The Effects of Drinking Goal on Treatment Outcome for Alcoholism PMC

By implementing certain strategies, people can develop resilience, self-compassion, and adaptive coping skills to counteract the effects of the AVE and maintain lifelong sobriety. The AVE describes the negative emotional response that often accompanies a failure to maintain abstinence from drugs or alcohol. The Abstinence Violation Effect is a psychological phenomenon that occurs when a person experiences abstinence violation effect relapse after attempting to abstain from drug or alcohol use. Ark Behavioral Health offers 100% confidential substance abuse assessment and treatment placement tailored to your individual needs. In a study by McCrady evaluating the effectiveness of psychological interventions for alcohol use disorder such as Brief Interventions and Relapse Prevention was classified as efficacious23.

Approaches to Alcoholism Treatment

Relapse Prevention (RP) is another well-studied model used in both AUD and DUD treatment (Marlatt & Gordon, 1985). In its original form, RP aims to reduce risk of relapse by teaching participants cognitive and behavioral skills for coping in high-risk situations (Marlatt & Gordon, 1985). More recent versions of RP have included mindfulness-based techniques (Bowen, Chawla, & Marlatt, 2010; Witkiewitz et al., 2014). The RP model has been studied among individuals with both AUD and DUD (especially Cocaine Use Disorder, e.g., Carroll, Rounsaville, & Gawin, 1991); with the largest effect sizes identified in the treatment of AUD (Irvin, Bowers, Dunn, & Wang, 1999).

• It involves the degree of balance in the person’s life between perceived external demands and internally fulfilling or enjoyable activities.
• Additionally, the support of a solid social network and professional help can play a pivotal role.
• The results of the Sobell’s studies challenged the prevailing understanding of abstinence as the only acceptable outcome for SUD treatment and raised a number of conceptual and methodological issues (e.g., the Sobell’s liberal definition of controlled drinking; see McCrady, 1985).
• Even among those who do perceive a need for treatment, less than half (40%) make any effort to get it (SAMHSA, 2019a).

Drinking Goal Item of the Treatment Experiences and Expectations questionnaire

It is, however, most commonly used to refer to a resumption of substance-use behavior after a period of abstinence from substances (Miller, 1996). The term relapse may be used to describe a prolonged return to substance use, whereas lapsemay be used to describe discrete,… Most importantly, 12-step programs tend to be abstinence-based, emphasizing that an authentic or high-quality recovery depends on abstaining completely from drugs and alcohol. Furthermore, 12-step programs often celebrate abstinence milestones and encourage participants to count abstinent days, leading to a perception that someone who resumes substance use is “going back to the beginning” and has not made progress in recovery. There are many relapse prevention models used in substance abuse treatment to counter AVE and give those in recovery important tools and coping skills.

• The debate between abstinence and non-abstinence approaches, specifically controlled drinking (CD), has remained a controversial topic in the alcoholism field since the 1960s (Davies, 1962; Miller & Caddy, 1977).
• Exclusion criteria were any serious mental illnesses or unstable medical conditions, current abuse or dependence on any drug other than nicotine or marijuana, and taking or requiring any medication that interfered with the study medications, including any current opioid use.
• Rather, when people with SUD are surveyed about reasons they are not in treatment, not being ready to stop using substances is consistently the top reason cited, even among individuals who perceive a need for treatment (SAMHSA, 2018, 2019a).
• However, it is also possible that adaptations will be needed for individuals with nonabstinence goals (e.g., additional support with goal setting and monitoring drug use; ongoing care to support maintenance goals), and currently there is a dearth of research in this area.

4. Current status of nonabstinence SUD treatment

Additionally, some groups target individuals with co-occurring psychiatric disorders (Little, Hodari, Lavender, & Berg, 2008). Important features common to these groups include low program barriers (e.g., drop-in groups, few rules) and inclusiveness of clients with difficult presentations (Little & Franskoviak, 2010). In sum, research suggests that achieving and sustaining moderate substance use after treatment is feasible for between one-quarter to one-half of individuals with AUD when defining moderation as nonhazardous drinking. While there is evidence that a subset of individuals who use drugs engage in low-frequency, non-dependent drug use, there is insufficient research on this population to determine the proportion for whom moderation is a feasible treatment goal. However, among individuals with severe SUD and high-risk drug or alcohol use, the urgency of reducing substance-related harms presents a compelling argument for engaging these individuals in harm reduction-oriented treatment and interventions. It is important to highlight that most of the studies cited above did not provide goal-matched treatment; thus, these outcomes generally reflect differences between individuals with abstinence vs. non-abstinence goals who participated in abstinence-based AUD treatment.

• The most recent national survey assessing rates of illicit drug use and SUDs found that among individuals who report illicit drug use in the past year, approximately 15% meet criteria for one or more DUD (SAMHSA, 2019a).
• Elucidating the “active ingredients” of CBT treatments remains an important and challenging goal, Also, integration of neurocognitive parameters in relapse models as well as neural (such as functional circuitry involved in relapse) and genetic markers of relapse will be major challenges moving ahead19.
• This can create a cycle of self-recrimination and further substance use, making it challenging to maintain long-term abstinence.
• Coping is defined as the thoughts and behaviours used to manage the internal and external demands of situations that are appraised as stressful.

The assumption of RP is that it is problematic to expect that the effects of a treatment that is designed to moderate or eliminate an undesirable behaviour will endure beyond the termination of that treatment. Further, there are reasons to presume a problem will re-emerge on returning to the old environment that elicited and maintained the problem behaviour; for instance, forgetting the skills, techniques, and information taught during therapy; and decreased motivation5. Another example is Taylor, who has been doing a wonderful job taking walks and engaging in healthier eating. Taylor uses an app to watch her intake of calorie limit and does see positive outcomes to her new lifestyle. We would like to know what GOAL you have chosen for yourself about using alcohol at this time…Pick only one of the following goals.

Relapse road maps

Understand The Relapse Process