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

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. Findings from these studies suggested that participants’ SE was lower on the day before a lapse, and that lower SE in the abstinence violation effect days following a lapse in turn predicted progression to relapse [43,45]. One study [46] reported increases in daily SE during abstinent intervals, perhaps indicating mounting confidence as treatment goals were maintained [45]. 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.

• The brain is remarkably plastic—it shapes and reshapes itself, adapts itself in response to experience and environment.
• Or they may be caught by surprise in a situation where others around them are using and not have immediate recourse to recovery support.
• Additionally, momentary coping responses can serve as phasic events that may determine whether a high-risk situation culminates in a lapse.
• 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.

Understand The Relapse Process

Nevertheless, these studies were useful in identifying limitations and qualifications of the RP taxonomy and generated valuable suggestions [121]. Ecological momentary assessment, either via electronic device or interactive voice response methodology, could provide the data necessary to fully test the dynamic model of relapse19. In a study by McCrady evaluating the effectiveness of psychological interventions for alcohol use disorder such as Brief Interventions and Relapse Prevention was classified as efficacious23.

Outcome expectancies

In addition to the recent advances outlined above, we highlight selected areas that are especially likely to see growth over the next several years. All rights are reserved, including those for text and data mining, AI training, and similar technologies. Taylor may think, “All that good work down the drain, I am never going to be able to keep this up for my life.” Like Jim, this may also trigger a negative mindset and a return to unhealthy eating and a lack of physical exercise.

RP Intervention Strategies

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 https://ecosoberhouse.com/ 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.

• Also, many studies that have examined potential mediators of outcomes have not provided a rigorous test [129] of mechanisms of change.
• Our treatment options include detox, inpatient treatment, outpatient treatment, medication-assisted treatment options, and more.
• A relapse is a sustained return to heavy and frequent substance use that existed prior to treatment or the commitment to change.
• (Moderating effects of OPRM1 were specific to participants receiving medication management without the cognitive-behavioral intervention [CBI] and were not evident in participants receiving NTX and CBI).
• Functional imaging is increasingly being incorporated in treatment outcome studies (e.g., [133]) and there are increasing efforts to use imaging approaches to predict relapse [134].
• However, we review these findings in order to illustrate the scope of initial efforts to include genetic predictors in treatment studies that examine relapse as a clinical outcome.

1. Review aims

Counteracting the drinker’s misperceptions about alcohol’s effects is an important part of relapse prevention. To accomplish this goal, the therapist first elicits the client’s positive expectations about alcohol’s effects using either standardized questionnaires or clinical interviews. Positive expectancies regarding alcohol’s effects often are based on myths or placebo effects of alcohol (i.e., effects that occur because the drinker expects them to, not because alcohol causes the appropriate physiological changes). In particular, considerable research has demonstrated that alcohol’s perceived positive effects on social behavior are often mediated by placebo effects, resulting from both expectations (i.e., “set”) and the environment (i.e., “setting”) in which drinking takes place (Marlatt and Rohsenow 1981).

• One study, in which substance-abusing individuals were randomly assigned to RP or twelve-step (TS) treatments, found that RP participants showed increased self-efficacy, which accounted for unique variance in outcomes [69].
• Chronic stressors 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.
• The Abstinence Violation Effect (AVE) is a pivotal RP construct describing one’s cognitive and affective response to re-engaging in a prohibited behavior.
• It can impact someone who is trying to be abstinent from alcohol and drug use in addition to someone trying to make positive changes to their diet, exercise, and other aspects of their lives.
• Importantly, this client might not have ever considered such an invitation as a high-risk situation, yet various contextual factors may interact to predict a lapse.

Specific Intervention Strategies

• An additional concern is that the lack of research supporting the efficacy of established interventions for achieving nonabstinence goals presents a barrier to implementation.
• The Minnesota Model involved inpatient SUD treatment incorporating principles of AA, with a mix of professional and peer support staff (many of whom were members of AA), and a requirement that patients attend AA or NA meetings as part of their treatment (Anderson, McGovern, & DuPont, 1999; McElrath, 1997).
• Even when alcohol’s perceived positive effects are based on actual drug effects, often only the immediate effects are positive (e.g., euphoria), whereas the delayed effects are negative (e.g., sleepiness), particularly at higher alcohol doses.
• Despite significant empirical support for nonabstinence alcohol interventions, there is a clear gap in research examining nonabstinence psychosocial treatment for drug use disorders.
• However, it is also possible that adaptations will be needed for individuals with nonabstinence goals (e.g., additional support with goal setting and monitoring drug use; ongoing care to support maintenance goals), and currently there is a dearth of research in this area.
• Attention to sleep and healthy eating is minimal, as is attention to emotions and including fun in one’s life.

2. Controlled drinking