Expanding the continuum of substance use disorder treatment: Nonabstinence approaches

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). As a newer iteration of RP, Mindfulness-Based Relapse Prevention (MBRP) has a less extensive research base, though it has been tested in samples with a range of SUDs (e.g., Bowen et al., 2009; Bowen et al., 2014; Witkiewitz et al., 2014). 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.

2. Established treatment models compatible with nonabstinence goals

• Have knowledge of Food and Drug Administration–approved medications used to treat problematic substance use.
• The AVE describes the negative emotional response that often accompanies a failure to maintain abstinence from drugs or alcohol.
• Relapse prevention (RP) is a strategy for reducing the likelihood and severity of relapse following the cessation or reduction of problematic behaviours4.
• Lapse management includes drawing a contract with the client to limit use, to contact the therapist as soon as possible, and to evaluate the situation for factors that triggered the lapse6.
• It involves the degree of balance in the person’s life between perceived external demands and internally fulfilling or enjoyable activities.

That way, the individual may be better able to avoid the most likely causes of relapse and the potential resulting AVE. It can also be particularly vital for mental health professionals to communicate the reality of addiction. Substance use disorders are clinical mental health disorders, meaning addiction is a matter of neurological and biological predispositions and marijuana addiction changes that take time to rectify. These rectifying steps usually include changing external elements rather than finding a magic button of willpower. A good treatment program should explain the difference between a lapse and relapse. It should also teach a person how to stop the progression from a lapse into relapse.

Getting support for substance use disorders and/or relapses

• Individuals with greater SUD severity tend to be most receptive to therapist input about goal selection (Sobell, Sobell, Bogardis, Leo, & Skinner, 1992).
• It is essential to understand what individuals with SUD are rejecting when they say they do not need treatment.
• Altogether, these thoughts and attributions are frequently driven by strong feelings of personal failure, defeat, and shame.
• Maintain communication with recovery resource partners (e.g., if a counselor links a client to peer support services, the counselor should be available to the peer provider for consultation and feedback on how the client is doing).

Introducing an approach to promoting a healthy life for clients who are beyond early recovery. Recurrence of substance use happens, but recovery-oriented counseling can help clients avoid it or confidently return to recovery when it does occur. Research suggests that online therapy can be effective in treating things like gambling disorders and helping with smoking cessation. It has also been shown to promote a decrease in symptoms of anxiety, depression, and specific phobias, all which the abstinence violation effect refers to have a comorbid relationship with substance use disorders.

1. Nonabstinence treatment effectiveness

Instead of learning and growing from their mistake, an individual may believe that they are unable to complete a successful recovery and feel shame and guilt. Inaction has typically been interpreted as the acceptance of substance cues which can be described as “letting go” and not acting on an urge. “Staying in the moment” and being mindful of urges are helpful coping strategies4.

Using a person-centered, strengths-based approach and unconditional positive regard, counselors should affirm clients’ efforts to continue in recovery and encourage them to reflect on their goals and how the recurrence could be an opportunity to gain greater insight and adjust their action plan. Clients who have a recurrence should hear from their counselors that they are not alone, because the counselors can offer continuous support while they navigate a path back to recovery. Implicit bias is a prejudice or bias outside one’s conscious awareness that can lead to a negative evaluation of a person based on such characteristics as race or gender. As Chapter 1 noted, counselors can provide recovery-oriented counseling in a wide range of settings. This diversity is a strength, given the need for supports for people seeking or in recovery. But to provide such clients with consistent, high-quality care, counselors need a common foundation of knowledge and skills.450 The consensus panel identified the following competencies for working with individuals who have problematic substance use or who are in recovery.

• Concerns that providers wouldn’t treat problematic substance use effectively or in a culturally responsive way.
• The Abstinence Violation Effect (AVE) is a psychological phenomenon that refers to a person’s reaction to breaking a self-imposed rule of abstinence or self-control.
• Marlatt, based on clinical data, describes categories of relapse determinants which help in developing a detailed taxonomy of high-risk situations.
• The verdict is strongest for interventions focused on identifying and resolving tempting situations, as most studies were concerned with these24.

Stigma and Discrimination Among Healthcare Providers

For example, counselors could encourage clients to go for an outdoor walk or attend an exercise class in the evenings, if this is a time when problematic substance use would normally occur. Even small changes in the timing of activities may help deter problematic substance use and promote wellness. During early recovery, clients need to develop coping and avoidance skills to reduce risk of recurrence to use.590 Clients should determine which coping and avoidance skills work best for them. Abstinence can be considered a decision to avoid behaviors that are risky in and of themselves, like using drugs.