The model defines the relapse process as a progression centered on “triggering” events, both internal and external, that can leave an individual in high-risk situations and the individual’s ability to respond to these situations. In this process, after experiencing a trigger, an individual will make a series of choices and thoughts that will lead to being placed in a high-risk situation or not. There are two major types of high-risk situations, those with intrapersonal determinants, in which the person’s response is physical or psychological in nature, and interpersonal determinants, those that are influenced by other individuals or social networks. 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.
- There is also a need for updated research examining standards of practice in community SUD treatment, including acceptance of non-abstinence goals and facility policies such as administrative discharge.
- 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].
- Consistent with this idea, EMA studies have shown that social drinkers report greater alcohol consumption and violations of self-imposed drinking limits on days when self-control demands are high [79].
- It was noted that in focusing on Marlatt’s relapse taxonomy the RREP did not comprehensive evaluation of the full RP model [121].
- Combinations of precipitating and predisposing risk factors are innumerable for any particular individual and may create a complex system in which the probability of relapse is greatly increased.
We also provide updated reviews of research areas that have seen notable growth in the last few years; in particular, the application of advanced statistical modeling techniques to large treatment outcome datasets and the development of mindfulness-based relapse prevention. Additionally, we review the nascent but rapidly growing literature on genetic predictors of relapse following substance use interventions. 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.
Abstinence violation effect
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). In 1988 legislation was passed prohibiting the use of federal funds to support syringe access, a policy which remained in effect until 2015 even as numerous studies demonstrated the effectiveness of SSPs in reducing disease transmission (Showalter, 2018; Vlahov et al., 2001). Despite these obstacles, SSPs and their advocates grew into a national and international harm reduction movement (Des Jarlais, 2017; Friedman, Southwell, Bueno, & Paone, 2001).
Another factor that may occur is the Problem of Immediate Gratification where the client settles for shorter positive outcomes and does not consider larger long term adverse consequences when they lapse. This can be worked on by creating a decisional matrix where the pros and cons of continuing the behaviour versus abstaining are written down within both shorter and longer time frames and the therapist helps the client to identify unrealistic outcome expectancies5. These covert antecedents include lifestyle factors, such as overall stress level, one’s temperament and personality, as well as cognitive factors. These may serve to set up a relapse, for example, using rationalization, denial, or a desire for immediate gratification.
2. Established treatment models compatible with nonabstinence goals
While there are multiple such intervention approaches for treating AUD with strong empirical support, we highlight a dearth of research testing models of harm reduction treatment for DUD. We focus our review on two well-studied approaches that were initially conceptualized – and have been frequently discussed in the abstinence violation effect empirical literature – as client-centered alternatives to abstinence-based treatment. 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.