Considering the numerous developments related to RP over the last decade, empirical and clinical extensions of the RP model will undoubtedly continue to evolve. In addition to the recent advances outlined above, we highlight selected areas that are especially likely to see growth over the next several years. RP has also been used in eating disorders in combination with other interventions such as CBT and problem-solving skills4. Alan Marlatt is a professor of Psychology and Director abstinence violation effect of the Addictive Behaviors Research Center at the University of Washington. He has received continuous funding for his research from a variety of agencies including the National Institute on Alcohol Abuse and Alcoholism, the National Institute on Drug Abuse, the Alcoholic Beverage Medical Research Foundation, and the Robert Wood Johnson Foundation. DPF conducted the systematic search, data extraction, and wrote the first draft of the manuscript under the supervision of MDG.
Relapse Prevention
Rather than only focusing on the end goal, celebrate small victories and all positive steps you’ve taken thus far. Learning healthy coping mechanisms can help you manage stress, cravings, and triggers without resorting to substance use. There are several factors that can contribute to the development of the AVE in people recovering from addiction.
Psychology of Sport and Exercise
Here the assessment and management of both the intrapersonal and interpersonal determinants of relapse are undertaken. This article discusses the concepts of relapse prevention, relapse determinants and the specific interventional strategies. When abstinence is violated, individuals typically also have an emotional response consisting of guilt, shame, hopelessness, loss of control, and/or a sense of failure; they may use drugs or alcohol in an attempt to cope with the negative feelings that resulted from their abstinence violation. A person may experience a particularly stressful emotional event in their lives and may turn to alcohol and/or drugs to cope with these negative emotions. An abstinence violation can also occur in individuals with low self-efficacy, since they do not feel very confident in their ability to carry out their goal of abstinence. 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.
- Indeed, this argument has been central to advocacy around harm reduction interventions for people who inject drugs, such as SSPs and safe injection facilities (Barry et al., 2019; Kulikowski & Linder, 2018).
- 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].
- Despite the growth of the harm reduction movement globally, research and implementation of nonabstinence treatment in the U.S. has lagged.
- Additionally, attitudes or beliefs about the causes and meaning of a lapse may influence whether a full relapse ensues.
- In RP client and therapist are equal partners and the client is encouraged to actively contribute solutions for the problem.
Addiction Biology
Advocates of nonabstinence approaches often point to indirect evidence, including research examining reasons people with SUD do and do not enter treatment. This literature – most of which has been conducted in the U.S. – suggests a strong link between abstinence goals and treatment entry. For example, in one study testing the predictive validity of a measure of treatment readiness among non-treatment-seeking people who use drugs, the authors found that the only item in their measure that significantly predicted future treatment entry was motivation to quit using (Neff & Zule, 2002). The study was especially notable because most other treatment readiness measures have been validated on treatment-seeking samples (see Freyer et al., 2004).
- Rather, when people with SUD are surveyed about reasons they are not in treatment, not being ready to stop using substances is consistently the top reason cited, even among individuals who perceive a need for treatment (SAMHSA, 2018, 2019a).
- These patterns can be actively identified and corrected, helping participants avoid lapses before they occur and continue their recovery from substance use disorder.
- Instead, prospective studies of abstinence situations are particularly useful in allowing observation of these psychological phenomena as they may arise over an abstinence period.
- Drawing from Intrinsic Motivation Theory (Deci, 1975) and the controlled drinking literature, Miller (1985) argued that clients benefit most when offered choices, both for drinking goals and intervention approaches.
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 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). In the last several years increasing emphasis has been placed on “dual process” models of addiction, which hypothesize that distinct (but related) cognitive networks, each reflective of specific neural pathways, act to influence substance use behavior.
The selective adaptation of the alcoholics anonymous program by gamblers anonymous
Given the rapid growth in this area, we allocate a portion of this review to discussing initial evidence for genetic associations with relapse. Specifically, we focus on recent, representative findings from studies evaluating candidate single nucleotide polymorphisms (SNPs) as moderators of response to substance use interventions. It is important to note that these studies were not designed to evaluate specific components of the RP model, nor do these studies explicitly espouse the RP model. Also, many studies have focused solely on pharmacological interventions, and are therefore not directly related to the RP model. However, we review these findings in order to illustrate the scope of initial efforts to include genetic predictors in treatment studies that examine relapse as a clinical outcome.
A Lapse Vs. A Relapse
Historically, abstinence has also been the dominant long-term treatment goal within treatment settings for gambling disorder (Ladouceur, Lachance, & Fournier, 2009). Accordingly, because some addiction-related symptoms (i.e., withdrawal, relapse, and salience/craving) only manifest (or manifest more strongly) under abstinence conditions, it is possible that they might be masked under non-abstinence conditions. In behavioral addiction research, retrospective and cross-sectional self-report questionnaires asking individuals whether they experience withdrawal symptoms, craving, or relapse are inherently limited if individuals generally do not engage in significant periods of abstinence in the first place. Instead, prospective studies of abstinence situations are particularly useful in allowing observation of these psychological phenomena as they may arise over an abstinence period. Naturally occurring periods of abstinence (e.g., intrinsically motivated cessation attempts) are useful for researchers to systematically observe where they do occur but may be rare depending on the behavior of interest.
Outcome Studies for Relapse Prevention
- For gambling disorder, controlled gambling is increasingly being advocated as a viable goal alongside traditional abstinence treatment goals (e.g., Stea, Hodgins, & Fung, 2015).
- Relapse Prevention (RP) is another well-studied model used in both AUD and DUD treatment (Marlatt & Gordon, 1985).
- Additionally, momentary coping responses can serve as phasic events that may determine whether a high-risk situation culminates in a lapse.
- Tonic processes include distal risks–stable background factors that determine an individual’s “set point” or initial threshold for relapse [8,31].
While AUD treatment studies commonly rely on guidelines set by government agencies regarding a “low-risk” or “nonhazardous” level of alcohol consumption (e.g., Enggasser et al., 2015), no such guidelines exist for illicit drug use. Thus, studies will need to emphasize measures of substance-related problems in addition to reporting the degree of substance use (e.g., frequency, quantity). Multiple theories of motivation for behavior change support the importance of self-selection of goals in SUD treatment (Sobell et al., 1992). For example, Bandura, who developed Social Cognitive Theory, posited that perceived choice is key to goal adherence, and that individuals may feel less motivation when goals are imposed by others (Bandura, 1986). Miller, whose seminal work on motivation and readiness for treatment led to multiple widely used measures of SUD treatment readiness and the development of Motivational Interviewing, also argued for the importance of goal choice in treatment (Miller, 1985).
Relapse Prevention (RP) is another well-studied model used in both AUD and DUD treatment (Marlatt & Gordon, 1985). In its original form, RP aims to reduce risk of relapse by teaching participants cognitive and behavioral skills for coping in high-risk situations (Marlatt & Gordon, 1985). 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).
