RP strategies can now be disseminated using simple but effective methods; for instance, mail-delivered RP booklets are shown to reduce smoking relapse 135,136. As noted earlier, the broad influence of RP is also evidenced by the current clinical vernacular, as “relapse prevention” has evolved into an umbrella term synonymous with most cognitive-behavioral skills-based interventions addressing high-risk situations and coping responses. While attesting to the influence and durability of the RP model, the tendency to subsume RP within various treatment modalities can also complicate efforts to systematically evaluate intervention effects across studies (e.g., 21). Unfortunately, there has been little empirical research evaluating this approach among individuals with DUD; evidence of effectiveness comes primarily from observational research.
Marlatt’s relapse prevention model: Historical foundations and overview
- However, the temptation from a familiar setting, coupled with the thought “one drink won’t hurt,” makes resisting the drink extra hard.
- Such studies have shown that both positive and negative moods show close temporal links to alcohol use 73.
- Relapse has been variously defined, depending on theoretical orientation, treatment goals, cultural context, and target substance (Miller 1996; White 2007).
- Some researchers propose that the self-control required to maintain behavior change strains motivational resources, and that this “fatigue” can undermine subsequent self-control efforts 78.
Although SE is proposed as a fluctuating and dynamic construct 26, most studies rely on static measures of SE, preventing evaluation of within-person changes over time or contexts 43. 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 maintained 45. The client’s appraisal of lapses also serves as a pivotal intervention point in that these reactions can determine whether a lapse escalates or desists.
Defining The Abstinence Violation Effect (AVE)
Relative to a control condition, ABM resulted in significantly improved ability to disengage from alcohol-related stimuli during attentional bias tasks. While incidence of relapse did not differ between groups, the ABM group showed a significantly longer time to first heavy drinking day compared to the control group. Additionally, the intervention had no effect on subjective measures of craving, suggesting the possibility that intervention effects may have been specific to implicit cognitive processes 62. Overall, research on implicit cognitions stands to enhance understanding of dynamic relapse processes and abstinence violation effect could ultimately aid in predicting lapses during high-risk situations. Efforts to develop, test and refine theoretical models are critical to enhancing the understanding and prevention of relapse 1,2,14.
- The study was especially notable because most other treatment readiness measures have been validated on treatment-seeking samples (see Freyer et al., 2004).
- 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).
4. Consequences of abstinence-only treatment
For some, even a brief lapse may generate so much self-doubt, guilt, and a belief about personal failure, that the person gives up and continues to use. Gordon as part of their cognitive-behavioral model of relapse prevention, and it is used particularly in the context of substance use disorders. There is less research examining the extent to which moderation/controlled use goals are feasible for individuals with DUDs. The most recent national survey assessing rates of illicit drug use and SUDs found that among individuals who report illicit drug use in the past year, approximately 15% meet criteria for one or more DUD (SAMHSA, 2019a). About 10% of individuals who report cannabis use in the past year meet criteria for a cannabis use disorder, while this proportion increases to 18%, 19%, 58%, and 65% of those with past year use of cocaine, opioids (misuse), methamphetamine, and heroin, respectively. These data suggest that non-disordered drug use is possible, even for a substantial portion of individuals who use drugs such as heroin (about 45%).
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- Understanding the AVE is crucial for individuals in recovery and those focused on healthier lifestyle choices.
- Most scientists who studied SUD treatment believed that abstinence was the only acceptable treatment goal until at least the 1980s (Des Jarlais, 2017).
Moreover, an emphasis on post-treatment maintenance renders RP a useful adjunct to various treatment modalities (e.g., cognitive-behavioral, twelve step programs, pharmacotherapy), irrespective of the strategies used to enact initial behavior change. The terms “relapse” and “relapse prevention” have seen evolving definitions, complicating efforts to review and evaluate the relevant literature. drug addiction Definitions of relapse are varied, ranging from a dichotomous treatment outcome to an ongoing, transitional process 8,12,13. Overall, a large volume of research has yielded no consensus operational definition of the term 14,15. For present purposes we define relapse as a setback that occurs during the behavior change process, such that progress toward the initiation or maintenance of a behavior change goal (e.g., abstinence from drug use) is interrupted by a reversion to the target behavior. 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).
