Future research must test the effectiveness of nonabstinence treatments for drug use and address barriers to implementation. A number of studies have examined psychosocial risk reduction interventions for abstinence violation effect individuals with high-risk drug use, especially people who inject drugs. In contrast to the holistic approach of harm reduction psychotherapy, risk reduction interventions are generally designed to target specific HIV risk behaviors (e.g., injection or sexual risk behaviors) without directly addressing mechanisms of SUD, and thus are quite limited in scope.
Theoretical and empirical rationale for nonabstinence treatment
It’s important to challenge negative beliefs and cognitive distortions that may arise following a relapse. When people don’t have the proper tools to navigate the challenges of recovery, the AVE is more likely to occur, which can make it difficult to achieve long-term sobriety. This can create a cycle of self-recrimination and further substance use, making it challenging to maintain long-term abstinence. Counselors should refer to someone as having SUD only if they have received a clinical diagnosis. Concerns that providers wouldn’t treat problematic substance use effectively or in a culturally responsive way.
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Counselors can also help clients identify goals and objectives that will help them avoid a recurrence. Counselors can also help clients structure their days to incorporate enjoyable activities and encourage healthy choices during a period when they would normally engage in problematic substance use623. 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. Clients in early recovery may also need to be aware of coping mechanisms that can potentially become unhealthy, such as high or significantly increased caffeine or nicotine intake or binge eating. Chapter 3 provides more details about how counselors can help clients identify and develop positive coping and avoidance skills that fit into their treatment plan.
- The Form 90 (Miller & Del Boca, 1994; Tonigan, Miller, & Brown, 1997) was used to obtain pretreatment measures of drinking and the Time-Line Follow-Back (TLFB) interview (Sobell & Sobell 1992) was used to obtain daily reports of the number of drinks consumed during the 16 week treatment period.
- 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.
- It stems from the belief that individuals who establish strict rules of abstinence may be more vulnerable to relapse when faced with a violation of those rules.
- Additionally, individuals may engage in cognitive distortions or negative self-talk, such as believing that the relapse is evidence of personal weakness.
- As noted by Adamson and colleagues (2010), treatment goals may change over the course of treatment and must be continuously evaluated in order to promote the best possible outcomes.
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The dynamic nature of drinking goal may be an important clinical variable in its own right (Hodgins, Leigh, Milne, & Gerrish, 1997). The present study was limited to the assessment of drinking goal at the onset of treatment and future studies examining drinking goals over the course of treatment seem warranted. Likewise, further research should consider matching patients’ drinking goals to specific treatment modalities, whether behavioral or pharmacological in nature. It is well known to both clinicians and researchers in the addiction field that patients in alcoholism treatment vary dramatically with respect to their alcohol use goals. Patients differ on the continuum between not wanting to change their drinking at all to seeking complete and long-term abstinence from alcohol.
Researchers have long posited that offering goal choice (i.e., nonabstinence and abstinence treatment options) may be key to engaging more individuals in SUD treatment, including those earlier in their addictions (Bujarski et al., 2013; Mann et al., 2017; Marlatt, Blume, & Parks, 2001; Sobell & Sobell, 1995). To date, however, there has been little empirical research directly testing this hypothesis. Advocates of nonabstinence approaches often point to indirect evidence, including research examining reasons people with SUD do and do not enter treatment.