One study found that among those who did not complete an abstinence-based (12-Step) SUD treatment program, ongoing/relapse to substance use was the most frequently-endorsed reason for leaving treatment early (Laudet, Stanick, & Sands, 2009). A recent qualitative study found that concern about missing substances was significantly correlated with not completing treatment (Zemore, Ware, Gilbert, & Pinedo, 2021). Unfortunately, few quantitative, survey-based studies have included substance use during treatment as a potential reason for treatment noncompletion, representing a significant gap in this body of literature (for a review, see Brorson, Ajo Arnevik, Rand-Hendriksen, & Duckert, 2013). Additionally, no studies identified in this review compared reasons for not completing treatment between abstinence-focused and nonabstinence treatment.
- Recontact contracts can also be useful where it is agreed in advance what the criterion will be for a time where a gambler should recontact the therapist.
- In other words, AVE describes the thoughts, feelings, and actions a person goes through after they make a mistake and have a drink or abuse a substance, despite trying to quit.
- Put simply, the AVE occurs when a client perceives no intermediary step between a lapse and a relapse.
- Coping is defined as the thoughts and behaviours used to manage the internal and external demands of situations that are appraised as stressful.
- One of the most critical predictors of relapse is the individual’s ability to utilize effective coping strategies in dealing with high-risk situations.
As AVE is a form of all-or-nothing thinking, some may argue that it is a person’s outlook, not abstinence itself, that is harmful. But in cases in which a person is prone to this cognitive distortion, abstinence may not be the healthiest approach to take. Other research reveals there may be some benefits to abstinence—some abstinence programs have been positively correlated with reduced teen pregnancy. One study published in the Journal of Health Communication found the “Not Me, Not Now” campaign in Monroe County, New York, was strongly connected to a decline in teen pregnancy rates for that county.
4. Current status of nonabstinence SUD treatment
Marlatt and Gordon’s (1985) model of the relapse process in addictive disorders has had a major impact in the field of relapse prevention since the late 1980s. Marlatt and Gordon postulate that newly abstinent patients experience a sense of perceived control up to the point at which they encounter a high-risk abstinence violation effect situation, which most commonly entails a negative emotional state, an interpersonal conflict, or an experience of social pressure. If individuals cope effectively in the high-risk situation, perceived control and self-efficacy increase, which in turn makes the probability of relapse decrease.
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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, https://ecosoberhouse.com/ 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 Prevention
Conversely, the hypothesized result of a failure to cope with a high-risk situation is a decrease in a sense of self-efficacy, which in turn increases the probability of relapse. Each experience of successful or unsuccessful coping with a high-risk situation builds up a greater or lesser sense of self-efficacy, which determines the future risk of relapse in similar circumstances. Marlatt and Gordon (1985) contend that individuals’ reactions to the initial slip and their attributions regarding the cause of the slip are the determining factors in the escalation of a lapse or setback into a full-blown relapse. The transition from slip or lapse to relapse involves the “abstinence violation effect,” which results from a state of cognitive dissonance regarding the nonabstinent behavior and the individual’s image of being abstinent.
