Attending or resuming attending meetings of some form of mutual support group can be extremely valuable immediately after a lapse or relapse. Discussing the relapse can yield valuable advice on how to continue recovery without succumbing to the counterproductive feelings of shame or self-pity. Whether or not emotional pain causes addition, every person who has ever experienced abstinence violation effect an addiction, as well as every friend and family member, knows that addiction creates a great deal of emotional pain. Therapy for those in recovery and their family is often essential for healing those wounds. The power to resist cravings rests on the ability to summon and interpose judgment between a craving and its intense motivational command to seek the substance.
4. Current status of nonabstinence SUD treatment
- In the absence of other non-drinking pleasurable activities, the person may view drinking as the only means of obtaining pleasure or escaping pain.
- This can include abstinence from substance abuse, overeating, gambling, smoking, or other behaviors a person has been working to avoid.
- Although high-risk situations can be conceptualized as the immediate determinants of relapse episodes, a number of less obvious factors also influence the relapse process.
- For example, if the client understands that using alcohol in the day time triggers a binge, agreeing for a meeting in the afternoon in a restaurant that serves alcohol would be a SID5.
Interpersonal relationships and support systems are highly influenced by intrapersonal processes such as emotion, coping, and expectancies18. Inaction has typically been interpreted as the acceptance of substance cues which can be described as “letting go” and not acting on an urge. 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. 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. Efforts to evaluate the validity [119] and predictive validity [120] of the taxonomy failed to generate supportive data.
2. Established treatment models compatible with nonabstinence goals
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. In RP client and therapist are equal partners and the client is encouraged to actively contribute solutions for the problem. Client is taught that overcoming the problem behaviour is not about will power rather it has to do with skills acquisition. 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.
Cognitive Dissonance
However, these groups’ momentary ratings diverged significantly at high levels of urges and negative affect, such that those with low baseline SE had large drops in momentary SE in the face of increasingly challenging situations. These findings support that higher distal risk can result in bifurcations (divergent patterns) of behavior as the level of proximal risk factors increase, consistent with predictions from nonlinear dynamic systems theory [31]. The client’s appraisal of lapses also serves as a pivotal intervention point in that these reactions can determine whether a lapse escalates or desists. Establishing lapse management plans can aid the client in self-correcting soon after a slip, and cognitive restructuring can help clients to re-frame the meaning of the event and minimize the AVE [24].
A Lapse Vs. A Relapse
A relapse or even a lapse might be interpreted as proof that a person doesn’t have what it takes to leave addiction behind. Some people arrange a tight network of friends to call on in an emergency, such as when they are experiencing cravings. Since cravings do not last forever, engaging in conversation about the feelings as they occur with someone who understands their nature can help a person ride out the craving.
Systematic reviews and large-scale treatment outcome studies
Historical context of nonabstinence approaches
- Finally, an intriguing direction is to evaluate whether providing clients with personalized genetic information can facilitate reductions in substance use or improve treatment adherence [110,111].
- In this study incarcerated individuals were offered the chance to participate in an intensive 10-day course in Vipassana meditation (VM).
- In this model, treatment success is defined as achieving and sustaining total abstinence from alcohol and drugs, and readiness for treatment is conflated with commitment to abstinence (e.g., Harrell, Trenz, Scherer, Martins, & Latimer, 2013).
- For one, it bolsters self-respect, which usually comes under siege after a relapse but helps motivate and sustain recovery and the belief that one is worthy of good things.