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. Traditional alcoholism treatment approaches often conceptualize relapse as an end-state, a negative outcome equivalent to treatment failure. Thus, this perspective considers only a dichotomous treatment outcome—that is, a person is either abstinent or relapsed. In contrast, several models of relapse that are based on social-cognitive or behavioral theories emphasize relapse as a transitional process, a series of events that unfold over time (Annis 1986; Litman et al. 1979; Marlatt and Gordon 1985). According to these models, the relapse process begins prior to the first posttreatment alcohol use and continues after the initial use.
The selective adaptation of the alcoholics anonymous program by gamblers anonymous
Whether a high-risk situation culminates in a lapse depends largely on the individual’s capacity to enact an effective coping response–defined as any cognitive or behavioral compensatory strategy that reduces the likelihood of lapsing. Researchers have long posited that offering goal choice (i.e., non-abstinence and abstinence treatment options) may be key to engaging more individuals in SUD treatment, including those earlier in their addictions (Bujarski et al., 2013; Mann et al., 2017; Marlatt, Blume, & Parks, 2001; Sobell & Sobell, 1995). Advocates of nonabstinence approaches often point to indirect evidence, including research examining reasons people with SUD do and do not enter treatment.
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Abstinence effects across different addictive substances, while useful for comparison with behavioral addictions, are beyond the scope of the present review. The extant literature reviewing abstinence effects in relation to withdrawal and relapse for substances is substantial, particularly in relation to tobacco (e.g., Hughes, 2007a, Hughes, 2007b). Withdrawal syndromes for most addictive substances are also well-established (for comparisons across substances, see Hughes et al., 1994; Shmulewitz, http://docload.ru/standart/Pages_gost/674.htm Greene, & Hasin, 2015; West & Gossop, 1994). The relationships between withdrawal, craving and relapse in substance use are complex and have been reviewed and discussed extensively elsewhere (e.g., Patten & Martin, 1996; Piasecki, 2006; Serre, Fatseas, Swendsen, & Auriacombe, 2015; Wray, Gass, & Tiffany, 2013). However, it is important to bear in mind for this review that the term ‘withdrawal’ may have a somewhat different meaning for behavioral addictions when compared with substance addictions.
Personality profiles of substance and behavioral addictions
Given data demonstrating a clear link between abstinence goals and treatment engagement in a primarily abstinence-based SUD treatment system, it is reasonable to hypothesize that offering nonabstinence treatment would increase overall engagement by appealing to those with nonabstinence goals. Indeed, there is anecdotal evidence that this may be the case; for example, a qualitative study of nonabstinence drug treatment in Denmark described a client saying that he would not have presented to abstinence-only treatment due to his goal of moderate use (Järvinen, 2017). Additionally, in the United Kingdom, where there is greater access to nonabstinence treatment (Rosenberg & Melville, 2005; Rosenberg & Phillips, 2003), the proportion of individuals with opioid use disorder engaged in treatment is more than twice that of the U.S. (60% vs. 28%; Burkinshaw et al., 2017). Put simply, the AVE occurs when a client perceives no intermediary step between a lapse and a relapse. For example, overeaters may have an AVE when they express to themselves, “one slice of cheesecake is a lapse, so I may as well go all-out, and have the rest of the cheesecake.” That is, since they have violated the rule of abstinence, they “may as well” get the most out of the lapse. Treatment in this component involves describing the AVE, and working with the client to learn alternative coping skills for when a lapse occurs, such that a relapse is prevented.
- Marlatt’s work inspired the development of multiple nonabstinence treatment models, including harm reduction psychotherapy (Blume, 2012; Denning, 2000; Tatarsky, 2002).
- While multiple harm reduction-focused treatments for AUD have strong empirical support, there is very little research testing models of nonabstinence treatment for drug use.
- 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.
- These components include both interpersonal influences by other individuals or social networks, and intrapersonal factors in which the person’s response is physical or psychological.
Online social network site addiction: A comprehensive review
This is an open-access report distributed under the terms of the Creative Commons Public Domain License. You can copy, modify, distribute and perform the work, even for commercial purposes, all without asking permission. Feelings of guilt, shame, and self-blame may lead people to question their ability to overcome addiction and exacerbate underlying issues of low self-esteem. Overall, the Abstinence Violation Effect is a complex phenomenon influenced by a combination of cognitive, emotional, and biological factors.
- Thus, instead of focusing on a distant end goal (e.g., maintaining lifelong abstinence), the client is encouraged to set smaller, more manageable goals, such as coping with an upcoming high-risk situation or making it through the day without a lapse.
- We also take the perspective that relapse is best conceptualized as a dynamic, ongoing process rather than a discrete or terminal event (e.g., [1,8,10]).
- People who attribute the lapse to their own personal failure are likely to experience guilt and negative emotions that can, in turn, lead to increased drinking as a further attempt to avoid or escape the feelings of guilt or failure7.
- He has received continuous funding for his research from a variety of agencies including the National Institute on Alcohol Abuse and Alcoholism, the National Institute on Drug Abuse, the Alcoholic Beverage Medical Research Foundation, and the Robert Wood Johnson Foundation.
- 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.
Consistent with the tenets of the reformulated RP model, several studies suggest advantages of nonlinear statistical approaches for studying relapse. The following section reviews selected empirical findings that support or coincide with tenets of the RP https://esenin.ru/o-esenine/gibel-poeta/lagunovskii-a-prichina-samoubiistva-sergeia-esenina model. Because the scope of this literature precludes an exhaustive review, we highlight select findings that are relevant to the main tenets of the RP model, in particular those that coincide with predictions of the reformulated model of relapse.
Systematic reviews and large-scale treatment outcome studies
Shiffman, Gwaltney and colleagues have used ecological momentary assessment (EMA; [44]) to examine temporal variations in SE in relation to smoking relapse. Findings from these studies suggested that participants’ SE was lower on the day before a lapse, and that lower SE in the days following a lapse in turn predicted progression to relapse [43,45]. One study [46] reported increases in daily SE during abstinent intervals, perhaps indicating mounting confidence as treatment goals were http://ua-vet.com/addtmc.php?info=10284 maintained [45]. Abstinence as a temporary intervention, on the other hand, has not received as much attention within the empirical literature. Concerns about the viability of abstinence as a long-term goal do not preclude the possibility that short-term periods of abstinence could be beneficial, depending on the behavior in question. The crucial difference is that with short-term abstinence the goal in many cases would be to return to controlled use following the abstinence period.