Also critical is building a support network that understands the importance of responsiveness. Not least is developing adaptive ways for dealing with negative feelings and uncertainty. Those ways are essential skills for everyone, whether recovering from addiction or not—it’s just that the stakes are usually more immediate for those in recovery. Many experts believe that people turn to substance use—then get trapped in addiction—in an attempt to escape from uncomfortable feelings. How individuals deal with setbacks plays a major role in recovery—and influences the very prospects for full recovery. Many who embark on addiction recovery see it in black-and-white, all-or-nothing terms.
- Self-monitoring, behavior assessment, analyses of relapse fantasies, and descriptions of past relapses can help identify a person’s high-risk situations.
- Whereas tonic processes may dictate initial susceptibility to relapse, its occurrence is determined largely by phasic responses–proximal or transient factors that serve to actuate (or prevent) a lapse.
- Although research with various addictive behaviors has indicated that a lapse greatly increases the risk of eventual relapse, the progression from lapse to relapse is not inevitable.
- Among the most important coping skills needed are strategies of distraction that can be quickly engaged when cravings occur.
- This literature – most of which has been conducted in the U.S. – suggests a strong link between abstinence goals and treatment entry.
Initial evidence suggests that implicit measures of expectancies are correlated with relapse outcomes, as demonstrated in one study of heroin users . In another recent study, researchers trained participants in attentional bias modification (ABM) during inpatient treatment for alcohol dependence and measured relapse over the course of three months post-treatment . Relative to a control condition, ABM resulted in significantly improved ability to disengage from alcohol-related stimuli during attentional bias tasks. While incidence of relapse did not differ between groups, the ABM group showed a significantly longer time to first heavy drinking day compared to the control group.
Relapse and Lapse
Too, maintaining healthy practices, especially getting abundant sleep, fortifies the ability to ride out cravings and summon coping skills in crisis situations, when they are needed most. At this stage, a person might not even think about using substances, but there is a lack of attention to self-care, the person is isolating from others, and they may be attending therapy sessions or group meetings only intermittently. Attention to sleep and healthy eating is minimal, as is attention to emotions and including fun in one’s life. Self-care helps minimize stress—important because the experience of stress often encourages those in recovery to glamorize past substance use and think about it longingly.
These data suggest that non-disordered drug use is possible, even for a substantial portion of individuals who use drugs such as heroin (about 45%). However, they do not elucidate patterns of non-disordered use over time, nor the likelihood of maintaining drug use without developing a DUD. It is essential to understand what individuals with SUD are rejecting when they say they do not need treatment. In this model, treatment success is defined as achieving and sustaining total abstinence from alcohol and drugs, and readiness for treatment is conflated with commitment to abstinence (e.g., Harrell, Trenz, Scherer, Martins, & Latimer, 2013). Additionally, the system is punitive to those who do not achieve abstinence, as exemplified by the widespread practice of involuntary treatment discharge for those who return to use (White, Scott, Dennis, & Boyle, 2005).
Abstinence Violation Effect
Although SE is proposed as a fluctuating and dynamic construct , most studies rely on static measures of SE, preventing evaluation of within-person changes over time or contexts . Shiffman, Gwaltney and colleagues have used ecological momentary assessment (EMA; ) to examine temporal variations in SE in relation to smoking relapse. Findings from these studies suggested that participants’ SE was lower on the day before a lapse, and that lower SE in the days following a lapse in turn predicted progression to relapse [43,45]. One study  reported increases in daily SE during abstinent intervals, perhaps indicating mounting confidence as treatment goals were maintained . The terms “relapse” and “relapse prevention” have seen evolving definitions, complicating efforts to review and evaluate the relevant literature. Definitions of relapse are varied, ranging from a dichotomous treatment outcome to an ongoing, transitional process [8,12,13].
Recent studies have also explored whether abnormalities in metabolic signals related to energy metabolism contribute to symptoms in the eating disorders. Several studies have suggested that patients with bulimia nervosa may have a lower rate of energy utilization (measured as resting metabolic rate) than healthy individuals. Thus, a biological predisposition toward greater than average weight gain could lead to preoccupation with body weight and food intake in bulimia nervosa. Indeed, because of the way the brain is wired, each time an addict lets an urge pass without engaging in the unwanted behavior, it weakens the neural connections that underlie the desire; each time he or she rewards the craving with the bad habit, the brain pathways, and the addiction, are strengthened. It helps for people to remind themselves that if they can resist an addictive urge once, it will become easier and easier to do it again in the future.
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. Helping the client to develop “positive addictions” (Glaser 1976)—that is, activities (e.g., meditation, exercise, or yoga) that abstinence violation effect have long-term positive effects on mood, health, and coping—is another way to enhance lifestyle balance. Self-efficacy often increases as a result of developing positive addictions, largely caused by the experience of successfully acquiring new skills by performing the activity.
Recovery benefits from a detailed relapse prevention plan kept in a handy place—next to your phone charger, taped to the refrigerator door or the inside of a medicine cabinet—for immediate access when cravings hit. A good relapse prevention plan specifies a person’s triggers for drug use, lists some coping skills to summon up and distractions to engage in, and lists people to call on for immediate support, along with their contact information. It’s an acknowledgement that recovery takes lots of learning, especially about oneself. Recovery from addiction requires significant changes in lifestyle and behavior, ranging from changing friend circles to developing new coping mechanisms. By definition, those who want to leave drug addiction behind must navigate new and unfamiliar paths and, often, burnish work and other life skills.
Overcoming the Abstinence Violation Effect:
John’s key responsibilities include maintaining the day-to-day operations from both a clinical and housing perspective. John’s goal is to monitor every department to ensure proper policies and procedures are in place and client care is carried out effortlessly. John joined Amethyst as a behavioral health technician where he quickly developed strong personal relationships with the clients through support and guidance. John understands first hand the struggles of addiction and strives to provide a safe environment for clients. Brie works closely with the leadership team to develop and implement effective HR strategies that support our organization’s goals and values. As an HR professional, Brie’s primary focus is on ensuring that our organization attracts and retains the most talented and qualified individuals to help us fulfill our mission of providing compassionate care to those struggling with addiction.
Recent studies have reported genetic associations with alcohol-related cognitions, including alcohol expectancies, drinking refusal self-efficacy, drinking motives, and implicit measures of alcohol-related motivation [51,52, ]. Overall, the body of research on genetic influences on relapse and related processes is nascent and virtually all findings require replication. Consistent with the broader literature, it can be anticipated that most genetic associations with relapse outcomes will be small in magnitude and potentially difficult to replicate.