Expanding the continuum of substance use disorder treatment: Nonabstinence approaches PMC

For example, despite being widely cited as a primary rationale for nonabstinence treatment, the extent to which offering nonabstinence options increases treatment utilization (or retention) is unknown. In addition to evaluating nonabstinence treatments specifically, researchers could help move the field forward by increased attention to nonabstinence goals more broadly. 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. Harm reduction therapy has also been applied in group format, mirroring the approach and components of individual harm reduction psychotherapy but with added focus on building social support and receiving feedback and advice from peers (Little, 2006; Little & Franskoviak, 2010). These groups tend to include individuals who use a range of substances and who endorse a range of goals, including reducing substance use and/or substance-related harms, controlled/moderate use, and abstinence (Little, 2006). Additionally, some groups target individuals with co-occurring psychiatric disorders (Little, Hodari, Lavender, & Berg, 2008).

This phenomenon, called the Abstinence Violation Effect, has been observed in a variety of contexts including dieting, alcohol or smoking cessation, and efforts to change interpersonal behaviors. But what if we recognized that behavior change is an ongoing process, and created a plan for coping with occasional slip? If you know you are likely to overeat on a holiday, you could adjust your plan to prioritize weight maintenance rather than loss during the break and then go back to dieting the following week. If you know you won’t have time to do your full workouts for a while, you could set a smaller achievable goal like doing sit-ups when you wake up and push-ups before you go to bed so you don’t lose your forward momentum. Like most things in life, behavior change doesn’t have to be perfect to be rewarding, and some of the joy can stem from the process.

Longitudinal investigation of the abstinence violation effect in binge eaters.

Thus, a biological predisposition toward greater than average weight gain could lead to preoccupation with body weight and food intake in bulimia nervosa. The neurotransmitter serotonin has been the focus of considerable research in patients with anorexia nervosa and bulimia nervosa. Laboratory studies have shown that patients with eating disorders often experience abnormal patterns of hunger and satiety over the course of a meal. Serotonin plays an important role abstinence violation effect in postingestive satiety, and appears to be important in regulation of mood and anxiety-related symptoms. Preliminary findings suggest that impaired function in central nervous system serotonergic pathways may contribute to binge eating and mood instability in bulimia nervosa. Therapeutic effects of antidepressant medications in bulimia nervosa are thought to be related to their capacity to restore more normal signaling patterns in serotonergic pathways.

abstinence violation effect psychology

CBT comprises of heterogeneous treatment components that allow the therapist to use this approach across a variety of addictive behaviours, including behavioural addictions. Relapse prevention programmes addressing not just the addictive behaviour, but also factors that contribute to it, thereby decreasing the probability of relapse. Addictive behaviours are characterized by a high degree of co-morbidity and these may interfere with treatment response. For example, in AUD treatment, individuals with both goal choices demonstrate significant improvements in drinking-related outcomes (e.g., lower percent drinking days, fewer heavy drinking days), alcohol-related problems, and psychosocial functioning (Dunn & Strain, 2013). Another cause of failure stems from viewing behavior change in all or nothing terms. Far too often people set extremely high goals and assume even a single lapse erases all prior success, so they might as well quit trying.

AVE in the Context of the Relapse Process

2021 just might be the perfect time to take charge of your own behavior so you can make your resolutions a reality. Relapse prevention (RP) is a cognitive behavioural treatment program, based on the relapse prevention model27,28. A psycho-educational self-management approach is adopted in this program and the client is trained in a variety of coping skills and responses. The client is also encouraged to change maladaptive habits and life style patterns. The model incorporates the stages of change proposed by Procahska, DiClement and Norcross (1992) and treatment principles are based on social-cognitive theories11,29,30.

  • Although there is some debate about the best definitions of lapse and relapse from theoretical and conceptual levels, these definitions should suffice.
  • We first provide an overview of the development of abstinence and nonabstinence approaches within the historical context of SUD treatment in the U.S., followed by an evaluation of literature underlying the theoretical and empirical rationale for nonabstinence treatment approaches.
  • Matching interventions to the stage of change at which an individual is, can maximize outcome.
  • This model has received a good deal of empirical support and has the merit of dismantling the process of relapse and exploring subjective and cognitive variables in a manner that has important treatment implications.

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. Although specific CBT interventions may focus more or less on particular techniques or skills, the primary goal of CBT for addictions is to assist clients in mastering skills that will allow them to become and remain abstinent from alcohol and/or drugs (Kadden et al., 1994). CBT treatments are usually guided by a manual, are relatively short term (12 to 16 weeks) in duration, and focus on the present and future. Clients are expected to monitor substance use (see Table 8.1) and complete homework exercises between sessions. The abstinence violation effect (AVE) refers to the negative cognitive and affective responses that an individual experiences after the return to substance abuse after a period of abstinence.


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