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

It is, however, an important clinical finding that CBI conferred no advantage over a brief, medically oriented intervention for participants whose drinking goal was complete abstinence. However, while designed to approximate the style of intervention delivered in a primary care setting, the medical management delivered in the COMBINE study was confounded with extensive and state-of-the-art assessment and follow-up. As such, further research may be required before these findings can be generalized to real-world primary care settings. It was also hypothesized that, given naltrexone’s effect on hedonic response to alcohol (King et al., 1997; McCaul et al., 2001; Ray et al., 2010), naltrexone would be more effective among those with a controlled drinking goal versus those with an abstinence oriented goal.

Approaches to Alcoholism Treatment

In other words, AVE describes the thoughts, feelings, and actions a person goes through after they make a mistake and have a drink or abuse a substance, despite trying to quit. AVE describes the negative, indulgent, or self-destructive feelings and behavior people often experience after lapsing during a period of abstinence. abstinence violation effect RP has also been used in eating disorders in combination with other interventions such as CBT and problem-solving skills4. 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.

Historical context of nonabstinence approaches

Another possible outcome of a lapse is that the client may manage to abstain and thus continue to go forward in the path of positive change, “prolapse”4. Many researchers define relapse as a process rather than as a discrete event and thus attempt to characterize the factors contributing to relapse3. Additionally, the support of a solid social network and professional help can play a pivotal role. Encouragement and understanding from friends, family, or support groups can help individuals overcome the negative emotional aftermath of the AVE. Before any substance use even occurs, clinicians can talk to clients about the AVE and the cognitive distortions that can accompany it. This preparation can empower a client to avoid relapse altogether or to lessen the impact of relapse if it occurs.

2. Relationship between goal choice and treatment outcomes

Addiction and related disorders are chronic lapsing and relapsing disorders where the combination of long term pharmacological and psychosocial managements are the mainstay approaches of management. Among the psychosocial interventions, the Relapse Prevention (RP), cognitive-behavioural approach, is a strategy for reducing the likelihood and severity of relapse following the cessation or reduction of problematic behaviours. Here the assessment and management of both the intrapersonal and interpersonal determinants of relapse are undertaken.

• Further, the more non-drinking friends a person with an AUD has, the better outcomes tend to be.
• Using a wave metaphor, urge surfing is an imagery technique to help clients gain control over impulses to use drugs or alcohol.
• By implementing certain strategies, people can develop resilience, self-compassion, and adaptive coping skills to counteract the effects of the AVE and maintain lifelong sobriety.

As a data check, all outcomes presented in the primary COMBINE manuscript were replicated prior to any model testing for this study. Additionally, drinking goal was initially analyzed as a five-level variable keeping all possible self-report responses separate. Visual inspection of these results supported our classification system (i.e., controlled drinking, conditional abstinence, and complete abstinence) in that the two possible responses for both controlled drinking and conditional abstinence clustered together across outcomes. Since drinking goal is a three-level variable, following the omnibus test, planned analyses were conducted to test differences between the three drinking goal groups for effects observed on all outcome variables. 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).

It occurs when the client perceives no intermediary step between a lapse and relapse i.e. since they have violated the rule of abstinence, “they may get most out” of the lapse5. People who attribute the lapse to their own personal failure are likely to experience guilt and negative emotions that can, in turn, lead to increased drinking as a further attempt to avoid or escape the feelings of guilt or failure7. It is essential to understand what individuals with SUD are rejecting when they say they do not need treatment. In this model, treatment success is defined as achieving and sustaining total abstinence from alcohol and drugs, and readiness for treatment is conflated with commitment to abstinence (e.g., Harrell, Trenz, Scherer, Martins, & Latimer, 2013). Additionally, the system is punitive to those who do not achieve abstinence, as exemplified by the widespread practice of involuntary treatment discharge for those who return to use (White, Scott, Dennis, & Boyle, 2005). Gordon as part of their cognitive-behavioral model of relapse prevention, and it is used particularly in the context of substance use disorders.

4. Consequences of abstinence-only treatment

1. Nonabstinence psychosocial treatment models