than 500 alcoholism outcome studies and reported that more than 75% of subjects relapsed within 1 year of treatment1.
- Moreover, people who have coped successfully with high-risk situations are assumed to experience a heightened sense of self-efficacy4.
- Functional imaging is increasingly being incorporated in treatment outcome studies (e.g., ) and there are increasing efforts to use imaging approaches to predict relapse .
- For instance, twelve-month relapse rates following alcohol or tobacco cessation attempts generally range from 80-95% [1,4] and evidence suggests comparable relapse trajectories across various classes of substance use [1,5,6].
- Given the rapid growth in this area, we allocate a portion of this review to discussing initial evidence for genetic associations with relapse.
- In the 1970s, the pioneering work of a small number of alcohol researchers began to challenge the existing abstinence-based paradigm in AUD treatment research.
Outcome expectancies (anticipated effects of substance use; ) also figure prominently in the RP model. Additionally, attitudes or beliefs about the causes and meaning of a lapse may influence whether a full relapse ensues. Viewing a lapse as a personal failure may lead to feelings of guilt and abandonment of the behavior change goal . This reaction, termed the Abstinence Violation Effect (AVE; ), is considered more likely when one holds a dichotomous view of relapse and/or neglects to consider situational explanations for lapsing. In sum, the RP framework emphasizes high-risk contexts, coping responses, self-efficacy, affect, expectancies and the AVE as primary relapse antecedents. 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).
Those participating in VM were compared to a treatment as usual (TAU) group on measures of post-incarceration substance use and psychosocial functioning. Relative to the TAU group, the VM group reported significantly lower levels of substance use and alcohol-related consequences and improved psychosocial functioning at follow-up . A key contribution of the reformulated relapse model is to highlight the need for non-traditional assessment and analytic approaches to better understand relapse. Most studies of relapse rely on statistical methods that assume continuous linear relationships, but these methods may be inadequate for studying a behavior characterized by discontinuity and abrupt changes . Consistent with the tenets of the reformulated RP model, several studies suggest advantages of nonlinear statistical approaches for studying relapse.
Miller, whose seminal work on motivation and readiness for treatment led to multiple widely used measures of SUD treatment readiness and the development of Motivational Interviewing, also argued for the importance of goal choice in treatment (Miller, 1985). Drawing from Intrinsic Motivation Theory (Deci, 1975) and the controlled drinking literature, Miller (1985) argued that clients benefit most when offered choices, both for drinking goals and intervention approaches. A key point in Miller’s theory is that motivation for change is “action-specific”; he argues that no one is “unmotivated,” but that people are motivated to specific actions or goals (Miller, 2006). One critical goal will be to integrate empirically supported substance use interventions in the context of continuing care models of treatment delivery, which in many cases requires adapting existing treatments to facilitate sustained delivery .
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). AA was established in 1935 as a nonprofessional mutual aid group for people who desire abstinence from alcohol, and its 12 Steps became integrated in SUD treatment programs in the 1940s and 1950s with the emergence of the Minnesota Model of treatment (White & Kurtz, 2008). The Minnesota Model involved inpatient SUD treatment incorporating principles of AA, with a mix of professional and peer support staff (many of whom were members of AA), and a requirement that patients attend AA or NA meetings as part of their treatment (Anderson, McGovern, & DuPont, 1999; McElrath, 1997).
The treatment is not lapse prevention; lapses are to be expected, planned for, and taken as opportunities for the client to demonstrate learning. Most often, relapse tends to be construed as a return to pretreatment levels of occurrence of the targeted behavior. Although there is some debate about the best definitions of lapse and relapse from theoretical and conceptual levels, these definitions should suffice.
Etiological Influences in Eating Disorders
Our treatment options include detox, inpatient treatment, outpatient treatment, medication-assisted treatment options, and more. These patterns can be actively identified and corrected, helping participants avoid lapses before they occur and continue their recovery from substance use disorder. Triggers include cravings, problematic thought patterns, and external cues or situations, all of which can contribute to increased self-efficacy (a sense of personal confidence, identity, and control) when properly managed. Lapses are, however, a major risk factor for relapse as well as overdose and other potential social, personal, and legal consequences of drug or alcohol abuse. Although many developments over the last decade encourage confidence in the RP model, additional research is needed to test its predictions, limitations and applicability. In particular, given recent theoretical revisions to the RP model, as well as the tendency for diffuse application of RP principles across different treatment modalities, there is an ongoing need to evaluate and characterize specific theoretical mechanisms of treatment effects.
The analysis evaluated the way emotional and cognitive responses to smoking lapses prospectively affect subsequent lapse progression. We assessed the implications of Marlatt’s AVE concept, which holds that each lapse – not just the first – represents a pivotal situation after which the lapser will either abstinence violation effect become increasingly demoralized or remain confident and committed to cessation. The current review highlights multiple important directions for future research related to nonabstinence SUD treatment. Overall, increased research attention on nonabstinence treatment is vital to filling gaps in knowledge.
Critiques of the RP Model
Positive social support is highly predictive of long-term abstinence rates across several addictive behaviours. 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. Negative social support in the form of interpersonal conflict and social pressure to use substances has been related to an increased risk for relapse. 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.
- This finding supplements the numerous studies that identify lack of readiness for abstinence as the top reason for non-engagement in SUD treatment, even among those who recognize a need for treatment (e.g., Chen, Strain, Crum, & Mojtabai, 2013; SAMHSA, 2019a).
- Overall, a large volume of research has yielded no consensus operational definition of the term [14,15].
- 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).
- The most recent national survey assessing rates of illicit drug use and SUDs found that among individuals who report illicit drug use in the past year, approximately 15% meet criteria for one or more DUD (SAMHSA, 2019a).
- Indeed, a prominent harm reduction psychotherapist and researcher, Rothschild, argues that the harm reduction approach represents a “third wave of addiction treatment” which follows, and is replacing, the moral and disease models (Rothschild, 2015a).
John joined Amethyst as a behavioral health technician where he quickly developed strong personal relationships with the clients through support and guidance. John understands first hand the struggles of addiction and strives to provide a safe environment for clients. We feel an urge or encounter a trigger, and suddenly we decide that our attempts at recovery have failed. It doesn’t seem logical that we would still experience cravings when we were only just recently hurt by a relapse. We fail to realize that putting drugs and alcohol back in our system was likely what reignited our cravings in the first place. Another factor that may occur is the Problem of Immediate Gratification where the client settles for shorter positive outcomes and does not consider larger long term adverse consequences when they lapse.
The point of coaching is to help you improve the abilities you already have, which will then make it easier and more enjoyable to practice the new behavior. RP has also been used in eating disorders in combination with other interventions such as CBT and problem-solving skills4. In a study by McCrady evaluating the effectiveness of psychological interventions for alcohol use disorder such as Brief Interventions and Relapse Prevention was classified as efficacious23. The myths related to substance use can be elicited by exploring the outcome expectancies as well as the cultural background of the client. Following this a decisional matrix can be drawn where pros and cons of continuing or abstaining from substance are elicited and clients’ beliefs may be questioned6.