Dealing effectively with interpersonal problems in the family, and improving communication and avoiding conflicts have been effectively employed in the Indian context16,17. Harm reduction may also be well-suited for people with high-risk drug use and severe, treatment-resistant SUDs (Finney & Moos, 2006; Ivsins, Pauly, Brown, & Evans, 2019). These individuals are considered good candidates for harm reduction interventions because of the severity of substance-related negative consequences, and thus the urgency of reducing these harms. Indeed, this argument has been central to advocacy around harm reduction interventions for people who inject drugs, such as SSPs and safe injection facilities (Barry et al., 2019; Kulikowski & Linder, 2018). It has also been used to advocate for managed alcohol and housing first programs, which represent a harm reduction approach to high-risk drinking among people with severe AUD (Collins et al., 2012; Ivsins et al., 2019).
Thus, while it is vital to empirically test nonabstinence treatments, implementation research examining strategies to obtain buy-in from agency leadership may be just as impactful. For example, offering nonabstinence treatment may provide a clearer path abstinence violation effect forward for those who are ambivalent about or unable to achieve abstinence, while such individuals would be more likely to drop out of abstinence-focused treatment. To date there has been limited research on retention rates in nonabstinence treatment.
Historical context of nonabstinence approaches
Given data demonstrating a clear link between abstinence goals and treatment engagement in a primarily abstinence-based SUD treatment system, it is reasonable to hypothesize that offering nonabstinence treatment would increase overall engagement by appealing to those with nonabstinence goals. Indeed, there is anecdotal evidence that this may be the case; for example, a qualitative study of nonabstinence drug treatment in Denmark described a client saying that he would not have presented to abstinence-only treatment due to his goal of moderate use (Järvinen, 2017). Additionally, in the United Kingdom, where there is greater access to nonabstinence treatment (Rosenberg & Melville, 2005; Rosenberg & Phillips, 2003), the proportion of individuals with opioid use disorder engaged in treatment is more than twice that of the U.S. (60% vs. 28%; Burkinshaw et al., 2017).
- Even among those who do perceive a need for treatment, less than half (40%) make any effort to get it (SAMHSA, 2019a).
- A careful functional analysis and identification of dysfunctional beliefs are important first steps in CBT.
- Some educators advocate instead for emphasizing the benefits of abstinence and then teaching strategies for avoiding disease, promoting healthy sexuality, and ensuring emotional needs are met.
- Other more general strategies include helping the person develop positive addictions and employing stimulus-control and urge-management techniques.
The technique involves exposure to a hierarchy of cues, which signal craving and subsequently substance use. These are presented repeatedly without the previously learned pattern of drinking so as to lead to extinction. Despite work on cue reactivity, there is limited empirical support for the efficacy of cue exposure in recent literature14. There is less research examining the extent to which moderation/controlled use goals are feasible for individuals with DUDs. 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). About 10% of individuals who report cannabis use in the past year meet criteria for a cannabis use disorder, while this proportion increases to 18%, 19%, 58%, and 65% of those with past year use of cocaine, opioids (misuse), methamphetamine, and heroin, respectively.
Cognitive Behavioural model of relapse
This dissonance can be reduced by either changing the behavior or changing the image, and characteristically in this population is resolved by the latter. This model has received a good deal of empirical support and has the merit of dismantling the process of relapse and exploring subjective and cognitive variables in a manner that has important treatment implications. A number of studies have examined psychosocial risk reduction interventions for individuals with high-risk drug use, especially people who inject drugs.
If an individual uses a substance after experiencing a remission, he/she may be vulnerable to the abstinence violation effect (AVE), which refers to an individual’s response to the recognition that he/she has broken a self-imposed rule by engaging in substance use or other unwanted behavior. This response often creates a feeling of self-blame and loss of perceived control due to breaking a self-imposed rule regarding https://ecosoberhouse.com/ substance use. According to AVE research, those who do chose to respond to their behavior with blame and a sense of lost perceived control are more likely to relapse than those who respond by attributing lapse to preventable events and not feeling as though they failed completely. So long as an individual maintains a perceived sense of self-control, he/she has a better chance at evading further lapses.