Expanding the continuum of substance use disorder treatment: Nonabstinence approaches

Relapse has been variously defined, depending on theoretical orientation, treatment goals, cultural context, and target substance (Miller 1996; White 2007). It is, however, most commonly used to refer to a resumption of substance use behavior after a period of abstinence from substances (Miller 1996). The term relapse may be used to describe a prolonged return to substance use, whereas lapsemay be used to describe discrete, circumscribed… The AVE was introduced into the substance abuse literature within the context of the “relapse process” (Marlatt & Gordon, 1985, p. 37). Relapse has been variously defined, depending on theoretical orientation, treatment goals, cultural context, and target substance (Miller, 1996; White, 2007).

The Abstinence Violation Approach

Previous reviews have described nonabstinence pharmacological approaches (e.g., Connery, 2015; Palpacuer et al., 2018), which are outside the scope of the current review. We first describe treatment models with an explicit harm reduction or nonabstinence focus. 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. Next, we review other established SUD treatment models that are compatible with non-abstinence goals. We focus our review on two well-studied approaches that were initially conceptualized – and have been frequently discussed in the empirical literature – as client-centered alternatives to abstinence-based treatment.

1. Nonabstinence treatment effectiveness

Researchers continue to evaluate the AVE and the efficacy of relapse prevention strategies. 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 abstinence violation effect 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.

How does ReachLink’s virtual therapy platform support recovery?

• Being able to understand how your thoughts, emotions, and behaviors play off of each other can help you to better control and respond to them in a positive way.
• It has also been shown to promote a decrease in symptoms of anxiety, depression, and specific phobias, all which have a comorbid relationship with substance use disorders.
• This model notes that those who have the latter mindset are proactive and strive to learn from their mistakes.
• Those in addiction treatment or contemplating treatment can benefit from this aspect of relapse prevention.

These rectifying steps usually include changing external elements rather marijuana addiction than finding a magic button of willpower. Recovery from addiction is often a challenging journey; one that is more often than not marked by setbacks. For many of the people that we work with at our clinic who are trying to establish themselves in recovery, relapses are a common occurrence.

Is a Relapse Dangerous?

Experiencing a setback in mental health recovery can feel disappointing, frightening, or devastating. These feelings may be compounded by reactions from concerned family and friends, who might view a setback as evidence of failure or lost progress. While such responses are understandable, they often reflect unrealistic, unhealthy, or inaccurate views of mental health recovery and can potentially cause more harm than good.

Coping

• Hopefully, one does not lose all the knowledge and experience gained along the journey.
• Global self-management strategy involves encouraging clients to pursue again those previously satisfying, nondrinking recreational activities.
• When it comes to recovery, understanding how to bounce back from challenges can transform temporary setbacks into powerful stepping stones for growth.
• Despite this, lapsing is still a risk factor and makes a person more prone to relapse.

At ReachLink, we focus on recovery as a continuous journey of growth, learning, and adaptation—one of the most important ways that therapists and clients can counter misconceptions about mental health challenges while supporting the development of healthier attitudes toward setbacks and potential relapses. While this can affect anyone making behavioral changes, it’s particularly impactful for those recovering from mental health challenges and substance use disorders. The abstinence violation effect in mental health recovery occurs when individuals interpret setbacks as complete failures, but professional therapeutic support can help develop resilience strategies, reframe recovery perspectives, and prevent minor lapses from derailing overall progress. Individuals with greater SUD severity tend to be most receptive to therapist input about goal selection (Sobell, Sobell, Bogardis, Leo, & Skinner, 1992). This suggests that treatment experiences and therapist input can influence participant goals over time, and there is value in engaging patients with non-abstinence goals in treatment.

As a newer iteration of RP, Mindfulness-Based Relapse Prevention (MBRP) has a less extensive research base, though it has been tested in samples with a range of SUDs (e.g., Bowen et al., 2009; Bowen et al., 2014; Witkiewitz et al., 2014). 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. While there is evidence that a subset of individuals who use drugs engage in low-frequency, non-dependent drug use, there is insufficient research on this population to determine the proportion for whom moderation is a feasible treatment goal. However, among individuals with severe SUD and high-risk https://www.varopakorn.com/alcohol-withdrawal-causes-symptoms-timeline-and-3/ drug or alcohol use, the urgency of reducing substance-related harms presents a compelling argument for engaging these individuals in harm reduction-oriented treatment and interventions. Administrative discharge due to substance use is not a necessary practice even within abstinence-focused treatment (Futterman, Lorente, & Silverman, 2004), and is likely linked to the assumption that continued use indicates lack of readiness for treatment, and that abstinence is the sole marker of treatment success. In the United Kingdom, where there is greater acceptance of nonabstinence goals and availability of nonabstinence treatment (Rosenberg et al., 2020; Rosenberg & Melville, 2005), the rate of administrative discharge is much lower than in the U.S. (1.42% vs. 6% of treatment episodes; Newham, Russell, & Davies, 2010; SAMHSA, 2019b).