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

Consistent with the RP model, changes in coping skills, self-efficacy and/or outcome expectancies are the primary putative mechanisms by which CBT-based interventions work [126]. 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]. Further, there was strong support that increases in self-efficacy following drink-refusal skills training was the primary mechanism of change.

Models of nonabstinence psychosocial treatment for SUD

However, these interventions also typically lack an abstinence focus and sometimes result in reductions in drug use. A key feature of the dynamic model is its emphasis on the complex interplay between tonic and phasic processes. As indicated in Figure ​Figure2,2, distal abstinence violation effect risks may influence relapse either directly or indirectly (via phasic processes). For instance, the return to substance use can have reciprocal effects on the same cognitive or affective factors (motivation, mood, self-efficacy) that contributed to the lapse.

Global Lifestyle Self-Control Strategies

People with effective coping responses have confidence that they can cope with the situation (i.e., increased self-efficacy), thereby reducing the probability of a relapse. 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. This lapse, in turn, can result in feelings of guilt and failure (i.e., an abstinence violation effect). The abstinence violation effect, along with positive outcome expectancies, can increase the probability of a relapse.

Understand The Relapse Process

Many advocates of harm reduction believe the SUD treatment field is at a turning point in acceptance of nonabstinence approaches. 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). Initial evidence suggests that implicit measures of expectancies are correlated https://ecosoberhouse.com/ with relapse outcomes, as demonstrated in one study of heroin users [61]. In another recent study, researchers trained participants in attentional bias modification (ABM) during inpatient treatment for alcohol dependence and measured relapse over the course of three months post-treatment [62]. Relative to a control condition, ABM resulted in significantly improved ability to disengage from alcohol-related stimuli during attentional bias tasks.

• In one clinical intervention based on this approach, the client is taught to visualize the urge or craving as a wave, watching it rise and fall as an observer and not to be “wiped out” by it.
• 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.
• Overall, the body of research on genetic influences on relapse and related processes is nascent and virtually all findings require replication.

2. Relationship between goal choice and treatment outcomes

• Currently, the dynamic model can be viewed as a hypothetical, theory-driven framework that awaits empirical evaluation.
• It is hoped that more severely mentally ill people will obtain life-saving treatment and pathways to better housing.
• Following the initial introduction of the RP model in the 1980s, its widespread application largely outpaced efforts to systematically validate the model and test its underlying assumptions.
• In a meta-analysis by Carroll, more than 24 RCT’s have been evaluated for the effectiveness of RP on substance use outcomes.
• Jim is a recovering alcoholic who successfully abstained from drinking for several months.

Outcome expectancies

• Given this limitation, the National Institutes on Alcohol Abuse and Alcoholism (NIAAA) sponsored the Relapse Replication and Extension Project (RREP), a multi-site study aiming to test the reliability and validity of Marlatt’s original relapse taxonomy.
• Helping the client to develop “positive addictions” (Glaser 1976)—that is, activities (e.g., meditation, exercise, or yoga) that have long-term positive effects on mood, health, and coping—is another way to enhance lifestyle balance.
• However, broadly speaking, there are clear features of 12-step programs that can contribute to the AVE.

RP Intervention Strategies

AVE in the Context of the Relapse Process

• Avoidance is an excellent coping strategy if you know that you are likely to run into danger.
• In addition, specific cognitive-behavioral skills training approaches, such as relaxation training, stress-management, and time management, can be used to help clients achieve greater lifestyle balance.
• The expected drug effects do not necessarily correspond with the actual effects experienced after consumption.
• It includes thoughts and feelings like shame, guilt, anger, failure, depression, and recklessness as well as a return to addictive behaviors and drug use.

Relapse Prevention And Ongoing Treatment At Bedrock