Altogether, these thoughts and attributions are frequently driven by strong feelings of personal failure, defeat, and shame. These negative emotions are, unfortunately, often temporarily placated by a renewed pattern of substance abuse. Otherwise, recovering individuals are likely to make the worst of a single mistake and accelerate back through the relapse process as a result.
There has been little research on the goals of non-treatment-seeking individuals; however, research suggests that nonabstinence goals are common even among individuals presenting to SUD treatment. Among those seeking treatment for alcohol use disorder (AUD), studies with large samples have cited rates of nonabstinence goals ranging from 17% (Berglund et al., 2019) to 87% (Enggasser et al., 2015). In Europe, about half (44–46%) of individuals seeking treatment for AUD have non-abstinence goals (Haug & Schaub, 2016; Heather, Adamson, Raistrick, & Slegg, 2010). In the U.S., about 25% of patients seeking abstinence violation effect treatment for AUD endorsed nonabstinence goals in the early 2010s (Dunn & Strain, 2013), while more recent clinical trials have found between 82 and 91% of those seeking treatment for AUD prefer nonabstinence goals (Falk et al., 2019; Witkiewitz et al., 2019). Upon breaking the self-imposed rule, individuals often experience negative emotions such as guilt, shame, disappointment, and a sense of failure.
Feeling somewhat uncomfortable with the offer the client might experience a slight decrease in self-efficacy, which cascades into positive outcome expectancies about the potential effects of having a drink as well as feelings of shame or guilt about saying no to his neighbor’s offer. Importantly, this client might not have ever considered such an invitation as a high-risk situation, yet various contextual factors may interact to predict a lapse. The current review highlights multiple important directions for future research related to nonabstinence SUD treatment.
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. 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. In the context of addiction, a breach of sobriety with a single drink or use of a drug has a high likelihood of a full relapse.
Findings 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. However, these groups’ momentary ratings diverged significantly at high levels of urges and negative affect, such that those with low baseline SE had large drops in momentary SE in the face of increasingly challenging situations. These findings support that higher distal risk can result in bifurcations (divergent patterns) of behavior as the level of proximal risk factors increase, consistent with predictions from nonlinear dynamic systems theory 31. 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.
Such findings have contributed to renewed interest in negative reinforcement models of drug use 63. Relapse poses a fundamental barrier to the treatment of addictive behaviors by representing the modal outcome of behavior change efforts 1-3. For instance, twelve-month relapse rates following alcohol or tobacco cessation attempts generally range from 80-95% 1,4 and evidence suggests comparable relapse trajectories across various classes of substance use 1,5,6. Preventing relapse or minimizing its extent is therefore a prerequisite for any attempt to facilitate successful, long-term changes in addictive behaviors. It is important to highlight that most of the studies cited above did not provide goal-matched treatment; thus, these outcomes generally reflect differences between individuals with abstinence vs. non-abstinence goals who participated in abstinence-based AUD treatment.
In 1990, Marlatt was introduced to the philosophy of harm reduction during a trip to the Netherlands (Marlatt, 1998). He adopted the language and framework of harm reduction in his own research, and in 1998 published a seminal book on harm reduction strategies for a range of substances and behaviors (Marlatt, 1998). Marlatt’s work inspired the development of multiple nonabstinence treatment models, including harm reduction psychotherapy (Blume, 2012; Denning, 2000; Tatarsky, 2002). Additionally, while early studies of SUD treatment used abstinence Sober living home as the single measure of treatment effectiveness, by the late 1980s and early 1990s researchers were increasingly incorporating psychosocial, health, and quality of life measures (Miller, 1994). Based on the cognitive-behavioral model of relapse, RP was initially conceived as an outgrowth and augmentation of traditional behavioral approaches to studying and treating addictions.
Similarly, self-regulation ability, outcome expectancies, and the abstinence violation effect could all be experimentally manipulated, which could eventually lead to further refinements of RP strategies. Initial evidence suggests that implicit measures of expectancies are correlated with relapse outcomes, as demonstrated in one study of heroin users 61. In another recent study, researchers trained participants in attentional bias modification (ABM) during inpatient treatment for alcohol dependence and measured relapse over the course of three months post-treatment 62.
8 de enero de 2021
Publicado en: Sober living