Expanding the continuum of substance use disorder treatment: Nonabstinence approaches

There are several factors that can contribute to the development of the AVE in people recovering from addiction. One of the key features of the AVE is its potential to trigger a downward spiral of further relapse and continued substance use. CP conceptualized the manuscript, conducted literature searches, synthesized the literature, and wrote the first draft of the manuscript.

• For example, all studies with SUD populations could include brief questionnaires assessing short-and long-term substance use goals, and treatment researchers could report the extent to which nonabstinence goals are honored or permitted in their study interventions and contexts, regardless of treatment type.
• Model-based predicted median hours of prospective abstinence preceding each lapse, plotted as a function of Active versus Placebo NRT patch assignment.
• Regardless of how we define relapse, the treatment outcome literature clearly demonstrates that some transgression is the most common outcome following treatment for a variety of psychological and substance use disorders.

1. Review aims

However, these interventions also typically lack an abstinence focus and sometimes result in reductions in drug use. Because relapse is the most common outcome of treatment for addictions, it must be addressed, anticipated, and prepared for abstinence violation effect during treatment. The RP model views relapse not as a failure, but as part of the recovery process and an opportunity for learning. Marlatt (1985) describes an abstinence violation effect (AVE) that leads people to respond to any return to drug or alcohol use after a period of abstinence with despair and a sense of failure. By undermining confidence, these negative thoughts and feelings increase the likelihood that an isolated “lapse” will lead to a full-blown relapse.

• Most adults with SUD do not seek treatment because they do not wish to stop using substances, though many also recognize a need for help.
• CBT treatments are usually guided by a manual, are relatively short term (12 to 16 weeks) in duration, and focus on the present and future.
• Although contradicting some particular aspects of AVE theory, this work confirms the importance of psychological responses in the relapse process.
• Rather than undermining self-efficacy after a lapse, results indicate that longer periods of pre-lapse abstinence potentiated the effect of self-efficacy in protecting against subsequent progression.
• The term relapse may be used to describe a prolonged return to substance use, whereas lapsemay be used to describe discrete,…
• Many smoking cessation studies have sought to identify factors that influence cessation success versus failure.
• The strengths of the study lie in its use of near-real-time EMA reports of AVE responses, recorded soon after each lapse, and the ability to use a stream of EMA reports over many lapses to characterize the prospective influence of AVE responses on progression to subsequent lapses.

Decoupling Goal Striving From Resource Depletion by Forming Implementation Intentions

If the client is high in distal risk, then the treatment provider may educate the client about the possibility of “falling from the wagon,” given small changes in proximal risks. Furthermore, relapse may be forestalled by targeting treatments to reduce a client’s level of proximal risk. Clients would benefit from skills training for managing lapses and encouragement to maintain lifestyle balance. When distal risk is low, clients can be educated about the probability of experiencing a steady increase in drinking that is proportional to increases in proximal risk. The client may be taught to monitor their proximal risks in conjunction with continuous monitoring of drinking, and be provided with skills for seeking support when proximal risks are on the rise. 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.

• Regarding SUD treatment, there has been a significant increase in availability of medication for opioid use disorder, especially buprenorphine, over the past two decades (opioid agonist therapies including buprenorphine are often placed under the “umbrella” of harm reduction treatments; Alderks, 2013).
• Furthermore, the timing of depressive episodes in individuals with major depression has been shown to predict relapse following treatment for substance dependence (Hasin, Liu, Nunes, McCloud, Samet, & Endicott, 2002).
• 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.
• Pseudo- R2 is provided as a general measure of model fit that is calculated using the difference between observed values and the expected value of the nearest mode (Cobb, 1978).

2. Established treatment models compatible with nonabstinence goals

Consistent with previous conceptualizations of risk factors (Shiffman, 1989), alcohol dependence and typology had the highest loadings on the distal risk component, and self-efficacy, depression, family conflict and psychiatric severity had the highest loadings on the proximal risk component. By substituting a range of values for the splitting (b) and normal (a) parameters, a range of values for Z is obtained and can be plotted in three dimensions, as shown in Figure 2. The bottom surface of the model, called the control plane, is defined by the range of the two control parameters. The top surface, called the behavior plane, is defined as the range of behavior values based on the values of the two control parameters (the values obtained when solving for Equation 2). The folded part of the behavior plane represents the discontinuity that is characteristic of the model, whereby two values of the control parameters can result in more than one value of the behavior variable. The two modes of behavior expression, labeled the bifurcation set, exist in a range of instability where major changes in drinking are controlled by minor shifts in the control parameters of Equation 2.

Cognitive Behavioral Treatments for Substance Use Disorders

We 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. We first provide an overview of the development of abstinence and nonabstinence approaches within the historical context of SUD treatment in the U.S., followed by an evaluation of literature underlying the theoretical and empirical rationale for nonabstinence treatment approaches. Lastly, we review existing models of nonabstinence psychosocial treatment for SUD among adults, with a special focus on interventions for drug use, to identify gaps in the literature and directions for future research. We identify a clear gap in research examining nonabstinence psychosocial treatment for drug use disorders and suggest that increased research attention on these interventions represents the logical next step for the field. A focus on abstinence is pervasive in SUD treatment, defining success in both research and practice, and punitive measures are often imposed on those who do not abstain. Most adults with SUD do not seek treatment because they do not wish to stop using substances, though many also recognize a need for help.

Cognitive Behavioral Therapy in Cannabis Use Disorder

Abstinence violators realize that their actions (e.g. “I drank”) do not line up with their personal goal (e.g. “I want to abstain”) and feel compelled to resolve the discrepancy. If the reason for the violation is attributed to internal, stable, and/or global factors, such as lack of willpower or possession of an underlying disease, then the individual is more likely to have a full-blown relapse after the initial violation occurs. On the other hand, if the reason for the violation is attributed to external, unstable, and/or local factors, such as an extremely tempting situation, then the individual is more likely to recover from the violation and get back onto the path of abstinence. The sudden jump flag can only be demonstrated with time series data and individual growth curves with multiple time points.

The Abstinence Violation Effect (AVE) is a psychological phenomenon that refers to a person’s reaction to breaking a self-imposed rule of abstinence or self-control. It occurs when individuals who have set strict rules for themselves regarding certain behaviors or habits (e.g., alcohol consumption, smoking, or eating certain foods) engage in the prohibited behavior, leading to feelings of guilt, shame, and loss of control. 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). It sheds light on the challenges individuals face when attempting to maintain abstinence and how a single lapse can trigger a surge of negative emotions, potentially leading to a full relapse or a return to unhealthy living (Collins & Witkiewitz, 2013; Larimer, Palmer, & Marlatt, 1999). Clayton Neighbors is a professor and Director of the Social Psychology Program at the University of Houston, USA.