In addition, the influence of the social or physical environment is often felt in combination with individual factors (e.g. not being able to cope with the social pressure at a party), which might make environmental factors more distal and therefore harder to recall. This remoteness of environmental factors is also reflected in the so-called fundamental attribution error, which is defined as ‘the tendency for attributors to underestimate the impact of situational factors and to overestimate the role of dispositional factors in controlling behavior’ (Ross, 1977). Participants’ greater focus on individual factors could furthermore be stimulated by the current stigma surrounding overweight and obese individuals and the notion that they are to blame for their weight (Puhl & Heuer, 2010). The current review highlights a notable gap in research empirically evaluating the effectiveness of nonabstinence approaches for DUD treatment. While multiple harm reduction-focused treatments for AUD have strong empirical support, there is very little research testing models of nonabstinence treatment for drug use. Despite compatibility with harm reduction in established SUD treatment models such as MI and RP, there is a dearth of evidence testing these as standalone treatments for helping patients achieve nonabstinence goals; this is especially true regarding DUD (vs. AUD).
Outcome expectancies
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,… The AVE was introduced into the substance abuse literature within the context of the “relapse process” (Marlatt and Gordon 1985, p. 37).
Relapse prevention for addictive behaviors
Against this backdrop, both tonic (stable) and phasic (transient) influences interact to determine relapse likelihood. Tonic processes include distal risks–stable background factors that determine an individual’s “set point” or initial threshold for relapse [8,31]. Personality, genetic or familial risk factors, drug sensitivity/metabolism and physical withdrawal profiles are examples of distal variables that could influence relapse liability a priori. Tonic processes also include cognitive factors that show relative stability over time, such as drug-related outcome expectancies, global self-efficacy, and personal beliefs about abstinence or relapse. Whereas tonic processes may dictate initial susceptibility to relapse, its occurrence is determined largely by phasic responses–proximal or transient factors that serve to actuate (or prevent) a lapse.
Cognitive strategies in managing addictive behaviours
This conceptualization provides a broader conceptual framework for intervening in the relapse process to prevent or reduce relapse episodes and thereby improve treatment outcome. One critical goal will be to integrate empirically supported substance use interventions in the context of continuing care models of treatment delivery, which in many cases requires adapting existing treatments to facilitate sustained delivery [140]. Given its focus on long-term maintenance of treatment gains, RP is a behavioral intervention that is particularly well suited for implementation in continuing care contexts. However, it is imperative that insurance providers and funding entities support these efforts by providing financial support for aftercare services. It is also important that policy makers and funding entities support initiatives to evaluate RP and other established interventions in the context of continuing care models.
Specific Intervention Strategies
Participants with controlled use goals in this center are typically able to achieve less problematic (38%) or non-problematic (32%) use, while a minority achieve abstinence with (8%) or without (6%) incidental relapse (outcomes were not separately assessed for those with AUD vs. DUD; Schippers & Nelissen, 2006). Here we provide a brief review of existing abstinence violation effect models of nonabstinence psychosocial treatment, with the goal of summarizing the state of the literature and identifying notable gaps and directions for future research. Previous reviews have described nonabstinence pharmacological approaches (e.g., Connery, 2015; Palpacuer et al., 2018), which are outside the scope of the current review.
Global Lifestyle Self-Control Strategies
- After the two stimuli have been paired repeatedly, the neutral stimulus becomes a conditioned stimulus that elicits the same physiological response.
- One study found that among those who did not complete an abstinence-based (12-Step) SUD treatment program, ongoing/relapse to substance use was the most frequently-endorsed reason for leaving treatment early (Laudet, Stanick, & Sands, 2009).
- In addition, relaxation training, time management, and having a daily schedule can be used to help clients achieve greater lifestyle balance.