McCrady [37] conducted a comprehensive review of 62 alcohol treatment outcome studies comprising 13 psychosocial approaches. Two approaches–RP and brief intervention–qualified as empirically validated treatments based on established criteria. Interestingly, Miller and Wilbourne’s [21] review of clinical trials, which evaluated the efficacy of 46 different alcohol treatments, ranked “relapse prevention” as 35th out of 46 treatments based on methodological quality and treatment effect sizes. However, many of the treatments ranked in the top 10 (including brief interventions, social skills training, community reinforcement, behavior contracting, behavioral marital therapy, and self-monitoring) incorporate RP components. These two reviews highlighted the increasing difficulty of classifying interventions as specifically constituting RP, given that many treatments for substance use disorders (e.g., cognitive behavioral treatment (CBT)) are based on the cognitive behavioral model of relapse developed for RP [16].
Exercise deprivation increases negative mood in exercise-addicted subjects and modifies their biochemical markers
Efforts to develop, test and refine theoretical models are critical to enhancing the understanding and prevention of relapse [1,2,14]. A major development in this respect was the reformulation of Marlatt’s cognitive-behavioral relapse model to place greater emphasis on dynamic abstinence violation effect relapse processes [8]. Whereas most theories presume linear relationships among constructs, the reformulated model (Figure (Figure2)2) views relapse as a complex, nonlinear process in which various factors act jointly and interactively to affect relapse timing and severity.
- These results suggest that researchers should strive to consider alternative mechanisms, improve assessment methods and/or revise theories about how CBT-based interventions work [77,130].
- 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).
- As noted by McLellan [138] and others [124], it is imperative that policy makers support adoption of treatments that incorporate a continuing care approach, such that addictions treatment is considered from a chronic (rather than acute) care perspective.
- Similarly, self-regulation ability, outcome expectancies, and the abstinence violation effect could all be experimentally manipulated, which could eventually lead to further refinements of RP strategies.
Personality profiles of substance and behavioral addictions
This type of policy is increasingly recognized as scientifically un-sound, given that continued substance use despite consequences is a hallmark symptom of the disease of addiction. Although it may be helpful for treatment centers to incorporate small penalties or rewards for specific client behaviors (for example, as part of a contingency management program), enforcing harsh consequences when clients do not maintain total abstinence will only exacerbate the AVE. Despite findings like these, many studies of treatment mechanisms have failed to show that theoretical mediators account for salutary effects of CBT-based interventions. Also, many studies that have examined potential mediators of outcomes have not provided a rigorous test [129] of mechanisms of change. These results suggest that researchers should strive to consider alternative mechanisms, improve assessment methods and/or revise theories about how CBT-based interventions work [77,130]. Findings concerning possible genetic moderators of response to acamprosate have been reported [99], but are preliminary.
What Does It Mean to Relapse?
- The AVE process typically involves a triggering event or cue, such as encountering a tempting situation, feeling stressed, or experiencing a moment of weakness.
- We evaluated abstinence violation effects (AVEs) (a constellation of negative reactions to a lapse) following an initial lapse to smoking in 105 recent lapsers, and in temptation episodes from these lapsers and from 35 maintainers.
- Importantly, this client might not have ever considered such an invitation as a high-risk situation, yet various contextual factors may interact to predict a lapse.
If an individual is regularly or habitually engaging in a behavior without restriction, it is possible that any latent withdrawal symptoms which might otherwise arise under abstinence conditions might be masked. Second, relapse refers to an individual losing control over a behavior and reverting to earlier patterns of behavior after a period of abstinence. If an individual does not try to abstain from the behavior in the first place, relapse, by definition, cannot be observed. Although withdrawal is usually viewed as a physiological process, recent theory emphasizes the importance of behavioral withdrawal processes [66].
Future research with a data set that includes multiple measures of risk factors over multiple days could also take advantage of innovative modeling tools that were designed for estimating nonlinear time-varying dynamics [125]. Initial evidence suggests that implicit measures of expectancies are correlated with relapse outcomes, as demonstrated in one study of heroin users [61]. In another recent study, researchers trained participants in attentional bias modification (ABM) during inpatient treatment for alcohol dependence and measured relapse over the course of three months post-treatment [62].
Restricting mobile phone access during homework increases attainment of study goals
Addictive Behaviors
Cognitive neuroscience of self-regulation failure
