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For instance, genetic factors could influence relapse in part via drug-specific cognitive processes. Recent studies have reported genetic associations with alcohol-related cognitions, including alcohol expectancies, drinking refusal self-efficacy, drinking motives, and implicit measures of alcohol-related motivation 51,52, . Overall, the body of research on genetic influences on relapse and related processes is nascent and virtually all findings require replication. Consistent with the broader literature, it can be anticipated that most genetic associations with relapse outcomes will be small in magnitude and potentially difficult to replicate. It is inevitable that the next decade will see exponential growth in this area, including greater use of genome-wide analyses of treatment response 109 and efforts to evaluate the clinical utility and cost effectiveness of tailoring treatments based on pharmacogenetics.
Empirical findings relevant to the RP model
In a prospective study among both men and women being treated for alcohol dependence using the Situational Confidence Questionnaire, higher self-efficacy scores were correlated to a longer interval for relapse to alcohol use8. The relationship between self-efficacy and relapse is possibly bidirectional, meaning that individuals who are more successful report greater self-efficacy and individuals who have lapsed report lower self-efficacy4. Chronic stressors may also overlap between self-efficacy and other areas of intrapersonal determinants, like emotional states, by presenting more adaptational strain on the treatment-seeking client4. Thus, while it is vital to empirically test nonabstinence treatments, implementation research examining strategies to obtain buy-in from agency leadership may be just as impactful.
But you may have the thought that you need the drug or alcohol to help get you through the tough situation. Unconscious cravings may turn into the conscious thought that it is the only way you can cope with your current situation. If you view your lapse as a mistake and as a product of external triggers, rather than as a personal failure, research shows that you will have a much better chance of return to abstinence quickly.
Emerging topics in relapse and relapse prevention
This reaction, termed the Abstinence Violation Effect (AVE; 16), 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. A basic assumption is that relapse events are immediately preceded by a high-risk situation, broadly defined as any context that confers vulnerability for engaging in the target behavior. Examples of high-risk contexts include emotional or cognitive states (e.g., negative affect, diminished self-efficacy), environmental contingencies (e.g., conditioned drug cues), or physiological states (e.g., acute withdrawal). Although some high-risk situations appear nearly universal across addictive behaviors (e.g., negative affect; 25), high-risk situations are likely to vary across behaviors, across individuals, and within the same individual over time 10. Whether a heroin addiction high-risk situation culminates in a lapse depends largely on the individual’s capacity to enact an effective coping response–defined as any cognitive or behavioral compensatory strategy that reduces the likelihood of lapsing.
1.3. Harm reduction integrated in SUD treatment
Although SE is proposed as a fluctuating and dynamic construct 26, most studies rely on static measures of SE, preventing evaluation of within-person changes over time or contexts 43. Shiffman, Gwaltney and colleagues have used ecological momentary assessment (EMA; 44) to examine temporal variations in SE in relation to smoking relapse. Findings from these studies suggested that participants’ SE was lower on the day before a lapse, and that lower SE in the days following a lapse in turn predicted progression to relapse 43,45. One study 46 reported increases in daily SE during abstinent intervals, perhaps indicating mounting confidence as treatment goals were maintained 45.
- Recent reviews provide a convincing rationale for the putative role of implicit processes in addictive behaviors and relapse 54,56,57.
- Our brains tend to remember past experiences more positively than they actually were, often overlooking the negative aspects.
- The abstinence violation effect (AVE) describes a common response among people practicing abstinence when relapse occurs.
- Before you know it, you’re back in the old pattern—hangovers, drunk arguments, the endless obsession around the wine o’clock.
3. Summary of the state of the literature
Another example is Taylor, who has been doing a wonderful job taking walks and engaging in healthier eating. Taylor uses an app to watch her intake of calorie limit and does see positive outcomes to her new lifestyle. One night, she craves pizza and wings, orders out, and goes over her calories for the day.
Instead, the literature indicates that most people with SUD do not want or need – or are not ready for – what the current treatment system is offering. The AVE was introduced into the substance abuse literature within the context of the “relapse process” (Marlatt and Gordon 1985, p. 37). 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 https://proterzaeta.com/?p=3242 a prolonged return to substance use, whereas lapsemay be used to describe discrete, circumscribed…
4. Current status of nonabstinence SUD treatment
The second strategy, which is possibly the most important aspect of RP, involves evaluating the client’s existing motivation and ability to cope with specific high-risk situations and then helping the client learn more effective coping skills. The term “abstinence violation effect” refers to the emotional response experienced by individuals who have relapsed after committing to abstain from a certain behavior, such as substance abuse or unhealthy eating habits. This effect often involves feelings of guilt, shame, and self-blame, which can further perpetuate the cycle of relapse. Understanding and addressing the abstinence violation effect is crucial in helping individuals break free from harmful behaviors and maintain long-term recovery. Modifying social and environmental antecedents and consequences another approach to working with addictive behaviours18.
- A more recent development in the area of managing addictive behaviours is the application of the construct of mindfulness to managing experiences related to craving, negative affect and other emotional states that are believed to impact the process of relapse34.
- By reducing the emotional weight of negative experiences more quickly than positive ones, this bias helps us move on from past adversities and fosters psychological resilience.
- When someone abuses a substance for a long time, they will have a higher tolerance for its effects.
2. Controlled drinking
Another technique is that the road to abstinence is broken down to smaller achievable targets so that client can easily master the task enhancing self-efficacy. Also, therapists can provide positive feedback of achievements that the client has been able to make in other facets of life6. 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. This can be worked on by creating a decisional matrix where the pros and cons of continuing the behaviour versus abstaining are written down within both shorter and longer time frames and the therapist helps the client to identify unrealistic outcome expectancies5. By implementing abstinence violation effect certain strategies, people can develop resilience, self-compassion, and adaptive coping skills to counteract the effects of the AVE and maintain lifelong sobriety. Although specific intervention strategies can address the immediate determinants of relapse, it is also important to modify individual lifestyle factors and covert antecedents that can increase exposure or reduce resistance to high-risk situations.
Is a Relapse Dangerous?
We identify a clear gap in research examining nonabstinence psychosocial treatment for drug use disorders and suggest that increased research attention on these interventions represents the logical next step for the field. Although the RP model considers the high-risk situation the immediate relapse trigger, it is actually the person’s response to the situation that determines whether he or she will experience a lapse (i.e., begin using alcohol). A person’s coping behavior in a high-risk situation is a particularly critical determinant of the likely outcome.
This success can then motivate the client’s effort to change his or her pattern of alcohol use and increase the client’s confidence that he or she will be able to successfully master the skills needed to change. Abstinence violation effect refers to the guilt and perceived loss of control that a person feels whenever he or she slips and finds himself or herself returning to drug use after an extended period of abstinence. Social skills training (SST) incorporates a wide variety of interpersonal dimensions15. The first step in planning a cognitive behavioural treatment program is to carry out a functional analysis to identify maintaining antecedents and set treatments targets, select interventions. Eleven of the 27 studies were rated as potentially high risk for selection bias (random sequence generation and allocation concealment) because they either used alternation as a nonrandom component in the sequence generation process (6 studies) or were nonrandomized (5 studies).