Expanding the continuum of substance use disorder treatment: Nonabstinence approaches

This protects their sobriety and enhances their ability to protect themselves from future threats of relapse. Ark Behavioral Health offers 100% confidential substance abuse assessment and treatment placement tailored to your individual needs. Our addiction treatment network offers comprehensive care for alcohol addiction, opioid addiction, and all other forms of drug addiction. Our treatment options include detox, inpatient treatment, outpatient treatment, medication-assisted treatment options, and more. The Abstinence Violation Effect is a psychological phenomenon that occurs when a person experiences relapse after attempting to abstain from drug or alcohol use.

• McCrady 37 conducted a comprehensive review of 62 alcohol treatment outcome studies comprising 13 psychosocial approaches.
• However, there are some common early psychological signs that a relapse may be on the way.
• The dynamic model further emphasizes the importance of nonlinear relationships and timing/sequencing of events.

How The Abstinence Violation Effect Impacts Long-Term Recovery

Counselors can ask these clients how they have overcome adversity in the past, and how they have previously managed problematic substance use. Counselors can also reframe as potential strengths what these clients—and the counselors themselves—may think of as deficits. Chapter 4 contains an indepth discussion of resources that are available to individuals in recovery to help them meet their personal needs in areas such as health care, affordable housing (e.g., Housing First), nutrition, employment, and social connection. A strengths-based, person-centered approach acknowledges and addresses clients’ problems, but doesn’t let these problems drive clients’ or counselors’ expectations for what clients can ultimately achieve in recovery. The chapter also looks at ways that payment systems can affect the delivery of care for counselors in healthcare and behavioral health service systems.

While there are multiple such intervention approaches for treating AUD with strong empirical support, we highlight a dearth of research testing models of harm reduction treatment for DUD. Next, we review other established SUD treatment models that are compatible with non-abstinence goals. We focus our review on two well-studied approaches that were initially conceptualized – and have been frequently discussed in the empirical literature – as client-centered alternatives to abstinence-based treatment. Of note, other SUD treatment approaches that could be adapted to target nonabstinence goals (e.g., contingency management, behavioral activation) are excluded from the current review due to lack of relevant empirical evidence. This paper presents a narrative review of the literature and a call for increased research attention on the development of empirically supported nonabstinence treatments for SUD to engage and treat more people with SUD. We marijuana addiction define nonabstinence treatments as those without an explicit goal of abstinence from psychoactive substance use, including treatment aimed at achieving moderation, reductions in use, and/or reductions in substance-related harms.

Findings concerning possible genetic moderators of response to acamprosate have been reported 99, but are preliminary. Additionally, other findings suggest the influence of a DRD4 variable number of tandem repeats (VNTR) polymorphism on response to olanzapine, a dopamine antagonist that has been studied as an experimental treatment for alcohol problems. Olanzapine was found to reduce alcohol-related craving those with the long-repeat VNTR (DRD4 L), but not individuals with the short-repeat version (DRD4 S; 100,101). Further, a randomized trial of olanzapine led to significantly improved drinking outcomes in DRD4 L but not DRD4 S individuals 100. Counselors can work with clients to identify the outcome expectancies (both positive and negative) for substance use. Counselors can also help clients identify goals and objectives that will help them avoid a recurrence.

Continued empirical evaluation of the RP model

It’s important to challenge negative beliefs and cognitive distortions that may arise following a relapse. When people don’t have the proper tools to navigate the challenges of recovery, the AVE is more likely to occur, which can make it difficult to achieve long-term sobriety. As a result, the AVE can trigger a cycle of further relapse and continued substance use, since people may turn to substances as a way to cope with the emotional distress. As with all things 12-step, the emphasis on accumulating “time” and community reaction to a lapse varies profoundly from group to group, which makes generalizations somewhat unhelpful. However, broadly speaking, there are clear features of 12-step programs that can contribute to the AVE.

