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

abstinence violation effect psychology

A good relapse prevention plan specifies a person’s triggers for drug use, lists some coping skills to summon up and distractions to engage in, and lists people to call on for immediate support, along with their contact information. It’s an acknowledgement that recovery takes lots of learning, especially about oneself. Recovery from addiction requires significant changes in lifestyle and behavior, ranging from changing friend circles to developing new coping mechanisms. By definition, those who want to leave drug addiction behind must navigate new and unfamiliar paths and, often, burnish work and other life skills. Recovery also requires discovery or rediscovery and development of interests that have the power to drive pursuit and deliver rewards, not only spurring the addicted brain to rewire itself but giving life real meaning—the ultimate goal of every person.

Cognitive Behavioral Treatments for Substance Use Disorders

A major development in this respect was the reformulation of Marlatt’s cognitive-behavioral relapse model to place greater emphasis on dynamic relapse processes [8]. Whereas most theories presume linear relationships among constructs, the reformulated model (Figure ​(Figure2)2) views relapse as a complex, nonlinear process in which various factors act jointly and interactively to affect relapse timing and severity. Similar to the original RP model, the dynamic model centers on the high-risk situation. Against this backdrop, both tonic (stable) and phasic (transient) influences interact to determine relapse likelihood. Tonic processes include distal risks–stable background factors that determine an individual’s “set point” or initial threshold for relapse [8,31].

G Alan Marlatt

Therapy for those in recovery and their family is often essential for healing those wounds. They are typically triggered by people, places, paraphernalia, and passing thoughts in some way related to previous drug use. In the absence of triggers, or cues, cravings are headed toward extinction soon after quitting. But sometimes triggers can’t be avoided—you accidentally encounter someone or pass a place where  you once used. A better understanding of one’s motives, one’s vulnerabilities, and one’s strengths helps to overcome addiction. RP has also been used in eating disorders in combination with other interventions such as CBT and problem-solving skills4.

  • Additionally, this model acknowledges the contributions of social cognitive constructs to the maintenance of substance use or addictive behaviour and relapse1.
  • A final emphasis in the RP approach is the global intervention of lifestyle balancing, designed to target more pervasive factors that can function as relapse antecedents.
  • This disinhibition of dietary restraint has been replicated numerous times [20,28] and demonstrates that dieters often eat a great deal after they perceive their diets to be broken.
  • 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.
  • This model both accelerated the spread of AA and NA and helped establish the abstinence-focused 12-Step program at the core of mainstream addiction treatment.
  • The focus is on identifying and accepting the urge, not acting on the urge or attempting to fight it4.

Behavior Change Is Hard

These are presented repeatedly without the previously learned pattern of drinking so as to lead to extinction. Despite work on cue reactivity, there is limited empirical support for the efficacy of cue exposure in the abstinence violation effect refers to recent literature14. 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.

abstinence violation effect psychology

Skinner argued that punishment simply induces us to avoid a behavior when we think we might get caught, and it doesn’t address the need that triggered the behavior in the first place. But starting a diet with the intention of forfeiting something you like if you err is literally a recipe for disaster. When we overeat because we are upset, we are meeting one need at the expense of another which makes us feel even worse. Doing so can bolster your motivation to continue, even if you have occasional lapses. Certainly, starting a diet or exercise plan with a friend is more fun than going it alone, and you can hold each other accountable too. However, telling your non-dieting partner to make sure you don’t snack after dinner is a set-up for a fight the first time you have a bad day and decide you need a treat.

On the one hand, it can serve as a valuable learning opportunity, highlighting the triggers and situations that lead to relapse or rule violation. This awareness can aid in the development of effective coping strategies and relapse prevention https://ecosoberhouse.com/ techniques. On the other hand, if individuals perceive the Abstinence Violation Effect as a sign of personal failure or lack of self-control, it may diminish their self-efficacy and motivation to continue pursuing behavior change.

abstinence violation effect psychology

Cognitive neuroscience of self-regulation failure

An abstinence violation can also occur in individuals with low self-efficacy, since they do not feel very confident in their ability to carry out their goal of abstinence. Harm reduction may also be well-suited for people with high-risk drug use and severe, treatment-resistant SUDs (Finney & Moos, 2006; Ivsins, Pauly, Brown, & Evans, 2019). These individuals are considered good candidates for harm reduction interventions because of the severity of substance-related negative consequences, and thus the urgency of reducing these harms. Indeed, this argument has been central to advocacy around harm reduction interventions for people who inject drugs, such as SSPs and safe injection facilities (Barry et al., 2019; Kulikowski & Linder, 2018). It has also been used to advocate for managed alcohol and housing first programs, which represent a harm reduction approach to high-risk drinking among people with severe AUD (Collins et al., 2012; Ivsins et al., 2019).

Cognitive strategies in managing addictive behaviours

One study found that in men, testosterone levels peaked after 7 days of abstaining from sex. Abstinence stands in contrast to concepts such as limited consumption or self-restraint, because the abstinence model requires complete avoidance of a substance or behavior. For example, a person who limited their drinking would not be practicing abstinence, but a person who refused all alcoholic beverages on a long-term basis would be abstaining from drinking. 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. Twelve-step can certainly contribute to extreme and negative reactions to drug or alcohol use.

  • Tonic processes also include cognitive factors that show relative stability over time, such as drug-related outcome expectancies, global self-efficacy, and personal beliefs about abstinence or relapse.
  • When we assess clients, we use well-validated research tools, like the Beck Depression Inventory (BDI) and the Addiction Severity Index (ASI), to measure baseline levels and subsequent changes in depression, anxiety, dependency, impulsivity, and more.
  • Findings also suggested that these relationships varied based on individual differences, suggesting the interplay of static and dynamic factors in AVE responses.

abstinence violation effect psychology

It is important to note that these studies were not designed to evaluate specific components of the RP model, nor do these studies explicitly espouse the RP model. Also, many studies have focused solely on pharmacological interventions, and are therefore not directly related to the RP model. However, we review these findings in order to illustrate the scope of initial efforts to include genetic predictors in treatment studies that examine relapse as a clinical outcome. These findings may be informative for researchers who wish to incorporate genetic variables in future studies of relapse and relapse prevention.

abstinence violation effect psychology

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