Cognitive behavioural interventions in addictive disorders PMC

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. Although many developments over the last decade encourage confidence in the abstinence violation effect RP model, additional research is needed to test its predictions, limitations and applicability. In particular, given recent theoretical revisions to the RP model, as well as the tendency for diffuse application of RP principles across different treatment modalities, there is an ongoing need to evaluate and characterize specific theoretical mechanisms of treatment effects. 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.

Cognitive behavioural interventions in addictive disorders

A basic assumption is that relapse events are immediately preceded by a high-risk situation, broadly defined as any context that confers vulnerability for engaging in the target behavior. Examples of high-risk contexts include emotional or cognitive states (e.g., negative affect, diminished self-efficacy), environmental contingencies (e.g., conditioned drug cues), or physiological states (e.g., acute withdrawal). Although some high-risk situations appear nearly universal across addictive behaviors (e.g., negative affect; [25]), high-risk situations are likely to vary across behaviors, across individuals, and within the same individual over time [10].

Emerging topics in relapse and relapse prevention

Olanzapine was found to reduce alcohol-related craving those with the long-repeat VNTR (DRD4 L), but not individuals with the short-repeat version (DRD4 S; [100,101]). Further, a randomized trial of olanzapine led to significantly improved drinking outcomes in DRD4 L but not DRD4 S individuals [100]. 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).

• Functional imaging is increasingly being incorporated in treatment outcome studies (e.g., [133]) and there are increasing efforts to use imaging approaches to predict relapse [134].
• Discussing the relapse can yield valuable advice on how to continue recovery without succumbing to the counterproductive feelings of shame or self-pity.
• Additionally, momentary coping responses can serve as phasic events that may determine whether a high-risk situation culminates in a lapse.
• One study [76] found that momentary coping differentiated smoking lapses from temptations, such that coping responses were reported in 91% of successful resists vs. 24% of lapses.

Theoretical and empirical rationale for nonabstinence treatment

This standard persisted in SUD treatment even as strong evidence emerged that a minority of individuals who receive 12-Step treatment achieve and maintain long-term abstinence (e.g., Project MATCH Research Group, 1998). Additionally, this model acknowledges the contributions of social cognitive constructs to the maintenance of substance use or addictive behaviour and relapse1. No matter how much abstinence is the desired goal, viewing any substance use at all as a relapse can actually increase the likelihood of future substance use.

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. 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. Possible substitutes can be designated in advance, made readily available, listed in a relapse prevention plan, and swiftly summoned when the need arises.

Self-control and coping responses

Additionally, the support of a solid social network and professional help can play a pivotal role. Encouragement and understanding from friends, family, or support groups can help individuals overcome the negative emotional aftermath of the AVE. Jim is a recovering alcoholic who successfully abstained from drinking for several months. One day, when he was faced with a stressful situation, he felt overwhelmed, gave in to the urge, and had a drink. I have lost all that time,” which can trigger a self-destructive mindset and potentially lead to further relapse.

Understand The Relapse Process

2. Established treatment models compatible with nonabstinence goals