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

Individuals with fewer years of addiction and lower severity SUDs generally have the highest likelihood of achieving moderate, low-consequence substance use after treatment (Öjehagen & Berglund, 1989; Witkiewitz, 2008). Notably, these individuals are also most likely to endorse nonabstinence goals (Berglund et al., 2019; Dunn & Strain, 2013; Lozano et al., 2006; Lozano et al., 2015; Mowbray et al., 2013). In contrast, individuals with greater SUD severity, who are more likely to have abstinence goals, generally have the best outcomes when working toward abstinence (Witkiewitz, abstinence violation effect definition 2008). Together, this suggests a promising degree of alignment between goal selection and probability of success, and it highlights the potential utility of nonabstinence treatment as an “early intervention” approach to prevent SUD escalation. Despite the growth of the harm reduction movement globally, research and implementation of nonabstinence treatment in the U.S. has lagged. Furthermore, abstinence remains a gold standard treatment outcome in pharmacotherapy research for drug use disorders, even after numerous calls for alternative metrics of success (Volkow, 2020).

This dissonance can be reduced by either changing the behavior or changing the image, and characteristically in this population is resolved by the latter. Internal and stable attributes for the slip also lead to further lapse behavior. This model has received a good deal of empirical support and has the merit of dismantling the process of relapse and exploring subjective and cognitive variables in a manner that has important treatment implications. The past 20 years has seen growing acceptance of harm reduction, evidenced in U.S. public health policy as well as SUD treatment research.

2. Relationship between goal choice and treatment outcomes

This is especially true if we are involved in a twelve-step program, as we now realize we must reset our chips. Going to the front of the room to grab a new one-day chip after months or years of sobriety makes us feel like complete failures. We feel ashamed of ourselves, and fear that everybody else must be ashamed of us as well. The Abstinence Violation Effect (AVE – think the abbreviation for avenue to help you remember it) is what happens when an individual deviates from his/her plan – and then continues to remain off that path due to frustration, shame, guilt, etc.

• As a result, those recovering from addiction can be harsh inner critics of themselves and believe they do not deserve to be healthy or happy.
• Sometimes we must be hard on ourselves, but we must never view ourselves through a lens of hatred and self-loathing.
• Abstinence may, however, increase the risk of developing erectile dysfunction.
• Distraction is a time-honored way of interrupting unpleasant thoughts of any kind, and particularly valuable for derailing thoughts of using before they reach maximum intensity.

Many experts believe that people turn to substance use—then get trapped in addiction—in an attempt to escape from uncomfortable feelings. Regarding setbacks as a normal part of progress enables individuals to broaden their array of coping skills, to engage in planning for problematic situations, and to devise strategies in advance for dealing with predictable difficulties. Among the most important coping skills needed are strategies of distraction that can be quickly engaged when cravings occur. Mindfulness training, for example, can modify the neural mechanisms of craving and open pathways for executive control over them.

ABSTINENCE VIOLATION EFFECT (AVE)

Lastly, treatment staff should help you to learn how to recognize the signs of an impending lapse or relapse so that you can ask for help before it happens. While some assert that relapse occurs after the first sip of alcohol or use of another drug, certain scientists believe it is a process which more closely resembles a domino effect. Social-cognitive and behavioral theories believe relapse begins before the person actually returns to substance abuse.

• The memories of our slips may always sting a bit, but at least we can sleep easy at night knowing that we used them to do some good.
• As of 2020, the number of drug-involved overdose deaths reached an all-time high of 91,799, according to the National Institute on Drug Abuse.
• A recent qualitative study found that concern about missing substances was significantly correlated with not completing treatment (Zemore, Ware, Gilbert, & Pinedo, 2021).

An abstinence violation can also occur in individuals with low self-efficacy, since they do not feel very confident in their ability to carry out their goal of abstinence. Harm reduction therapy has also been applied in group format, mirroring the approach and components of individual harm reduction psychotherapy but with added focus on building social support and receiving feedback and advice from peers (Little, 2006; Little & Franskoviak, 2010). These groups tend to include individuals who use a range of substances and who endorse a range of goals, including reducing substance use and/or substance-related harms, controlled/moderate use, and abstinence (Little, 2006).