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

One of the key distinctions between CBT and RP in the field is that the term “CBT” is more often used to describe stand-alone primary treatments that are based on the cognitive-behavioral model, whereas RP is more often used to describe aftercare treatment. Given that CBT is often used as a stand-alone treatment it may include additional components that are not always provided in RP. For example, https://ecosoberhouse.com/ the CBT intervention developed in Project MATCH [18] (described below) equated to RP with respect to the core sessions, but it also included elective sessions that are not typically a focus in RP (e.g., job-seeking skills, family involvement). Covert antecedents and immediate determinants of relapse and intervention strategies for identifying and preventing or avoiding those determinants.

Reactivity to written mental arithmetic: Effects of exercise lay-off and habituation

The client’s appraisal of lapses also serves as a pivotal intervention point in that these reactions can determine whether a lapse escalates or desists. Establishing lapse management plans can aid the client in self-correcting soon after a slip, and cognitive restructuring can help clients to re-frame the meaning of the event and minimize the AVE [24]. A final emphasis in the RP approach is the global intervention of lifestyle balancing, designed to target more pervasive factors that can function as relapse antecedents.

Relapse and Lapse

Following the initial introduction of the RP model in the 1980s, its widespread application largely outpaced efforts to systematically validate the model and test its underlying assumptions. Given this limitation, the National Institutes on Alcohol Abuse and Alcoholism (NIAAA) sponsored the Relapse Replication and Extension Project (RREP), a multi-site study aiming to test the reliability and validity of Marlatt’s original relapse taxonomy. Efforts to evaluate the validity [119] and predictive validity [120] of the taxonomy failed to generate supportive data. It was noted that in focusing on Marlatt’s relapse taxonomy the RREP did not comprehensive evaluation of the full RP model [121]. Nevertheless, these studies were useful in identifying limitations and qualifications of the RP taxonomy and generated valuable suggestions [121].

1. Nonabstinence psychosocial treatment models

It’s important to establish that a one-time lapse in a person’s recovery from drugs or alcohol is not considered a full blown relapse. A key contribution of the reformulated relapse model is to highlight the need for non-traditional assessment and analytic approaches to better understand relapse. Most studies of relapse rely on statistical methods that assume continuous linear relationships, but these methods may be inadequate for studying a behavior characterized by discontinuity and abrupt changes [33]. Consistent with the tenets of the reformulated RP model, several studies suggest advantages of nonlinear statistical approaches for studying relapse. The following section reviews selected empirical findings that support or coincide with tenets of the RP model. Because the scope of this literature precludes an exhaustive review, we highlight select findings that are relevant to the main tenets of the RP model, in particular those that coincide with predictions of the reformulated model of relapse.

In other words, AVE describes the thoughts, feelings, and actions a person goes through after they make a mistake and have a drink or abuse a substance, despite trying to quit.
Other studies have similarly found that relationships between daily events and/or mood and drinking can vary based on intraindividual or situational factors [73], suggesting dynamic interplay between these influences.
Additionally, attitudes or beliefs about the causes and meaning of a lapse may influence whether a full relapse ensues.
For example, in one study testing the predictive validity of a measure of treatment readiness among non-treatment-seeking people who use drugs, the authors found that the only item in their measure that significantly predicted future treatment entry was motivation to quit using (Neff & Zule, 2002).

Concerns about the viability of abstinence as a long-term goal do not preclude the possibility that short-term periods of abstinence could be beneficial, depending on the behavior in question. The crucial difference is that with short-term abstinence the goal in many cases would be to return to controlled use following the abstinence period. Temporarily disentangling from continued, unrestrained engagement in a behavior could, theoretically, undo to a specific extent negative effects caused by excessive engagement in the behavior (e.g., Wilson, 2016) or enhance self-awareness or insight into the behavior. Abstinence tasks also require practicing self-control, which might increase capacity for self-control strength (Muraven & Baumeister, 2000), and successful abstinence attempts might increase abstinence/avoidance self-efficacy (e.g., Hodgins, Peden, & Makarchuk, 2004; Kraus, Rosenberg, Martino, Nich, & Potenza, 2017).

Journal of Behavioral Addictions

Multiple theories of motivation for behavior change support the importance of self-selection of goals in SUD treatment (Sobell et al., 1992).
One day, when he was faced with a stressful situation, he felt overwhelmed, gave in to the urge, and had a drink.
This reframing of lapse episodes can help decrease the clients’ tendency to view lapses as the result of a personal failing or moral weakness and remove the self-fulfilling prophecy that a lapse will inevitably lead to relapse.
If, however, individuals view lapses as temporary setbacks or errors in the process of learning a new skill, they can renew their efforts to remain abstinent.

A person, by contrast, who vows not to have sex until marriage has committed to abstinence until marriage. Helping clients develop positive addictions or substitute indulgences (e.g. jogging, meditation, relaxation, exercise, hobbies, or creative tasks) also help to balance their lifestyle6. Global self-management strategy involves encouraging clients to pursue again those previously satisfying, nondrinking recreational activities. The results reported in the RREP study indicate that the original relapse taxonomy of the RP model has only moderate inter-rater reliability at the highest level of specificity, although reliability of abstinence violation effect the more general categories (e.g., negative affect and social pressure) was better. The model’s predictive validity also was modest; however, the definition of the key relapse episodes utilized in these studies failed to clarify whether these were voluntary change episodes or simply a return to drinking following a short period of abstinence that did not represent a serious attempt to quit drinking. Helping the client to develop “positive addictions” (Glaser 1976)—that is, activities (e.g., meditation, exercise, or yoga) that have long-term positive effects on mood, health, and coping—is another way to enhance lifestyle balance.

Effects of temporary withdrawal from regular running

For instance, in a high-risk context, a slight and momentary drop in self-efficacy could have a disproportionate impact on other relapse antecedents (negative affect, expectancies) [8]. Furthermore, the strength of proximal influences on relapse may vary based on distal risk factors, with these relationships becoming increasingly nonlinear as distal risk increases [31]. For example, one could imagine a situation whereby a client who is relatively committed to abstinence from alcohol encounters a neighbor who invites the client into his home for a drink. Feeling somewhat uncomfortable with the offer the client might experience a slight decrease in self-efficacy, which cascades into positive outcome expectancies about the potential effects of having a drink as well as feelings of shame or guilt about saying no to his neighbor’s offer. Importantly, this client might not have ever considered such an invitation as a high-risk situation, yet various contextual factors may interact to predict a lapse. Specific intervention strategies include helping the person identify and cope with high-risk situations, eliminating myths regarding a drug’s effects, managing lapses, and addressing misperceptions about the relapse process.

Theoretical and Practical Support for the RP Model

This concurs not only with clinical observations, but also with contemporary learning models stipulating that recently modified behavior is inherently unstable and easily swayed by context [32]. While maintaining its footing in cognitive-behavioral theory, the revised model also draws from nonlinear dynamical systems theory (NDST) and catastrophe theory, both approaches for understanding the operation of complex systems [10,33]. Detailed discussions of relapse in relation to NDST and catastrophe theory are available elsewhere [10,31,34]. These covert antecedents include lifestyle factors, such as overall stress level, one’s temperament and personality, as well as cognitive factors.