Dual process accounts of addictive behaviors [56,57] are likely to be useful for generating hypotheses about dynamic relapse processes and explaining variance in relapse, including episodes of sudden divergence from abstinence to relapse. Implicit cognitive processes are also being examined as an intervention target, with some potentially promising results [62]. 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). 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.
Ideally, assessments of coping, interpersonal stress, self-efficacy, craving, mood, and other proximal factors could be collected multiple times per day over the course of several months, and combined with a thorough pre-treatment assessment battery of distal risk factors. Future research with a data set that includes multiple measures of risk factors over multiple days could also take advantage of innovative modeling tools that were designed for estimating nonlinear time-varying dynamics [125]. Findings from numerous non-treatment studies are also relevant to the possibility of genetic influences on relapse processes. For instance, genetic factors could influence relapse in part via drug-specific cognitive processes. Recent studies have reported genetic associations with alcohol-related cognitions, including alcohol expectancies, drinking refusal self-efficacy, drinking motives, and implicit measures of alcohol-related motivation [51,52, ].
11.4.2 Cognitive Behavioral Models
In a prospective study among both men and women being treated for alcohol dependence using the Situational Confidence Questionnaire, higher self-efficacy scores were correlated to a longer interval for relapse to alcohol use8. The relationship between self-efficacy and relapse is possibly bidirectional, meaning that individuals who are more successful report greater self-efficacy and individuals who have lapsed report lower self-efficacy4. Chronic stressors abstinence violation effect may also overlap between self-efficacy and other areas of intrapersonal determinants, like emotional states, by presenting more adaptational strain on the treatment-seeking client4. Two publications, Cognitive Behavioral Coping Skills Training for Alcohol Dependence (Kadden et al., 1994; Monti, Kadden, Rohsenow, Cooney, & Abrams, 2002) and Cognitive Behavioral Therapy for Cocaine Addiction (Carroll, 1998), are based on the RP model and techniques.
While moderate drinking doesn’t equal a health benefit, it also doesn’t seem to raise the risk of death by very much, the authors said. Sometime between days 5 and 7, moderate to severe withdrawal symptoms typically lessen. Some people with a long history of alcohol misuse may start to experience seizures, which peak around 10 hours then taper off and subside entirely within 2 or 3 days. Quitting alcohol for one month seems like a short time, but a 2015 study found that many people who participate in Dry January continue to drink less six months later.
Outcome expectancies
Hopefully, one does not lose all the knowledge and experience gained along the journey. One of the biggest problems with the AVE is that periods of abstinence from opioids increase a person’s risk of overdose and today’s heroin is often tainted with super-potent fentanyl analogs. Because of heightened overdose risk, treatment providers can offer naloxone and overdose prevention training to all clients, even those whose “drug of choice” does not include opioids. Rather than communicating pessimism about a client’s potential to recover, these overdose prevention measures acknowledge the existence of the AVE and communicate that safety is more important than maintaining perfect abstinence. More information on overdose prevention strategies in treatment settings is available here.
In general, the longer a person has not used a substance, the lower their desire to use. Strengthening coping skills is a goal of virtually all cognitive-behavioral interventions for substance use [75]. One study [76] found that momentary coping differentiated smoking lapses from temptations, such that coping responses were reported in 91% of successful resists vs. 24% of lapses. Shiffman and colleagues [68] found that restorative coping following a smoking lapse decreased the likelihood of a second lapse the same day. One study found that momentary coping reduced urges among smokers, suggesting a possible mechanism [76].
‘This Time Will Be Different’
A JAMA review of 107 studies published from 1980 to 2021 found that occasional or low-volume drinkers did not have a lower risk of all-cause mortality than lifetime nondrinkers did. But there was a significantly increased risk of mortality among those who had a few drinks per day or more. While this might seem counterintuitive, it is a common thought that many people need to recognize if they want to avoid a relapse. While celebrating victories is important, you should also find constructive ways to acknowledge your sobriety.
- The harm reduction movement, and the wider shift toward addressing public health impacts of drug use, had both specific and diffuse effects on SUD treatment research.
- Moreover, an emphasis on post-treatment maintenance renders RP a useful adjunct to various treatment modalities (e.g., cognitive-behavioral, twelve step programs, pharmacotherapy), irrespective of the strategies used to enact initial behavior change.
- Findings from numerous non-treatment studies are also relevant to the possibility of genetic influences on relapse processes.
- In conclusion, the abstinence violation effect is a psychological effect that impacts those in recovery, as well as those who are focused on making more positive behavioral choices in their lives.
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.