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Additionally, individuals are most likely to achieve the outcomes that are consistent with their goals (i.e., moderation vs. abstinence), based on studies of both controlled drinking and drug use (Adamson, Heather, Morton, & Raistrick, 2010; Booth, Dale, & Ansari, 1984; Lozano et al., https://ecosoberhouse.com/ 2006; Schippers & Nelissen, 2006). Despite various treatment programmes for substance use disorders, helping individuals remain abstinent remains a clinical challenge. Cognitive behavioural therapies are empirically supported interventions in the management of addictive behaviours.
Current research and best-practice guidelines have indicated that a combination of these various treatment components and delivery formats may be helpful in providing brief yet comprehensive interventions to help smokers not only achieve initial cessation but prevent relapse over the longer term. On the other hand, the increased attention to stage-based research has highlighted challenges in operationalizing and delineating between interventions focusing on helping smokers attain (smoking cessation) versus maintain (relapse prevention) abstinence. The culmination of the evidence would suggest that attention to the initial smoking cessation effort bolstered by booster contacts and ongoing pharmacologic support may be effective means of supporting relapse prevention over the long term [20•]. Smoking reduction approaches often incorporate the pharmacologic aids discussed above.
Over the past few decades, there has been increasing public awareness of smoking-related morbidity and mortality and the health benefits of smoking cessation. Smoking rates in the United States have dropped by approximately 50% from 1965 through 2006 [10]. Despite this nationwide movement toward smoking cessation, 20.8% of American adults continue to smoke [10]. In a survey conducted in 2006, approximately 44% of smokers in the United States reported having made a serious attempt to quit smoking in the past year [10]. Unfortunately, among smokers who quit without formal treatment, approximately 95% to 98% will return to smoking within 6 to 12 months following a quit attempt [11]. Thus, findings indicate a continued need to not only support attaining smoking cessation, but also to prevent smoking relapse.
Individuals with greater SUD severity tend to be most receptive to therapist input about goal selection (Sobell, Sobell, Bogardis, Leo, & Skinner, 1992). This suggests that treatment experiences and therapist input can influence participant goals over time, and there is value in engaging patients with non-abstinence goals in treatment. AVE occurs when someone who is striving for abstinence from a particular behavior or substance experiences a setback, such as a lapse or relapse. Instead of viewing the incident as a temporary setback, the individual perceives it as evidence of personal failure, leading to increased feelings of guilt, shame, and hopelessness (Collins & Witkiewitz, 2013; Larimer, Palmer, & Marlatt, 1999). 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.
Marlatt, in particular, became well known for developing nonabstinence treatments, such as BASICS for college drinking (Marlatt et al., 1998) and Relapse Prevention (Marlatt & Gordon, 1985). Like the Sobells, Marlatt showed that reductions in drinking and harm were achievable in nonabstinence treatments (Marlatt & Witkiewitz, 2002). The abstinence violation effect can lead to negative emotions such as guilt, shame, and feelings of failure.
Smoking cessation approaches for pregnant and postpartum patients have generally shown strong effects on longer-term abstinence rates [57•]. Furthermore, some researchers have pointed out that interventions supporting smoking cessation may also be efficacious in supporting relapse prevention [16]. Thus, for the purpose of this current article, we highlight recent findings and developments in the smoking literature that may be applicable to both smoking cessation and relapse prevention goals.
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 the abstinence violation effect refers to years (motivation to change, influence of past learning experiences with abstinence). In a subsequent meta-analysis by Irwin, twenty-six published and unpublished studies representing a sample of 9,504 participants were included.
It’s important to establish that a one-time lapse in a person’s recovery from drugs or alcohol is not considered a full blown relapse. The abstinence violation effect (AVE) describes the tendency of people recovering from addiction to spiral out of control when they experience even a minor relapse. Instead of continuing with recovery, AVE refers to relapsing heavily after a single violation. The first step in planning a cognitive behavioural treatment program is to carry out a functional analysis to identify maintaining antecedents and set treatments targets, select interventions. 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.
While AUD treatment studies commonly rely on guidelines set by government agencies regarding a “low-risk” or “nonhazardous” level of alcohol consumption (e.g., Enggasser et al., 2015), no such guidelines exist for illicit drug use. Thus, studies will need to emphasize measures of substance-related problems in addition to reporting the degree of substance use (e.g., frequency, quantity). The effectiveness of Marlatt and Gordon’s [17] relapse prevention as a stand-alone treatment for smoking cessation has received mixed reviews [16, 25]. In fact, later meta-analyses on both group and individual smoking cessation counseling, which largely correspond to Marlatt and Gordon’s [17] relapse prevention approaches, were found to be highly effective in helping smokers achieve abstinence and prevent relapse over the longer term [21, 22]. The psychologist Alan Marlatt popularized the idea of the abstinence violation effect.
Others high risk situations include physical states such as hunger, thirst, fatigue, testing personal control, responsivity to substance cues (craving). The RP model highlights the significance of covert antecedents such as lifestyle patterns craving in relapse. The lapse process consists of a series of internal and external events, identified and analyzed in the process of therapy.
