1Classical or Pavlovian conditioning occurs when an originally neutral stimulus (e.g., the sight of a beer bottle) is repeatedly paired with a stimulus (e.g., alcohol consumption) that induces a certain physiological response. After the two stimuli have been paired repeatedly, the neutral stimulus becomes a conditioned stimulus that elicits the same physiological response. One of the most notable developments in the last decade has been the emergence and increasing application of Mindfulness-Based Relapse Prevention (MBRP) for addictive behaviours. Getting through the holidays while maintaining recovery, especially for people newer to this life-changing process, is an accomplishment worthy of celebration in its own right. One way of ensuring recovery from addiction is to remember the acronym DEADS, shorthand for an array of skills to deploy when faced with a difficult situation—delay, escape, avoid, distract, and substitute.

In one study of treatment-seeking methamphetamine users [132], researchers examined fMRI activation during a decision-making task and obtained information on relapse over one year later. Based on activation patterns in several cortical regions they were able to correctly identify 17 of 18 participants who relapsed and 20 of 22 who did not. Functional imaging is increasingly being incorporated in treatment outcome studies (e.g., [133]) and there are increasing efforts to abstinence violation effect use imaging approaches to predict relapse [134]. While the overall number of studies examining neural correlates of relapse remains small at present, the coming years will undoubtedly see a significant escalation in the number of studies using fMRI to predict response to psychosocial and pharmacological treatments. In this context, a critical question will concern the predictive and clinical utility of brain-based measures with respect to predicting treatment outcome.

A Lapse Vs. A Relapse

Subsequently, the therapist can address each expectancy, using cognitive restructuring (which is discussed later in this section) and education about research findings. The therapist also can use examples from the client’s own experience to dispel myths and encourage the client to consider both the immediate and the delayed consequences of drinking. One of the most critical predictors of relapse is the individual’s ability to utilize effective coping strategies in dealing with high-risk situations. Coping is defined as the thoughts and behaviours used to manage the internal and external demands of situations that are appraised as stressful. A person who can execute effective coping strategies (e.g. a behavioural strategy, such as leaving the situation, or a cognitive strategy, such as positive self-talk) is less likely to relapse compared with a person lacking those skills. Moreover, people who have coped successfully with high-risk situations are assumed to experience a heightened sense of self-efficacy4.

• For example, clients can be encouraged to increase their engagement in rewarding or stress-reducing activities into their daily routine.
• The difference in sorting and rating methods between stakeholder groups (online vs print) was based on recommendations given by the health practitioners, who believed sorting statements on paper would be easier than doing it online.
• One of the most important efficacy-enhancing strategies employed in RP is the emphasis on collaboration between the client and therapist instead of a more typical “top down” doctor-patient relationship.
• When an urge to use hits, it can be helpful to engage the brain’s reward pathway in an alternative direction by quickly substituting a thought or activity that’s more beneficial or fun— taking a walk, listening to a favorite piece of music.
• Multiple theories of motivation for behavior change support the importance of self-selection of goals in SUD treatment (Sobell et al., 1992).

In contrast to the cognitive restructuring strategies typical of traditional CBT, MBRP stresses nonjudgmental attention to thoughts or urges. From this standpoint, urges/cravings are labeled as transient events that need not be acted upon reflexively. This approach is exemplified by the “urge surfing” technique [115], whereby clients are taught to view urges as analogous to an ocean wave that rises, crests, and diminishes. Rather than being overwhelmed https://ecosoberhouse.com/ by the wave, the goal is to “surf” its crest, attending to thoughts and sensations as the urge peaks and subsides. The most promising pharmacogenetic evidence in alcohol interventions concerns the OPRM1 A118G polymorphism as a moderator of clinical response to naltrexone (NTX). Moreover, 87.1% of G allele carriers who received NTX were classified as having a good clinical outcome at study endpoint, versus 54.5% of Asn40 homozygotes who received NTX.

