Short-term abstinence effects across potential behavioral addictions: A systematic review

Self-monitoring, behavior assessment, analyses of relapse fantasies, and descriptions of past relapses can help identify a person’s high-risk situations. Shaded boxes indicate steps in the relapse process and intervention measures that are specific to each client and his or her ability to cope with alcohol-related situations. White boxes indicate steps in the relapse process and intervention strategies that are related to the client’s general lifestyle and coping skills. High-risk situations are related to both the client’s general and specific coping abilities. A number of studies have examined psychosocial risk reduction interventions for individuals with high-risk drug use, especially people who inject drugs.

• It is essential to understand what individuals with SUD are rejecting when they say they do not need treatment.
• We reviewed 47 prospective studies examining effects of short-term abstinence across six potential behavioral addictions (exercise, gambling, gaming, mobile phone use, pornography use, social media use).
• Traditional alcoholism treatment approaches often conceptualize relapse as an end-state, a negative outcome equivalent to treatment failure.
• A recent reformulation of the relapse prevention model presents a multi-disciplinary framework, retaining its emphasis on psychological responses to lapses while incorporating a greater role for pharmacologic factors such as nicotine withdrawal and reinforcement processes related to lapsing (Witkiewitz & Marlatt, 2004).

Another efficacy-enhancing strategy involves breaking down the overall task of behavior change into smaller, more manageable subtasks that can be addressed one at a time (Bandura 1977). Thus, instead of focusing on a distant end goal (e.g., maintaining lifelong abstinence), the client is encouraged to set smaller, more manageable goals, such as coping with an upcoming high-risk situation or making it through the day without a lapse. Because an increase in self-efficacy is closely tied to achieving preset goals, successful mastery of these individual smaller tasks is the best strategy to enhance feelings of self-mastery. The second strategy, which is possibly the most important aspect of RP, involves evaluating the client’s existing motivation and ability to cope with specific high-risk situations and then helping the client learn more effective coping skills. It has been proposed that internal, stable, and global attributions for the cause of a lapse following a period of abstinence and concomitant feelings of guilt and loss of control increased the probability of a return to regular substance use.

Assessment of Recidivism Risk in Sex Offenders: A Pilot Study in Central Italy

Human Rights Watch and Gerstein Crisis Centre hope this document inspires action among and across mental health service providers, service users, policymakers, and human rights and mental health advocates on providing community-based and rights-respecting support to people experiencing mental health crises. This document provides examples of how this is being done in Canada, and we invite you to consider their applicability to your current and future work. They need to be able to have access to the supports and services they need without losing their autonomy. Our commitment at Gerstein Centre is to really listen to and hear the voices of people with lived experience of mental health and substance use. Counteracting the drinker’s misperceptions about alcohol’s effects is an important part of relapse prevention. To accomplish this goal, the therapist first elicits the client’s positive expectations about alcohol’s effects using either standardized questionnaires or clinical interviews.

This suggests that smokers should be encouraged to remain on treatment even after they have lapsed, at least through the first 8–10 lapses, while persisting in efforts to recover abstinence as soon as possible. Conversely, it also suggests when it may no longer be productive to persist in patch treatment in the face of an extended series of recurring lapses. We also observed that the effects of active patch assignment on progression were moderated by lapse-related guilt, such that elevated guilt accelerated progression among those on active patch, while it was protective among those on placebo. It is not clear why such psychological reactions should interact with pharmacological treatment. Further exploration of the interaction between guilt and NRT treatment – and, more broadly, between pharmacological and psychological factors in relapse – is warranted.

Planning a cognitive behavioural programme

Indeed, this argument has been central to advocacy around harm reduction interventions for people who inject drugs, such as SSPs and safe injection facilities (Barry et al., 2019; Kulikowski & Linder, 2018). It has also been used to advocate for managed alcohol and housing first programs, which represent a harm reduction approach to high-risk drinking among people with severe AUD (Collins et al., 2012; Ivsins et al., 2019). In addition to issues with administrative discharge, abstinence-only treatment may contribute to high rates of individuals not completing SUD treatment. About 26% of all U.S. treatment episodes end by individuals leaving the treatment program prior to treatment completion (SAMHSA, 2019b).

