Also, the client is asked to keep a current record where s/he can self-monitor thoughts, emotions or behaviours prior to a binge. One is to help clients identify warning signs such as on-going stress, seemingly irrelevant decisions and significant positive outcome expectancies with the substance so that they can avoid the high-risk situation. The second is assessing coping skills of the client and imparting general skills such as relaxation, meditation or positive self-talk or dealing with the situation using drink refusal skills in social contexts when under peer pressure through assertive communication6. For example, offering nonabstinence treatment may provide a clearer path forward for those who are ambivalent about or unable to achieve abstinence, while such individuals would be more likely to drop out of abstinence-focused treatment. To date there has been limited research on retention rates in nonabstinence treatment. This suggests that individuals with non-abstinence goals are retained as well as, if not better than, those working toward abstinence, though additional research is needed to confirm these results and examine the effect of goal-matching on retention.
G Alan Marlatt
- Still, you should also realize that relapse isn’t guaranteed, especially if you stay vigilant in managing your continued recovery.
- According to this metaphor, learning to anticipate and plan for high-risk situations during recovery from alcoholism is equivalent to having a good road map, a well-equipped tool box, a full tank of gas, and a spare tire in good condition for the journey.
Related work has also stressed the importance of baseline levels of neurocognitive functioning (for example as measured by tasks assessing response inhibition and working memory; [56]) as predicting the likelihood of drug use in response to environmental cues. The study of implicit cognition and neurocognition in models of relapse would likely require integration of distal neurocognitive factors (e.g., baseline performance in cognitive tasks) in the context of treatment outcomes studies or EMA paradigms. Additionally, lab-based studies will be needed to capture dynamic processes involving cognitive/neurocognitive influences on lapse-related phenomena. Self-efficacy (SE), the perceived ability to enact a given behavior in a specified context [26], is a principal determinant of health behavior according to social-cognitive theories. 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.
2. Controlled drinking
The merger of mindfulness and cognitive-behavioral approaches is appealing from both theoretical and practical standpoints [115] and MBRP is a potentially effective and cost-efficient adjunct to CBT-based treatments. In contrast to the cognitive restructuring strategies typical of traditional CBT, MBRP stresses nonjudgmental attention to thoughts or urges. From this standpoint, urges/cravings are labeled as transient events that need not be acted upon reflexively. abstinence violation effect This approach is exemplified by the « urge surfing » technique [115], whereby clients are taught to view urges as analogous to an ocean wave that rises, crests, and diminishes. Rather than being overwhelmed by the wave, the goal is to « surf » its crest, attending to thoughts and sensations as the urge peaks and subsides. Despite the growth of the harm reduction movement globally, research and implementation of nonabstinence treatment in the U.S. has lagged.
Cognitive Dissonance
Consistent with the tenets of the reformulated RP model, several studies suggest advantages of nonlinear statistical approaches for studying relapse. The following section reviews selected empirical findings that support or coincide with tenets of the RP model. Because the scope of this literature precludes an exhaustive review, we highlight select findings that are relevant to the main tenets of the RP model, in particular those that coincide with predictions of the reformulated model of relapse. The RP model developed by Marlatt [7,16] provides both a conceptual framework for understanding relapse and a set of treatment strategies designed to limit relapse likelihood and severity.
4. Current status of nonabstinence SUD treatment
- Perhaps the most important thing to know about cravings is that they do not last forever.
- According to these models, the relative balance between controlled (explicit) and automatic (implicit) cognitive networks is influential in guiding drug-related decision making [54,55].
- 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]).
- 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.
- Central to the RP model is the role of cognitive factors in determining relapse liability.
1. Nonabstinence treatment effectiveness
Theoretical and Practical Support for the RP Model
- Overall, the body of research on genetic influences on relapse and related processes is nascent and virtually all findings require replication.
- Therapists also can enhance self-efficacy by providing clients with feedback concerning their performance on other new tasks, even those that appear unrelated to alcohol use.
- However, despite findings that coping can prevent lapses there is scant evidence to show that skills-based interventions in fact lead to improved coping [75].
- But their lifespan can be measured in minutes—10 or 15—and that enables people to summon ways to resist them or ride them out.
- One study found that momentary coping reduced urges among smokers, suggesting a possible mechanism [76].
- It is, however, most commonly used to refer to a resumption of substance use behavior after a period of abstinence from substances (Miller 1996).
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