Relapse prevention for addictive behaviors PMC

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. The initial transgression of problem behaviour after a quit attempt is defined as a “lapse,” abstinence violation effect which could eventually lead to continued transgressions to a level that is similar to before quitting and is defined as a “relapse”. Another possible outcome of a lapse is that the client may manage to abstain and thus continue to go forward in the path of positive change, “prolapse”4. Many researchers define relapse as a process rather than as a discrete event and thus attempt to characterize the factors contributing to relapse3. There is less research examining the extent to which moderation/controlled use goals are feasible for individuals with DUDs.

Cognitive Dissonance

abstinence violation effect

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. In the multifaceted journey of overcoming addiction and living a healthier life, individuals often encounter a psychological phenomenon known as the abstinence violation effect (AVE).

Ark Behavioral Health

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What’s more, attending or resuming group meetings immediately after a lapse or relapse and discussing the circumstances can yield good advice on how to continue recovery without succumbing to the counterproductive feelings of shame and self-pity. The longer someone neglects self-care, the more that inner tension builds to the point of discomfort and discontent. This stage is characterized by a tug of war between past habits and the desire to change. Thinking about and romanticizing past drug use, hanging out with old friends, lying, and thoughts about relapse are danger signs. Individuals may be bargaining with themselves about when to use, imagining that they can do so in a controlled way.

Integrating implicit cognition and neurocognition in relapse models

Among the psychosocial interventions, the Relapse Prevention (RP), cognitive-behavioural approach, is a strategy for reducing the likelihood and severity of relapse following the cessation or reduction of problematic behaviours. Here the assessment and management of both the intrapersonal and interpersonal determinants of relapse are undertaken. This article discusses the concepts of relapse prevention, relapse determinants and the specific interventional strategies. Harm reduction therapy has also been applied in group format, mirroring the approach and components of individual harm reduction psychotherapy but with added focus on building social support and receiving feedback and advice from peers (Little, 2006; Little & Franskoviak, 2010). These groups tend to include individuals who use a range of substances and who endorse a range of goals, including reducing substance use and/or substance-related harms, controlled/moderate use, and abstinence (Little, 2006). Additionally, some groups target individuals with co-occurring psychiatric disorders (Little, Hodari, Lavender, & Berg, 2008).

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. The general meaning of relapse is a deterioration in health status after an improvement. In the realm of addiction, relapse has a more specific meaning—a return to substance use after a period of nonuse. Whether it lasts a week, a month, or years, relapse is common enough in addiction recovery that it is considered a natural part of the difficult process of change. Between 40 percent and 60 percent of individuals relapse within their first year of treatment, according to the National Institute on Drug Abuse.

Taylor may think, “All that good work down the drain, I am never going to be able to keep this up for my life.” Like Jim, this may also trigger a negative mindset and a return to unhealthy eating and a lack of physical exercise. All rights are reserved, including those for text and data mining, AI training, and similar technologies. AVE also involves cognitive dissonance, a distressing experience people go through when their internal thoughts, beliefs, actions, or identities are put in conflict with one another.

  • The harm reduction movement, and the wider shift toward addressing public health impacts of drug use, had both specific and diffuse effects on SUD treatment research.
  • A study published by Hunt and colleagues demonstrated that nicotine, heroin, and alcohol produced highly similar rates of relapse over a one-year period, in the range of 80-95%2.
  • In a 2013 Cochrane review which also discussed regarding relapse prevention in smokers the authors concluded that there is insufficient evidence to support the use of any specific behavioural intervention to help smokers who have successfully quit for a short time to avoid relapse.
  • The current review highlights a notable gap in research empirically evaluating the effectiveness of nonabstinence approaches for DUD treatment.

1. Nonabstinence psychosocial treatment models

abstinence violation effect

  • There is an important distinction to be made between a lapse, or slipup, and a relapse.
  • 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.
  • Here the assessment and management of both the intrapersonal and interpersonal determinants of relapse are undertaken.
  • Not surprisingly, molecular genetic approaches have increasingly been incorporated in treatment outcome studies, allowing novel opportunities to study biological influences on relapse.

Outcome expectancies