Coping

• Questionnaires such as the situational confidence test (Annis 1982b) can assess the amount of self-efficacy a person has in coping with drinking-risk situations.
• When a client experiences a recurrence, it may be time to bolster or update their treatment or recovery plan and goals and reevaluate their need for other support services.
• Definitions of relapse are varied, ranging from a dichotomous treatment outcome to an ongoing, transitional process 8,12,13.
• The chapter also looks at ways that payment systems can affect the delivery of care for counselors in healthcare and behavioral health service systems.

With the right help, preparation, and support, you and your loved ones can still continue to build a long-lasting recovery from substance abuse. These patterns can be actively identified and corrected, helping participants avoid lapses before they occur and continue their recovery from substance use disorder. Altogether, these thoughts and attributions are frequently driven by strong feelings of personal failure, defeat, and shame.

Still, you should also realize that relapse isn’t guaranteed, especially if you stay vigilant in managing your continued recovery. There may be an internal conflict between resisting thoughts about drugs and compulsions to use them. There is a possibility that you might rationalize why you marijuana addiction might not experience the same consequences if you continue to use. A mindset shift caused by triggers or stress may lead you to take that drink or start using drugs again.

These findings may be informative for researchers who wish to incorporate genetic variables in future studies of relapse and relapse prevention. Ultimately, individuals who are struggling with behavior change often find that making the initial change is not as difficult as maintaining behavior changes over time. Many therapies (both behavioral and pharmacological) have been developed to help individuals cease or reduce addictive behaviors and it is critical to refine strategies for helping individuals maintain treatment goals.

Sign up for text support

These data suggest that non-disordered drug use is possible, even for a substantial portion of individuals who use drugs such as heroin (about 45%). However, they do not elucidate patterns of non-disordered use over time, nor the likelihood of maintaining drug use without developing a DUD. Even when alcohol’s perceived positive effects are based on actual drug effects, often only the immediate effects are positive (e.g., euphoria), whereas the delayed effects are negative (e.g., sleepiness), particularly at higher alcohol doses. Asking clients questions designed to assess expectancies for both immediate and delayed consequences of drinking versus not drinking (i.e., using a decision matrix) (see table, p. 157) often can be useful in both eliciting and modifying expectancies. With such a matrix, the client can juxtapose his or her own list of the delayed negative consequences with the expected positive effects.

Efforts to develop, test and refine theoretical models are critical to enhancing the understanding and prevention of relapse 1,2,14. 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 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.

The realization that HIV had been spreading widely among people who injected drugs in the mid-1980s led to the first syringe services programs (SSPs) in the U.S. (Des Jarlais, 2017). Early attempts to establish pilot SSPs were met with public outcry and were blocked by politicians (Anderson, 1991). In 1988 legislation was passed prohibiting the use of federal funds to support syringe access, a policy which remained in effect until 2015 even as numerous studies demonstrated the effectiveness of SSPs in reducing disease transmission (Showalter, 2018; Vlahov et al., 2001). Despite these obstacles, SSPs and their advocates grew into a national and international harm reduction movement (Des Jarlais, 2017; Friedman, Southwell, Bueno, & Paone, 2001).

Ready to make a change?

Individuals with fewer years of addiction and lower severity SUDs generally have the highest likelihood of achieving moderate, low-consequence substance use after treatment (Öjehagen & Berglund, 1989; Witkiewitz, 2008). Notably, these individuals are also most likely to endorse nonabstinence goals (Berglund et al., 2019; Dunn & Strain, 2013; Lozano et al., 2006; Lozano et al., 2015; Mowbray et al., 2013). In contrast, individuals with greater SUD severity, who are more likely to have abstinence goals, generally have the best outcomes when working toward abstinence (Witkiewitz, 2008). Together, this suggests a promising degree of alignment between goal selection and probability of success, and it highlights the potential utility of nonabstinence treatment as an “early intervention” approach to prevent SUD escalation. Relapse, or the return to heavy alcohol use following a period of abstinence or moderate use, occurs in many drinkers who have undergone alcoholism treatment.