Expanding the continuum of substance use disorder treatment: Nonabstinence approaches

When that person takes even abstinence violation effect one drink (”violating” their abstinence), the tendency is to think, “I really blew it…I’m a failure…might as well keep on drinking now! ” I refer to this as a case of the “screw-it’s” (although harsher language is not uncommon!); a sense of giving up. At Bedrock, we use evidence-based approaches such as cognitive-behavioral therapy (CBT) to help our clients develop coping skills and enhance resilience in the face of setbacks.

4. Current status of nonabstinence SUD treatment

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. In this case, individuals try to explain to themselves why they violated their goal of abstinence. 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. Thus, while it is vital to empirically test nonabstinence treatments, implementation research examining strategies to obtain buy-in from agency leadership may be just as impactful.

• However, the downside is that it can also make us forget the pains that spurred us to change.
• Next, we review other established SUD treatment models that are compatible with non-abstinence goals.
• Before you know it, you’re back in the old pattern—hangovers, drunk arguments, the endless obsession around the wine o’clock.
• Altogether, these thoughts and attributions are frequently driven by strong feelings of personal failure, defeat, and shame.

1. Review aims

• (b) Restrained eaters whose diets were broken by a milkshake preload showed increased activity in the nucleus accumbens (NAcc) compared to restrained eaters who did not consume the preload and satiated non-dieters 64.
• This suggests that individuals with nonabstinence goals are retained as well as, if not better than, those working toward abstinence, though additional research is needed to confirm these results and examine the effect of goal-matching on retention.
• It’s important to establish that a one-time lapse in a person’s recovery from drugs or alcohol is not considered a full blown relapse.
• For example, despite being widely cited as a primary rationale for nonabstinence treatment, the extent to which offering nonabstinence options increases treatment utilization (or retention) is unknown.
• These groups tend to include individuals who use a range of substances and who endorse a range of goals, including reducing substance use and/or substance-related harms, controlled/moderate use, and abstinence (Little, 2006).
• Furthermore, abstinence remains a gold standard treatment outcome in pharmacotherapy research for drug use disorders, even after numerous calls for alternative metrics of success (Volkow, 2020).

Our brains tend to remember past experiences more positively than they actually were, often overlooking the negative aspects. Our memory selectively highlights the pleasures while downplaying or entirely forgetting the pain. When it comes to alcohol or other addictive substances, this creates powerful yet distorted memories that lure a person back into use. Nonabstinence approaches to SUD treatment have a complex and contentious history, and significant social and political barriers have impeded research and implementation of alternatives to abstinence-focused treatment. We summarize historical factors relevant to non-abstinence treatment development to illuminate reasons these approaches are understudied. Additionally, the support of a solid social network and professional help can play a pivotal role.

False Sense of Control – One Drink Won’t Hurt

However, there are some common early psychological signs that a relapse may be on the way. If you are worried that you might be headed for a relapse, you don’t have to wait until it happens to reach out for help. There may be an internal conflict between resisting thoughts about drugs and compulsions to use them.

Testing judgments about attribution-emotion-action linkages: A life-span approach

AVE occurs when someone who is striving for abstinence from a particular behavior or substance experiences a setback, such as a lapse or relapse. Instead of viewing the incident as a temporary setback, the individual perceives it as evidence of personal failure, leading to increased feelings of guilt, shame, and hopelessness (Collins & Witkiewitz, 2013; Larimer, Palmer, & Marlatt, 1999). It can impact someone who is trying to be abstinent from alcohol and drug use in addition to someone trying to make positive changes to their diet, exercise, and other aspects of their lives.

Decoupling Goal Striving From Resource Depletion by Forming Implementation Intentions

A relapse is the result of a series of https://ecosoberhouse.com/article/how-art-therapy-can-help-in-addiction-recovery/ events that occur over time, according to psychologist and researcher Alan Marlatt, Ph.D. These patterns can be actively identified and corrected, helping participants avoid lapses before they occur and continue their recovery from substance use disorder. Before you know it, you’re back in the old pattern—hangovers, drunk arguments, the endless obsession around the wine o’clock. Overall, the Abstinence Violation Effect is a complex phenomenon influenced by a combination of cognitive, emotional, and biological factors. There are several factors that can contribute to the development of the AVE in people recovering from addiction.

• Indeed, a prominent harm reduction psychotherapist and researcher, Rothschild, argues that the harm reduction approach represents a “third wave of addiction treatment” which follows, and is replacing, the moral and disease models (Rothschild, 2015a).
• In other words, abstinence violation effects make a single lapse much more likely to turn into a full return to a full relapse into negative behavioral or mental health symptoms.
• However, the temptation from a familiar setting, coupled with the thought “one drink won’t hurt,” makes resisting the drink extra hard.
• The limit violation effect describes what happens when these individuals fail to restrict their use within their predetermined limits and the subsequent effects of this failure.
• Although reducing practical barriers to treatment is essential, evidence suggests that these barriers do not fully account for low rates of treatment utilization.