Relapse and the Hidden Dangers Behind One Drink Won’t Hurt

Drawing from Intrinsic Motivation Theory (Deci, 1975) and the controlled drinking literature, Miller (1985) argued that clients benefit most when offered choices, both for drinking goals and intervention approaches. A key point in Miller’s theory is that motivation for change is “action-specific”; he argues that no one is “unmotivated,” but that people are motivated to specific actions or goals (Miller, 2006). Individuals with fewer years of addiction and lower severity SUDs generally have the highest likelihood of achieving moderate, low-consequence substance use after treatment (Öjehagen & Berglund, 1989; Witkiewitz, 2008).

1. Nonabstinence treatment effectiveness

Most scientists who studied SUD treatment believed that abstinence was the only acceptable treatment goal until at least the 1980s (Des Jarlais, 2017). Abstinence rates became the primary outcome for determining SUD treatment effectiveness (Finney, Moyer, & Swearingen, 2003; Kiluk, Fitzmaurice, Strain, & Weiss, 2019; Miller, 1994; Volkow, 2020), a standard which persisted well into the 1990s (Finney et al., 2003). Little attention was given to whether people in abstinence-focused treatments endorsed abstinence goals themselves, or whether treatment could help reduce substance use and related problems for those who did not desire (or were not ready for) abstinence.

Find Support

Marlatt and Gordon (1980, 1985) have described a type of reaction by the drinker to a lapse called the abstinence violation effect, which may influence whether a lapse leads to relapse. This reaction focuses on the drinker’s emotional response to an initial lapse and on the causes to which he or she attributes the lapse. People who attribute the lapse to their own personal failure are likely to experience guilt and negative emotions that can, in turn, lead to increased drinking as a further attempt to avoid or escape the feelings of guilt or failure.

Brain, Behavior, and Immunity

This process may lead to a relapse setup or increase the client’s vulnerability to unanticipated high-risk situations. Clayton Neighbors is a professor and Director of the Social Psychology Program at the University of Houston, USA. His work focuses on social, motivational, and spiritual influences in etiology, prevention, and treatment of health and risk behaviors. Outcomes of interest include alcohol and substance abuse, problem gambling, body image and eating disorders, intimate partner violence, and aggressive driving. Support for this research has been provided by the National Institute on Alcohol Abuse and Alcoholism, the National Institute on Drug Abuse, the National Institute on Mental Health, and the Department of Defense.

• This suggests that individuals with nonabstinence goals are retained as well as, if not better than, those working toward abstinence, though additional research is needed to confirm these results and examine the effect of goal-matching on retention.
• This finding supplements the numerous studies that identify lack of readiness for abstinence as the top reason for non-engagement in SUD treatment, even among those who recognize a need for treatment (e.g., Chen, Strain, Crum, & Mojtabai, 2013; SAMHSA, 2019a).
• We define nonabstinence treatments as those without an explicit goal of abstinence from psychoactive substance use, including treatment aimed at achieving moderation, reductions in use, and/or reductions in substance-related harms.
• Although non-dieters ate less after consuming the milkshakes, presumably because they were full, dieters paradoxically ate more after having the milkshake (Figure 1a).

Theoretical and empirical rationale for nonabstinence treatment

• Updates may include additional strategies for managing thoughts, urges, and impulses related to problematic use.664 Other revisions may include starting or increasing attendance at mutual-help meetings, participating in more recreational activities, and initiating or expanding delivery of peer support services.
• Despite these obstacles, SSPs and their advocates grew into a national and international harm reduction movement (Des Jarlais, 2017; Friedman, Southwell, Bueno, & Paone, 2001).
• He has received continuous funding for his research from a variety of agencies including the National Institute on Alcohol Abuse and Alcoholism, the National Institute on Drug Abuse, the Alcoholic Beverage Medical Research Foundation, and the Robert Wood Johnson Foundation.

Many would rather keep on drinking rather than come back to a primary source of support in shame. It seems akin to failing one exam during senior year in high school and being sent back to first grade as a result! Hopefully, one abstinence violation effect does not lose all the knowledge and experience gained along the journey. Connections to other services and supports for clients in recovery, such as housing resources and child care. Some insurance providers and health plans require patients to obtain approval for certain types of care or medications prior to receiving them.

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). The study was especially notable because most other treatment readiness measures have been validated on treatment-seeking samples (see Freyer et al., 2004). This finding supplements the numerous studies that identify lack of readiness for abstinence as the top reason for non-engagement in SUD treatment, even among those who recognize a need for treatment (e.g., Chen, Strain, Crum, & Mojtabai, 2013; SAMHSA, 2019a). The current review highlights a notable gap in research empirically evaluating the effectiveness of nonabstinence approaches for DUD treatment. While multiple harm reduction-focused treatments for AUD have strong empirical support, there is very little research testing models of nonabstinence treatment for drug use.

2. Controlled drinking

The AVE process typically involves a triggering event or cue, such as encountering a tempting situation, feeling stressed, or experiencing a moment of weakness. This cue leads to a cognitive conflict, as the individual struggles between their desire to maintain abstinence and the urge to engage in the prohibited behavior. If the person succumbs to the urge and violates their self-imposed rule, the Abstinence Violation Effect is activated.