Cognitive behavioural interventions in addictive disorders PMC

If stressors are not balanced by sufficient stress management strategies, the client is more likely to use alcohol in an attempt to gain some relief or escape from stress. This reaction typically leads to a desire for indulgence that often develops into cravings and urges. Two cognitive mechanisms that contribute to the covert planning of a relapse episode—rationalization and denial—as well as apparently irrelevant decisions (AIDs) can help precipitate high-risk situations, which are the central determinants of a relapse. People who lack adequate coping skills for handling these situations experience reduced confidence in their ability to cope (i.e., decreased self-efficacy). Moreover, these people often have positive expectations regarding the effects of alcohol (i.e., outcome expectancies).

Relapse prevention

Gradually he began to drink before meetings or interactions (maladaptive coping and negative reinforcement). He reported difficulty sleeping if he did not drink, could not get past the day without drinking or thinking about his next drink (establishment of a dependence pattern). His wife brought him for treatment and he was not keen on taking help He did not believe it was a problem (stage of change). He believed that drinking helped him across many domains of life (positive outcome expectancies regarding alcohol use and its effects, stage of change). The terms “relapse” and “relapse prevention” have seen evolving definitions, complicating efforts to review and evaluate the relevant literature.

Theoretical and empirical rationale for nonabstinence treatment

  • In these situations, the drinker focuses primarily on the anticipation of immediate gratification, such as stress reduction, neglecting possible delayed negative consequences.
  • Most scientists who studied SUD treatment believed that abstinence was the only acceptable treatment goal until at least the 1980s (Des Jarlais, 2017).
  • These interventions integrate both cognitive behavioural and mindfulness based strategies.
  • Many people seeking to recover from addiction are eager to prove they have control of their life and set off on their own.

Despite serving as a chief diagnostic criterion, withdrawal often does not predict relapse, perhaps partly explaining its de-emphasis in contemporary motivational models of addiction [64]. However, recent studies show that withdrawal profiles are complex, multi-faceted and idiosyncratic, and that in the context of fine-grained analyses withdrawal indeed can predict relapse [64,65]. Such findings have contributed to renewed interest in negative reinforcement models of drug use [63]. Future research with a data set that includes multiple measures of risk factors over multiple days can help in validating the dynamic model of relapse.

Critiques of the RP Model

For that reason, some experts prefer not to use the term “relapse” but to use more morally neutral terms such as “resumed” use or a “recurrence” of symptoms. Many clients report that activities they once found pleasurable (e.g., hobbies and social interactions with family and friends) have gradually been replaced by drinking as a source of entertainment and gratification. Therefore, one global self-management strategy involves encouraging clients to pursue again those previously satisfying, non-drinking recreational activities.

According to these models, the relapse process begins prior to the first posttreatment alcohol use and continues after the initial use. This conceptualization provides a broader conceptual framework for intervening in the relapse process to prevent or reduce relapse episodes and thereby improve Top 5 Advantages of Staying in a Sober Living House treatment outcome. The use of functional magnetic resonance imaging (fMRI) techniques in addictions research has increased dramatically in the last decade [131] and many of these studies have been instrumental in providing initial evidence on neural correlates of substance use and relapse.

abstinence violation effect

Research has found that getting help in the form of supportive therapy from qualified professionals, and social support from peers, can prevent or minimize relapse. In particular, cognitive behavioral therapy (CBT) can help people overcome the fears and negative thinking that can trigger relapse. The results reported in the RREP study indicate that the original relapse taxonomy of the RP model has only moderate inter-rater reliability at the highest level of specificity, although reliability of the more general categories (e.g., negative affect and social pressure) was better. Therefore, the RREP studies do not represent a good test of the predictive validity of the taxonomy. In many cases, initial lapses occur in high-risk situations that are completely unexpected and for which the drinker is often unprepared.

abstinence violation effect

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