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

This disinhibition of dietary restraint has been replicated numerous times [20,28] and demonstrates that dieters often eat a great deal after they perceive their diets to be broken. It is currently not clear, however, how a small indulgence, which itself might not be problematic, escalates into a full-blown binge [29]. If an individual uses a substance after experiencing a remission, he/she may be vulnerable to the https://ecosoberhouse.com/ (AVE), which refers to an individual’s response to the recognition that he/she has broken a self-imposed rule by engaging in substance use or other unwanted behavior. This response often creates a feeling of self-blame and loss of perceived control due to breaking a self-imposed rule regarding substance use. According to AVE research, those who do chose to respond to their behavior with blame and a sense of lost perceived control are more likely to relapse than those who respond by attributing lapse to preventable events and not feeling as though they failed completely.

abstinence violation effect

A careful functional analysis and identification of dysfunctional beliefs are important first steps in CBT. The hallmark of CBT is collaborative empiricism and describes the nature of therapeutic relationship. At start of therapy, Rajiv was not confident of being able to help himself (self-efficacy and lapse- relapse pattern).

Celibacy vs. Abstinence

They assume a distinction between stress coping skills, which are responses intended to deal with general life stress, and temptation coping skills, which are coping responses specific to situations in which there are temptations for substance which could contribute to relapse13. Given the abstinence focus of many SUD treatment centers, studies may need to recruit using community outreach, which can yield fewer participants compared to recruiting from treatment (Jaffee et al., 2009). However, this approach is consistent with the goal of increasing treatment utilization by reaching those who may not otherwise present to treatment. Alternatively, researchers who conduct trials in community-based treatment centers will need to obtain buy-in to test nonabstinence approaches, which may necessitate waiving facility policies regarding drug use during treatment – a significant hurdle.

When abstinence violation effect kicks in, the first thing we often do is criticize ourselves. This is a problem faced by many addicts and alcoholics, and it actually applies to more than just AVE. But when we get a flat tire, we find ourselves practically on the verge of calling a suicide prevention hotline. Obviously this rhetoric is extreme, but that’s the point—we tend to think in extremes. According to Beck et al., (2005), “A cognitive therapist could do hundreds of interventions with any patient at any given time”1).


He adopted the language and framework of harm reduction in his own research, and in 1998 published a seminal book on harm reduction strategies for a range of substances and behaviors (Marlatt, 1998). Marlatt’s work inspired the development of multiple nonabstinence treatment models, including harm reduction psychotherapy (Blume, 2012; Denning, 2000; Tatarsky, 2002). Additionally, while early studies of SUD treatment used abstinence as the single measure of treatment effectiveness, by the late 1980s abstinence violation effect and early 1990s researchers were increasingly incorporating psychosocial, health, and quality of life measures (Miller, 1994). Specific intervention strategies include helping the person identify and cope with high-risk situations, eliminating myths regarding a drug’s effects, managing lapses, and addressing misperceptions about the relapse process. Other more general strategies include helping the person develop positive addictions and employing stimulus-control and urge-management techniques.

abstinence violation effect

We summarize historical factors relevant to non-abstinence treatment development to illuminate reasons these approaches are understudied. Substance use recovery programs should refrain from defining a mere slip as a total failure of abstinence. Instead, they should promote the notion that slips should be addressed immediately and that individuals can learn from them and improve. This does not mean endorsing slips, but recognizing that if they occur, something needs to be done immediately. Mark’s key responsibilities include handling day-to-day maintenance matters and oversees our Environment of Care management plan in conjunction with Joint Commission and DCF regulations. Mark’s goal is to provide a safe environment where distractions are minimized, and treatment is the primary focus for clients and staff alike.

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