Relapse prevention An overview of Marlatt’s cognitive-behavioral model

Despite significant empirical support for nonabstinence alcohol interventions, there is a clear gap in research examining nonabstinence psychosocial treatment for drug use disorders. Future research must test the effectiveness of nonabstinence treatments for drug use and address barriers to implementation. Additionally, given the nature of the COMBINE study, the effects of a medically oriented intervention (i.e., MM) without a pharmacological component could not be investigated. Furthermore, it should be noted that the literature does not offer consensus on the operational definition of drinking goal (Luquiens et al., 2011). Instead, the authors categorized responses to the Commitment to Abstinence item based largely on clinical judgment and prior research using this measure. To that end, it should be noted that the distribution of clinical outcomes across the three levels of drinking goal (complete abstinence, conditional abstinence, and controlled drinking) provided strong support for the validity of this coding system.

  • While relapse doesn’t mean you can’t achieve lasting sobriety, it can be a disheartening setback in your recovery.
  • Regarding pharmacological interventions for alcohol use disorders, recent laboratory studies of naltrexone have elucidated its mechanisms of action.
  • Indeed, about 95% of people with SUD say they do not need SUD treatment (SAMHSA, 2019a).
  • Cognitive behaviour therapy is a structured, time limited, psychological intervention that has is empirically supported across a wide variety of psychological disorders.

Importantly, one study examined the effects of naltrexone on alcohol non-abstainers and found that participants who drank regularly during the treatment period benefited more from naltrexone relative to placebo (Ray, Krull, & Leggio, 2010). Together, these findings suggest that naltrexone may be better suited to a controlled drinking approach and thus may be more effective among patients with controlled drinking goals. Lack of consensus around target outcomes also presents a challenge to evaluating the effectiveness of nonabstinence treatment. Experts generally recommend that SUD treatment studies report substance use as well as related consequences, and select primary outcomes based on the study sample and goals (Donovan et al., 2012; Kiluk et al., 2019).

5. Feasibility of nonabstinence goals

It is well known to clinicians and researchers in the field of alcoholism that patients vary with respect to drinking goal. The objective of this study is to elucidate the contribution of drinking goal to treatment outcome in the context of specific behavioral and pharmacological interventions. The AVE was introduced into the substance abuse literature within the context abstinence violation effect definition of the “relapse process” (Marlatt & Gordon, 1985, p. 37). Relapse has been variously defined, depending on theoretical orientation, treatment goals, cultural context, and target substance (Miller, 1996; White, 2007). It is, however, most commonly used to refer to a resumption of substance-use behavior after a period of abstinence from substances (Miller, 1996).

Translational opportunities in animal and human models to study … – Nature.com

Translational opportunities in animal and human models to study ….

Posted: Wed, 29 Sep 2021 07:00:00 GMT [source]

At IGNTD, we recognize that addiction is a systemic problem requiring a holistic solution. We offer personalized, customizable treatment plans to cater to the individual needs of each client. When we assess clients, we use well-validated research tools, like the Beck Depression Inventory (BDI) and the Addiction Severity Index (ASI), to measure baseline levels and subsequent changes in depression, anxiety, dependency, impulsivity, and more.

AVE and the 12-Step Approach

Likewise, the clinical implications of drinking goal on treatment matching are largely unknown. Mindfulness based interventions or third wave therapies have shown promise in addressing specific aspects of addictive behaviours such as craving, negative affect, impulsivity, distress tolerance. These interventions integrate both cognitive behavioural and mindfulness based strategies. The greatest strength of cognitive behavioural programmes is that they are individualized, and have a wide applicability. Modifying social and environmental antecedents and consequences another approach to working with addictive behaviours18. Therapeutic strategies such as contingency management, differential reinforcement of incompatible and alternate behaviours and rearrangement of environmental cues that set the occasion for addictive behaviour, including emotional triggers are used in this approach.

  • RP has also been used in eating disorders in combination with other interventions such as CBT and problem-solving skills4.
  • MET adopts several social cognitive as well as Rogerian principles in its approach and in keeping with the social cognitive theory, personal agency is emphasized.
  • (a) When restrained eaters’ diets were broken by consumption of a high-calorie milkshake preload, they subsequently show disinhibited eating (e.g. increased grams of ice-cream consumed) compared to control subjects and restrained eaters who did not drink the milkshake (figure based on data from [30]).
  • Although abstainers had the best outcomes, this study suggests that moderate drinking may be considered a viable drinking goal option for some individuals who may not be willing or able to abstain completely.
  • It occurs when the client perceives no intermediary step between a lapse and relapse i.e. since they have violated the rule of abstinence, “they may get most out” of the lapse5.

A “controlled drinking controversy” followed, in which the Sobells as well as those who supported them were publicly criticized due to their claims about controlled drinking, and the validity of their research called into question (Blume, 2012; Pendery, Maltzman, & West, 1982). Despite the intense controversy, the Sobell’s high-profile research paved the way for additional studies of nonabstinence treatment for AUD in the 1980s and later (Blume, 2012; Sobell & Sobell, 1995). 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 onset of bulimia nervosa is often preceded by extended periods of recurrent dieting occurring in the context of other psychosocial stressors.

Abstinence Violation Effect (AVE)

The current review highlights multiple important directions for future research related to nonabstinence SUD treatment. Overall, increased research attention on nonabstinence treatment is vital to filling gaps in knowledge. For example, despite being widely cited as a primary rationale for nonabstinence treatment, the extent to which offering nonabstinence options increases treatment utilization (or retention) is unknown.


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