Drug-related processes of tolerance, sensitization and withdrawal further facilitate the feed-forward disruptions in emotion, pain, and reward pathways to promote increased craving and risk of drug use escalation, relapse, and treatment failure. Perhaps a more appropriate goal at this stage of research is to identify the broader mechanisms underlying the effects of relapse prevention, prior to focusing on specific behaviors or activities that manifest these mechanisms. In the first study to examine relapse in relation to phasic changes in SE [46], researchers reported results that appear consistent with the dynamic model of relapse.
The stress–drug use cycle and treatment failure
After 14 days of abstinence, active lever pressing (drug seeking) on the first extinction relapse test was comparable to the end of training (right-most panel of Figure 2). Albeit lower, active lever pressing still persisted above that of the inactive lever on the second relapse test. Drug addiction is defined as a “chronic relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences” [1].
- During this stage, the person might be fully aware of the harm the addiction is causing in their life—whether it’s damaging relationships, affecting their health, or leading to legal or financial problems—but they find it extremely difficult to stop.
- Additionally, some groups target individuals with co-occurring psychiatric disorders (Little, Hodari, Lavender, & Berg, 2008).
Stress and substance use disorders: risk, relapse, and treatment outcomes
The initial transgression of problem behaviour after a quit attempt is defined as a “lapse,” which could eventually lead to continued transgressions to a level that is similar to before quitting and is defined as a “relapse”. Another possible outcome of a lapse is that the client may manage to abstain and thus continue to go forward in the path of positive change, “prolapse”4. Many researchers define abstinence violation effect relapse as a process rather than as a discrete event and thus attempt to characterize the factors contributing to relapse3. These activities included assignments that both the therapist and the patient agreed were achievable, such as incremental behavioral tasks that were incompatible with continued illicit drug use (eg, attending an employment interview, parenting class, or exercise group).
2. Established treatment models compatible with nonabstinence goals
- An important, if unavoidable, limitation of this study is its reliance on self-report to measure subjects’ post-treatment engagement in prosocial behaviors that compete with substance use.
- Support networks can be tailored to individual needs and may include SAMHSA-approved recovery support groups or alternative programs.
- This article reviews various immediate and covert triggers of relapse proposed by the RP model, as well as numerous specific and general intervention strategies that may help patients avoid and cope with relapse-inducing situations.
- 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).
- Based on the cognitive-behavioral model of relapse, RP was initially conceived as an outgrowth and augmentation of traditional behavioral approaches to studying and treating addictions.
According to this metaphor, learning to anticipate and plan for high-risk situations during recovery from alcoholism is equivalent to having a good road map, a well-equipped tool box, a full tank of gas, and a spare tire in good condition for the journey. 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. Moreover, people who have coped successfully with high-risk situations are assumed to experience a heightened sense of self-efficacy (i.e., a personal perception of mastery over the specific risky situation) (Bandura 1977; Marlatt et al. 1995, 1999; Marlatt and Gordon 1985). Conversely, people with low self-efficacy perceive themselves as lacking the motivation or ability to resist drinking in high-risk situations.