Cognitive behavioural interventions in addictive disorders PMC

Of note, other SUD treatment approaches that could be adapted to target nonabstinence goals (e.g., contingency management, behavioral activation) are excluded from the current review due to lack of relevant empirical evidence. Despite the empirical support for many components of the cognitive-behavioral model, there have also been many criticisms of the model for being too static and hierarchical. In response to these criticisms, Witkiewitz and Marlatt proposed a revision of the cognitive-behavioral model of relapse that incorporated both static and dynamic factors that are believed to be influential in the relapse process.

Two cognitive mechanisms that contribute to the covert planning of a relapse episode—rationalization and denial—as well as apparently irrelevant decisions (AIDs) can help precipitate high-risk situations, which are the central determinants of a relapse. People who lack adequate coping skills for handling these situations experience reduced confidence in their ability to cope (i.e., decreased self-efficacy). Moreover, these people often have positive expectations regarding the effects of alcohol (i.e., outcome expectancies). These factors can lead to initial alcohol use (i.e., a lapse), which can induce an abstinence violation effect that, in turn, influences the risk of progressing to a full relapse. Self-monitoring, behavior assessment, analyses of relapse fantasies, and descriptions of past relapses can help identify a person’s high-risk situations.

Moving Forward in Recovery After AVE

It hypothesizes that following recovery, mild states of depression can reactivate depressogenic cycles of cognitive processing similar to those found during a major depressive episode. Teasdale et al. suggest that preventive interventions such as cognitive therapy operate by changing the patterns of cognitive processing that become active in states of mild negative affect preceding a full relapse into major depression. They suggest that the redeployment of attention utilized in stress-reduction procedures based on the techniques of mindfulness meditation (Kabat-Zinn, 1990) can be integrated with cognitive therapy procedures into a system of attentional control training. This approach would be applicable to recovered depressed patients and would serve as a means of preventing relapse. Teasdale and colleagues provide a description of this training which teaches generic psychological, self-control skills and can be used on a continuing basis to maintain skills after initial training. While no data on the effectiveness of this approach in preventing relapse exist to date, this appears to be a useful and stimulating conceptualization of relapse and relapse prevention that deserves further attention.

In the 1980s and 1990s, the HIV/AIDS epidemic prompted recognition of the role of drug use in disease transmission, generating new urgency around the adoption of a public health-focused approach to researching and treating drug use problems (Sobell & Sobell, 1995). The realization that HIV had been spreading widely among people who injected drugs in the mid-1980s led to the first syringe services programs (SSPs) in the U.S. (Des Jarlais, 2017). Early attempts to establish pilot SSPs were met with public outcry and were blocked by politicians (Anderson, 1991).

2. Relationship between goal choice and treatment outcomes

Importantly, there has also been increasing acceptance of non-abstinence outcomes as a metric for assessing treatment effectiveness in SUD research, even at the highest levels of scientific leadership (Volkow, 2020). Many advocates of harm reduction believe the SUD treatment field is at a turning point in acceptance of nonabstinence approaches. 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). Only a small minority of people with substance use disorders (SUDs) receive treatment.

Modifying social and environmental antecedents and consequences another approach to working with addictive behaviours18. Therapeutic strategies such as contingency management, differential reinforcement of incompatible and alternate behaviours and rearrangement of environmental cues that set the occasion for addictive behaviour, including emotional triggers are used in this approach. Family members are counselled so as identify potential risk factors for relapse, such as emotional and behavioural changes. Dealing effectively with interpersonal problems in the family, and improving communication and avoiding conflicts have been effectively employed in the Indian context16,17. It is similar to the cognitive model of emotional disorders proposed by Beck9.

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More recent versions of RP have included mindfulness-based techniques (Bowen, Chawla, & Marlatt, 2010; Witkiewitz et al., 2014). The RP model has been studied among individuals with both AUD and DUD (especially Cocaine Use Disorder, e.g., Carroll, Rounsaville, & Gawin, 1991); with the largest effect sizes identified in the treatment of AUD (Irvin, Bowers, Dunn, & Wang, 1999). As a newer iteration of RP, Mindfulness-Based Relapse Prevention (MBRP) has a less extensive research base, though it has been tested in samples with a range of SUDs (e.g., Bowen et al., 2009; Bowen et al., 2014; Witkiewitz et al., 2014). In sum, research suggests that achieving and sustaining moderate substance use after treatment is feasible for between one-quarter to one-half of individuals with AUD when defining moderation as nonhazardous drinking. While there is evidence that a subset of individuals who use drugs engage in low-frequency, non-dependent drug use, there is insufficient research on this population to determine the proportion for whom moderation is a feasible treatment goal. However, among individuals with severe SUD and high-risk drug or alcohol use, the urgency of reducing substance-related harms presents a compelling argument for engaging these individuals in harm reduction-oriented treatment and interventions.

abstinence violation effect

The treatment is not lapse prevention; lapses are to be expected, planned for, and taken as opportunities for the client to demonstrate learning. Most often, relapse tends to be construed as a return to pretreatment levels of occurrence of the targeted behavior. Although there is some debate about the best definitions of lapse and relapse from theoretical and conceptual levels, these definitions should suffice.

However, it can sometimes lead to the thought that you have earned a drink or a night of using drugs. It sounds counterintuitive, and it is, but it is a common thought that many people have to recognize to avoid relapse. Celebrating victories is a good thing, but it’s important to find constructive ways to appreciate abstinence violation effect definition your sobriety. A physical relapse occurs when you take your first drug or drink after achieving sobriety. Marlatt differentiates between slipping into abstinence for the first time and totally abandoning the goal. Seeking help in time can prevent you from slipping into uncontrolled active addiction.

  • 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.
  • Mindfulness, is drawn from Zen Buddhist teachings and refers to viewing things in a special way.
  • Marlatt coined the term abstinence violation effect to refer to situations in which addicts respond to an initial indulgence by consuming even more of the forbidden substance [11].

Abstinence violation effect can be overcome, but it is far better to avoid suffering AVE in the first place. Enroll in Amethyst Recovery, and you’ll learn the skills you need to practice effective relapse prevention. The result of this lackluster planning is that we recognize future disturbances, yet do nothing to truly resolve them.

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