Relapse prevention PMC

abstinence violation effect psychology

Therefore, many of the techniques discussed under relapse prevention that aim at modification of dysfunctional beliefs related to outcomes of substance use, coping or self-efficacy are relevant and overlapping. It is now believed that relapse prevention strategies must be taught to the individual during the course of therapy, and various strategies to enhance patient involvement and adherence such as increasing patient responsibility, promoting internal attributions to events are to be introduced in therapy. Working with the abstinence violation effect refers to a variety of targets helps in generalization of gains, patients are helped in anticipating high risk situations33. Lindsey Rodriguez is a third-year doctoral student in the Social Psychology Program at the University of Houston, USA. Her long-term research interests include the development of a comprehensive understanding of how problematic alcohol use and interpersonal relationship processes interact to influence various physical, emotional, and relational outcomes for individuals and their relationship partners.

  • First characterized as an important ingredient in the relapse process in the mid-1980s, the AVE has profound relevance for addiction professionals today.
  • Shiffman, Gwaltney and colleagues have used ecological momentary assessment (EMA; [44]) to examine temporal variations in SE in relation to smoking relapse.
  • More and more, behavioral health organizations are moving away from “kicking people out of treatment” if they return to substance use.
  • Relapse poses a fundamental barrier to the treatment of addictive behaviors by representing the modal outcome of behavior change efforts [1-3].
  • For example, successful navigation of high-risk situations may increase self-efficacy (one’s perceived capacity to cope with an impending situation or task; [26]), in turn decreasing relapse probability.
  • Specifically, RP was most effective when applied to alcohol or polysubstance use disorders, combined with the adjunctive use of medication, and when evaluated immediately following treatment.

Relapse Prevention

  • 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.
  • Family members are counselled so as identify potential risk factors for relapse, such as emotional and behavioural changes.
  • Early learning theories and later social cognitive and cognitive theories have had a significant influence on the formulation CBT for addictive behaviours.
  • One study [74] found evidence suggesting a feedback cycle of mood and drinking whereby elevated daily levels of NA predicted alcohol use, which in turn predicted spikes in NA.

Although there is some debate about the best definitions of lapse and relapse from theoretical and conceptual levels, these definitions should suffice. The AVE was introduced into the substance abuse literature within the context of the “relapse process” (Marlatt & Gordon, 1985, p. 37). Relapse has been variously defined, depending on theoretical orientation, treatment goals, cultural context, and target substance (Miller, 1996; White, 2007). It is, however, most commonly used to refer to a resumption of substance-use behavior after a period of abstinence from substances (Miller, 1996). The term relapse may be used to describe a prolonged return to substance use, whereas lapsemay be used to describe discrete,…

Outcome expectancies

abstinence violation effect psychology

Overall, the body of research on genetic influences on relapse and related processes is nascent and virtually all findings require replication. Consistent with the broader literature, it can be anticipated that most genetic associations with relapse outcomes will be small in magnitude and potentially difficult to replicate. It is inevitable that the next decade will see exponential growth in this area, including greater use of genome-wide analyses of treatment response [109] and efforts to evaluate the clinical utility and cost effectiveness of tailoring treatments based on pharmacogenetics. Finally, an intriguing direction is to evaluate whether providing clients with personalized genetic information can facilitate reductions in substance use or improve treatment adherence [110,111]. The most promising pharmacogenetic evidence in alcohol interventions concerns the OPRM1 A118G polymorphism as a moderator of clinical response to naltrexone (NTX). Moreover, 87.1% of G allele carriers who received NTX were classified as having a good clinical outcome at study endpoint, versus 54.5% of Asn40 homozygotes who received NTX.

Systematic reviews and large-scale treatment outcome studies

At that time, there is typically a greater sensitivity to stress and lowered sensitivity to reward. At this stage, a person might not even think about using substances, but there is a lack of attention to self-care, the person is isolating from others, and they may be attending therapy sessions or group meetings only intermittently. Attention to sleep and healthy eating is minimal, as is attention to emotions and including fun in one’s life.

Relapse and Lapse

  • Although MI incorporates the principles of the trans theoretical model, it has been distinguished from both trans theoretical model and CBT21.
  • Given supportive data for the efficacy of mindfulness-based interventions in other behavioral domains, especially in prevention of relapse of major depression [114], there is increasing interest in MBRP for addictive behaviors.
  • 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).
  • For that reason, some experts prefer not to use the term “relapse” but to use more morally neutral terms such as “resumed” use or a “recurrence” of symptoms.
  • MET adopts several social cognitive as well as Rogerian principles in its approach and in keeping with the social cognitive theory, personal agency is emphasized.

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]). Elucidating the “active ingredients” of CBT treatments remains an important and challenging goal. Consistent with the RP model, changes in coping skills, self-efficacy and/or outcome expectancies are the primary putative mechanisms by which CBT-based interventions work [126]. One study, in which substance-abusing individuals were randomly assigned to RP or twelve-step (TS) treatments, found that RP participants showed increased self-efficacy, which accounted for unique variance in outcomes [69]. Further, there was strong support that increases in self-efficacy following drink-refusal skills training was the primary mechanism of change. In another study examining the behavioral intervention arm of the COMBINE study [128], individuals who received a skills training module focused on coping with craving and urges had significantly better drinking outcomes via decreases in negative mood and craving that occurred after receiving the module.

These results suggest that researchers should strive to consider alternative mechanisms, improve assessment methods and/or revise theories about how CBT-based interventions work [77,130]. The dynamic model of relapse assumes that relapse can take the form of sudden and unexpected returns to the target behavior. This concurs not only with clinical observations, but also with contemporary learning models stipulating that recently modified behavior is inherently unstable and easily swayed by context [32]. While maintaining its footing in cognitive-behavioral theory, the revised model also draws from nonlinear dynamical systems theory (NDST) and catastrophe theory, both approaches for understanding the operation of complex systems [10,33]. Detailed discussions of relapse in relation to NDST and catastrophe theory are available elsewhere [10,31,34]. With regard to addictive behaviours Cognitive Therapy emphasizes psychoeducation and relapse prevention.

abstinence violation effect psychology

As a result, those recovering from addiction can be harsh inner critics of themselves and believe they do not deserve to be healthy or happy. Prolonged stress during childhood dysregulates the normal stress response and can lastingly impair emotion regulation and cognitive development. What is more, it can alter the sensitivity of the stress response system so that it overresponds to low levels of threat, making people feel easily overwhelmed by life’s normal difficulties. Research shows a strong link between ACEs and opioid drug abuse as well as alcoholism.

abstinence violation effect psychology

abstinence violation effect psychology

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