Definitions of relapse and relapse prevention

These responses cause a minor breakdown in self-control, often activating factors that prevent the reassertion of self-control, resulting in an acceleration of the breakdown. Often, it is not the lapse itself, but the subsequent breakdown in self-control that has the most severe effects on behavioral maintenance (Baumeister & Heatherton, 1996; Baumeister, Schmeichel, & Vohs, 2007). The abstinence violation effect (AVE) occurs when an individual, having made a personal commitment to abstain from using a substance or to cease engaging in some other unwanted behavior, has an initial lapse whereby the substance or behavior is engaged in at least once. The AVE occurs when the person attributes the cause of the initial lapse (the first violation of abstinence) to internal, stable, and global factors within (e.g., lack of willpower or the underlying addiction or disease). There has been little research on the goals of non-treatment-seeking individuals; however, research suggests that nonabstinence goals are common even among individuals presenting to SUD treatment.

• Future research must test the effectiveness of nonabstinence treatments for drug use and address barriers to implementation.
• It is possible that individuals do not know or like to admit they are being influenced by their social or physical environment.
• One recent large-scale research effort assessing the RP model was the Relapse Replication and Extension Project (RREP), which was funded by the National Institute on Alcohol Abuse and Alcoholism (Lowman et al. 1996).
• A key feature of the dynamic model is its emphasis on the complex interplay between tonic and phasic processes.
• Overall, however, research findings support both the overall model of the relapse process and the effectiveness of treatment strategies based on the model.

Persons who regained weight indicated lifestyle imbalance or experiencing a life event, lack of perseverance, negative emotional state, abstinence violation effect, decrease in motivation and indulgence as most important recurrent predictors. Specific intervention strategies include helping the person identify and cope with high-risk situations, eliminating myths regarding a drug’s effects, managing lapses, and addressing misperceptions about the relapse process. Other more general strategies include helping the person develop positive addictions and employing stimulus-control and urge-management techniques.

More from Merriam-Webster on abstinence

Most notably, we provide a recent update of the RP literature by focusing primarily on studies conducted within the last decade. We also provide updated reviews of research areas that have seen notable growth in the last few years; in particular, the application of advanced statistical modeling techniques to large treatment outcome datasets and the development of mindfulness-based relapse prevention. Additionally, we review the nascent but rapidly growing literature on genetic predictors of relapse following substance use interventions. Last, it would be of interest to develop a theoretical framework, consisting of various predictors of relapse in weight loss maintenance behaviors and its dynamic interactions. Such a framework should not only include predictors that are known from prior models, such as Marlatt’s Relapse Prevention Model, but also predictors that have been newly identified in this study and other recent studies (Kwasnicka, Dombrowski, White, & Sniehotta, 2019; Roordink et al., 2021). For example, in this study self-value and resilience received high importance ratings, but these are not reflected in current models.

It’s wise to create in advance a plan that can be enacted on the spot—for example, pre-arranging for a friend or family member to pick you up if you text or call. Whether or not emotional pain causes addition, every person who has ever experienced an addiction, as well as every friend and family member, knows that addiction creates a great deal of emotional pain. Therapy for those in recovery and their family is often essential for healing those wounds. Helping people understand whether emotional pain or some other unacknowledged problem is the cause of addition is the province of psychotherapy and a primary reason why it is considered so important in recovery. Therapy not only gives people insight into their vulnerabilities but teaches them  healthy tools for handling emotional distress. Experts in the recovery process believe that relapse is a process and that identifying its stages can help people take preventative action.

Global Lifestyle Self-Control Strategies

One of the key distinctions between CBT and RP in the field is that the term “CBT” is more often used to describe stand-alone primary treatments that are based on the cognitive-behavioral model, whereas RP is more often used to describe aftercare treatment. Given that CBT is often used as a stand-alone treatment it may include additional components that are not always provided in RP. For example, the CBT intervention developed in Project MATCH [18] (described below) equated to RP with respect to the core sessions, but it also included elective sessions that are not typically a focus in RP (e.g., job-seeking skills, family involvement). Perhaps the most notable gap identified by this review is the dearth of research empirically evaluating the effectiveness of nonabstinence approaches for DUD treatment.