This is an open-access report distributed under the terms of the Creative Commons Public Domain License. You can copy, modify, distribute and perform the work, even for commercial purposes, all without asking permission.
Cognitive Factors in Addictive Processes
Broad implementation of a continuing care approach will require policy change at numerous levels, including the adoption of long-term patient-based and provider-based strategies and contingencies to optimize and sustain treatment outcomes [139,140]. In terms of clinical applications of RP, the most notable development in the last decade has been the emergence and increasing application of Mindfulness-Based Relapse Prevention (MBRP) for addictive behaviors [112,113]. Given supportive data for the efficacy of mindfulness-based interventions in other behavioral domains, especially in prevention of relapse of major depression [114], there is increasing interest in MBRP for addictive behaviors. The merger of mindfulness and cognitive-behavioral approaches is appealing from both theoretical and practical standpoints [115] and MBRP is a potentially effective and cost-efficient adjunct to CBT-based treatments. In contrast to the cognitive restructuring strategies typical of traditional CBT, MBRP stresses nonjudgmental attention to thoughts or urges. From this standpoint, urges/cravings are labeled as transient events that need not be acted upon reflexively.
Emerging topics in relapse and relapse prevention
Consistent with the tenets of the reformulated RP model, several studies suggest advantages of nonlinear statistical approaches for studying relapse. The RP model developed by Marlatt [7,16] provides both a conceptual framework for understanding relapse and a set of treatment strategies designed to limit relapse likelihood and severity. Because detailed accounts of the model’s historical background and theoretical underpinnings have been published elsewhere (e.g., [16,22,23]), we limit the current discussion to a concise review of the model’s history, core concepts and clinical applications.
- You can copy, modify, distribute and perform the work, even for commercial purposes, all without asking permission.
- One of the key distinctions between CBT and RP in the field is that the term “CBT” is more often used to describe stand-alone primary treatments that are based on the cognitive-behavioral model, whereas RP is more often used to describe aftercare treatment.
- One study found that momentary coping reduced urges among smokers, suggesting a possible mechanism [76].
- He believed that drinking helped him across many domains of life (positive outcome expectancies regarding alcohol use and its effects, stage of change).
- This success can then motivate the client’s effort to change his or her pattern of alcohol use and increase the client’s confidence that he or she will be able to successfully master the skills needed to change.
The reformulated cognitive-behavioral model of relapse
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,… At Bedrock, we use evidence-based approaches such as cognitive-behavioral therapy (CBT) to help our clients develop coping skills and enhance resilience in the face of setbacks. The AVE was introduced into the substance abuse literature within the context of the “relapse process” (Marlatt and Gordon 1985, p. 37). Relapse has been variously defined, depending on theoretical orientation, treatment goals, cultural context, and target substance (Miller 1996; White 2007).
For example, if the client understands that using alcohol in the day time triggers a binge, agreeing for a meeting in the afternoon in a restaurant that serves alcohol would be a SID5. Rajiv was anxious since childhood (early learning and temperamental contributions) and avoided social situations (poor coping). He started using alcohol in his college, with friends and found that drinking helped him cope with his anxiety. Gradually he began to drink before meetings or interactions (maladaptive coping and negative reinforcement). He reported difficulty sleeping if he did not drink, could not get past the day without drinking or thinking about his next drink (establishment of a dependence pattern).
Theoretical and Practical Support for the RP Model
Various psychological factors were significant in initiating and maintaining Rajiv’s dependence on alcohol. At the start of treatment, Rajiv was not keen engage to in the process of recovery, having failed at multiple attempts over the years (motivation to change, influence of past learning experiences with abstinence). A key contribution of the reformulated relapse model is to highlight the need for non-traditional assessment and analytic approaches to better understand relapse. Most studies of relapse rely on statistical methods that assume continuous linear relationships, but these methods may be inadequate for studying a behavior characterized by discontinuity and abrupt changes [33].
Self-control and coping responses
Understanding the AVE is crucial for individuals in recovery and those focused on healthier lifestyle choices. Instead of surrendering to the negative spiral, individuals can benefit from reframing the lapse as a learning opportunity and teachable moment. Recognizing the factors that contributed to the lapse, such as stressors or triggers, helps individuals to develop strategies and techniques https://ecosoberhouse.com/ to navigate similar challenges in the future. Therapists also can enhance self-efficacy by providing clients with feedback concerning their performance on other new tasks, even those that appear unrelated to alcohol use. In general, success in accomplishing even simple tasks (e.g., showing up for appointments on time) can greatly enhance a client’s feelings of self-efficacy.
Continued empirical evaluation of the RP model
Advocates of nonabstinence approaches often point to indirect evidence, including research examining reasons people with SUD do and do not enter treatment. This literature – most of which has been conducted in the U.S. – suggests a strong link between abstinence goals and treatment entry. The study was especially notable because most other treatment readiness measures have been validated on treatment-seeking samples (see Freyer the abstinence violation effect refers to et al., 2004). This finding supplements the numerous studies that identify lack of readiness for abstinence as the top reason for non-engagement in SUD treatment, even among those who recognize a need for treatment (e.g., Chen, Strain, Crum, & Mojtabai, 2013; SAMHSA, 2019a). There are many relapse prevention models used in substance abuse treatment to counter AVE and give those in recovery important tools and coping skills.
- A critical implication is that rather than signaling a failure in the behavior change process, lapses can be considered temporary setbacks that present opportunities for new learning to occur.
- Stages imply a readiness to change and therefore the TTM has been particularly relevant in the timing of interventions.
- 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.
- For instance, a person recovering from alcohol use disorder who has a drink may feel a sense of confusion or a lack of control and they may make unhealthy attributions or rationalizations to try to define and understand what they’re doing.
- This finding supplements the numerous studies that identify lack of readiness for abstinence as the top reason for non-engagement in SUD treatment, even among those who recognize a need for treatment (e.g., Chen, Strain, Crum, & Mojtabai, 2013; SAMHSA, 2019a).
- A key contribution of the reformulated relapse model is to highlight the need for non-traditional assessment and analytic approaches to better understand relapse.
- AVE occurs when someone who is striving for abstinence from a particular behavior or substance experiences a setback, such as a lapse or relapse.
Unfortunately, few quantitative, survey-based studies have included substance use during treatment as a potential reason for treatment noncompletion, representing a significant gap in this body of literature (for a review, see Brorson, Ajo Arnevik, Rand-Hendriksen, & Duckert, 2013). Additionally, no studies identified in this review compared reasons for not completing treatment between abstinence-focused and nonabstinence treatment. When abstinence is violated, individuals typically also have an emotional response consisting of guilt, shame, hopelessness, loss of control, and/or a sense of failure; they may use drugs or alcohol in an attempt to cope with the negative feelings that resulted from their abstinence violation.