In 1990, Marlatt was introduced to the philosophy of harm reduction during a trip to the Netherlands (Marlatt, 1998). 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 https://ecosoberhouse.com/ SUD treatment used abstinence as the single measure of treatment effectiveness, by the late 1980s and early 1990s researchers were increasingly incorporating psychosocial, health, and quality of life measures (Miller, 1994). Cognitions—specifically, thoughts and expectations about drinking behavior and sobriety—contribute importantly to the process of relapse. These alcohol-related cognitions are placed in the relapse prevention model within the overlap of the tonic stable processes and the phasic fluid responses.
- Moreover, people who have coped successfully with high-risk situations are assumed to experience a heightened sense of self-efficacy4.
- For instance, some studies have shown abstinence isn’t as effective when used as the only form of education to reduce rates of teen pregnancy, and a 2011 study found abstinence-only state policies regarding sex ed were positively correlated with high rates of teen pregnancy.
- Equally bad can be the sense of failure and shame that a formerly “clean” individual can experience following a return to substance use.
- Despite significant empirical support for nonabstinence alcohol interventions, there is a clear gap in research examining nonabstinence psychosocial treatment for drug use disorders.
- In extreme cases and in many cases of opioid addiction, this method has proven unreliable, as drugs such as Buprenorphine may be prescribed to help people abstain from the drug they misuse, allowing them to maintain a functional lifestyle.
We identify a clear gap in research examining nonabstinence psychosocial treatment for drug use disorders and suggest that increased research attention on these interventions represents the logical next step for the field. A number of studies have examined psychosocial risk reduction interventions for individuals with high-risk drug use, especially people who inject drugs. In contrast to the holistic approach of harm reduction psychotherapy, risk reduction interventions are generally designed to target specific HIV risk behaviors (e.g., injection or sexual risk behaviors) without directly addressing mechanisms of SUD, and thus are quite limited in scope.
Expanding the continuum of substance use disorder treatment: Nonabstinence approaches
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. At least 74.8% of those deaths involved opioids, 14% involved heroin, 26% involved psychostimulants, primarily…
Additionally, some groups target individuals with co-occurring psychiatric disorders (Little, Hodari, Lavender, & Berg, 2008). Important features common to these groups include low program barriers (e.g., drop-in groups, few rules) and inclusiveness of clients with difficult presentations (Little & Franskoviak, 2010). AA was established in 1935 as a nonprofessional mutual aid group for people who desire abstinence from alcohol, and its 12 Steps became integrated in SUD treatment programs in the 1940s and 1950s with the emergence of the Minnesota Model of treatment (White & Kurtz, 2008).
Cognitive Behavioral Treatments for Substance Use Disorders
Although there is some debate about the best definitions of lapse and relapse from theoretical and conceptual levels, these definitions should suffice. Additionally, this model acknowledges the contributions of social cognitive constructs to the maintenance of substance use or addictive behaviour and relapse1. Individuals with greater SUD severity tend to be most receptive to therapist input about goal selection (Sobell, Sobell, Bogardis, Leo, & Skinner, 1992).
This can be worked on by creating a decisional matrix where the pros and cons of continuing the behaviour versus abstaining are written down within both shorter and longer time frames and the therapist helps the client to identify unrealistic outcome expectancies5. Being able to understand how your thoughts, emotions, and behaviors play off of each other can help you to better control and respond abstinence violation effect to them in a positive way. Acknowledging your triggers and developing the appropriate coping skills should be a part of a solid relapse prevention program. 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. A good treatment program should explain the difference between a lapse and relapse.
Relapse Prevention
In RP client and therapist are equal partners and the client is encouraged to actively contribute solutions for the problem. Client is taught that overcoming the problem behaviour is not about will power rather it has to do with skills acquisition. Another technique is that the road to abstinence is broken down to smaller achievable targets so that client can easily master the task enhancing self-efficacy. Also, therapists can provide positive feedback of achievements that the client has been able to make in other facets of life6.