Based on the classification of relapse determinants and high-risk situations proposed in the RP model, numerous treatment components have been developed that are aimed at helping the recovering alcoholic cope with high-risk situations. The results of recent research, particularly the RREP study, likely will lead to modifications of the original RP model, particularly with regard to the assessment of high-risk situations as well as the conceptualization of covert and immediate antecedents of relapse. Overall, however, research findings support both the overall model of the relapse process and the effectiveness of treatment strategies based on the model. Although the RP model considers the high-risk situation the immediate relapse trigger, it is actually the person’s response to the situation that determines whether he or she will experience a lapse (i.e., begin using alcohol). A person’s coping behavior in a high-risk situation is a particularly critical determinant of the likely outcome. Thus, a person who can execute effective coping strategies (e.g., a behavioral 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.

Abstinence Violation Effect (AVE)

All stays in the crisis beds are consent-based, and Gerstein Crisis Centre does not report to the police any infractions with bail orders. Instead, the Centre works with people on setting goals that are meaningful to them and supports them in pursuing those goals. The overarching goal of the present research was to examine the way psychological responses to lapses influenced quitters’ ability to maintain abstinence. We used EMA measures of three core components of the AVE (internal attribution of self-blame for the lapse, abstinence self-efficacy and guilt) obtained at the time of lapse as smokers struggled to avert relapse over the course of 6 weeks after quitting. EMA captured the timing of lapses, the amount smoked during each lapse episode, and participants’ immediate AVE responses.

• Further, the more non-drinking friends a person with an AUD has, the better outcomes tend to be.
• He believed that drinking helped him across many domains of life (positive outcome expectancies regarding alcohol use and its effects, stage of change).
• To avoid data from periods when smoking had become routine, we limited the analysis to lapses that occurred before the onset of routine daily smoking.
• The focus of CBT is manifold and the focus is on targeting maintaining factors of addictive behaviours and preventing relapse.

It is now believed that relapse prevention strategies must be taught to the individual during the course of therapy, and various strategies to enhance patient involvement and adherence such as increasing patient responsibility, promoting internal attributions to events are to be introduced in therapy. Working with a variety of targets helps in generalization of gains, patients are helped in anticipating high risk situations33. The lapse process consists of a series of internal and external events, identified and analyzed in the process of therapy. Therapy focuses on providing the individual the necessary skills to prevent a lapse from escalating into a relapse31.

MeSH terms

In sum, the current body of literature reflects multiple well-studied nonabstinence approaches for treating AUD and exceedingly little research testing nonabstinence treatments for drug use problems, representing a notable gap in the literature. A focus on abstinence is pervasive in SUD treatment, defining success in both research and practice, and punitive measures are often imposed on those who do not abstain. Most adults with SUD do not seek treatment because they do not wish to stop using substances, though many also recognize a need for help. This narrative review considers the need for increased research attention on nonabstinence psychosocial treatment of SUD – especially drug use disorders – as a potential way to engage and retain more people in treatment, to engage people in treatment earlier, and to improve treatment effectiveness. Despite significant empirical support for nonabstinence alcohol interventions, there is a clear gap in research examining nonabstinence psychosocial treatment for drug use disorders.

Short-term abstinence shows promise as an intervention for some problematic behaviors, especially gaming, pornography use, mobile phone use, and social media use. However, potential counterproductive consequences of abstinence (e.g., rebound effects and compensatory behaviors) were not adequately assessed by the studies, which limits current evaluation of the utility of abstinence as an intervention. Despite precautions and preparations, many clients committed to abstinence will experience a lapse after abstinence violation effect definition initiating abstinence. Lapse-management strategies focus on halting the lapse and combating the abstinence violation effect to prevent an uncontrolled relapse episode. Lapse management includes contracting with the client to limit the extent of use, to contact the therapist as soon as possible after the lapse, and to evaluate the situation for clues to the factors that triggered the lapse. Often, the therapist provides the client with simple written instructions to refer to in the event of a lapse.