In a similar fashion, the nature of these attributions determines whether the violation will lead to full-blown relapse. Marlatt is currently conducting studies of the latest version of his behavior-modification techniques — which he collectively calls “mindfulness-based relapse prevention” — in comparison with typical addiction treatment. His research, on alcohol and other drug abuse, isn’t completed yet, but he says, “We’re getting very positive results.” The on-site concept mapping session for the health practitioners lasted 1.5 h and the session for the persons who regained weight lasted two hours. The difference in sorting and rating methods between stakeholder groups (online vs print) was based on recommendations given by the health practitioners, who believed sorting statements on paper would be easier than doing it online. As participants came up with new statements during the brainstorm session, a portable label printer was used to print new cards for the persons who regained weight.

Implicit cognitive processes are also being examined as an intervention target, with some potentially promising results [62]. In the first study to examine relapse in relation to phasic changes in SE [46], researchers reported results that appear consistent with the dynamic model of relapse. During a smoking cessation attempt, participants reported on SE, negative affect and urges at random intervals. Findings abstinence violation effect indicated nonlinear relationships between SE and urges, such that momentary SE decreased linearly as urges increased but dropped abruptly as urges peaked. Moreover, this finding appeared attributable to individual differences in baseline (tonic) levels of SE. When urge and negative affect were low, individuals with low, intermediate or high baseline SE were similar in their momentary SE ratings.

5. Feasibility of nonabstinence goals

Only a small minority of people with substance use disorders (SUDs) receive treatment. 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. This narrative review considers the need for increased research attention on nonabstinence psychosocial treatment of SUD – especially drug use disorders – as a potential way to engage and retain more people in treatment, to engage people in treatment earlier, and to improve treatment effectiveness. Despite significant empirical support for nonabstinence alcohol interventions, there is a clear gap in research examining nonabstinence psychosocial treatment for drug use disorders. Future research must test the effectiveness of nonabstinence treatments for drug use and address barriers to implementation.

  • What is more, negative feelings can create a negative mindset that erodes resolve and motivation for change and casts the challenge of recovery as overwhelming, inducing hopelessness.
  • Although many developments over the last decade encourage confidence in the RP model, additional research is needed to test its predictions, limitations and applicability.
  • It was initially not favored by the medical community because it had side effects such as dizziness, fainting, irregular heartbeat, and priapism…
  • Harm reduction may also be well-suited for people with high-risk drug use and severe, treatment-resistant SUDs (Finney & Moos, 2006; Ivsins, Pauly, Brown, & Evans, 2019).

The majority of people who decide to end addiction have at least one lapse or relapse during the recovery process. Studies show that those who detour back to substance use are responding to drug-related cues in their surroundings—perhaps seeing a hypodermic needle or a whiskey bottle or a person or a place where they once obtained or used drugs. Such triggers are especially potent in the first 90 days of recovery, when most relapse occurs, before the brain has had time to relearn to respond to other rewards and rewire itself to do so. There is an important distinction to be made between a lapse, or slipup, and a relapse. The distinction is critical to make because it influences how people handle their behavior. A relapse is a sustained return to heavy and frequent substance use that existed prior to treatment or the commitment to change.

Behavioral Treatments for Smoking

People with effective coping responses have confidence that they can cope with the situation (i.e., increased self-efficacy), thereby reducing the probability of a relapse. Conversely, people with ineffective coping responses will experience decreased self-efficacy, which, together with the expectation that alcohol use will have a positive effect (i.e., positive outcome expectancies), can result in an initial lapse. This lapse, in turn, can result in feelings of guilt and failure (i.e., an abstinence violation effect). The abstinence violation effect, along with positive outcome expectancies, can increase the probability of a relapse. Findings from numerous non-treatment studies are also relevant to the possibility of genetic influences on relapse processes. For instance, genetic factors could influence relapse in part via drug-specific cognitive processes.