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. For example, clients can be encouraged to increase their engagement in rewarding or stress-reducing activities into their daily routine. Overall, the RP model is characterized by a highly ideographic treatment approach, a contrast to the «one size fits all» approach typical of certain traditional treatments. Moreover, an emphasis on post-treatment maintenance renders RP a useful adjunct to various treatment modalities (e.g., cognitive-behavioral, twelve step programs, pharmacotherapy), irrespective of the strategies used to enact initial behavior change. For gambling disorder, controlled gambling is increasingly being advocated as a viable goal alongside traditional abstinence treatment goals (e.g., Stea, Hodgins, & Fung, 2015). Harm reduction therapy has also been applied in group format, mirroring the approach and components of individual harm reduction psychotherapy but with added focus on building social support and receiving feedback and advice from peers (Little, 2006; Little & Franskoviak, 2010).

Clinical Psychology Review

Future research must test the effectiveness of nonabstinence treatments for drug use and address barriers to implementation. Unfortunately, there has been little empirical research evaluating this approach among individuals with DUD; evidence of effectiveness comes primarily from observational research. For example, at a large outpatient SUD treatment center in Amsterdam, goal-aligned treatment for drug and alcohol use involves a version of harm reduction psychotherapy that integrates MI and CBT approaches, and focuses on motivational enhancement, self-control training, and relapse prevention (Schippers & Nelissen, 2006).

The neurocognitive correlates of non-substance addictive behaviors

Outcome expectancies (anticipated effects of substance use; [27]) also figure prominently in the RP model. Additionally, attitudes or beliefs about the causes and meaning of a lapse may influence whether a full relapse ensues. Viewing a lapse as a personal failure may lead to feelings of guilt and abandonment of the behavior change goal [24]. This reaction, termed the Abstinence Violation Effect (AVE; [16]), is considered more likely when one holds a dichotomous view of relapse and/or neglects to consider situational explanations for lapsing. In sum, the RP framework emphasizes high-risk contexts, coping responses, self-efficacy, affect, expectancies and the AVE as primary relapse antecedents. A basic assumption is that relapse events are immediately preceded by a high-risk situation, broadly defined as any context that confers vulnerability for engaging in the target behavior.

Relapse prevention for addictive behaviors

In the assessment of addiction, it is not simply an individual’s psychological state while actively engaged in a behavior that is taken into account, but also how they react to situations where they are prevented, whether voluntarily or involuntarily, from engaging in a behavior. Three out of the six components in the ‘components model of addiction’ (Griffiths, 2005) refer in some way to symptomatology that presuppose (attempted) abstinence situations. First, withdrawal symptoms refer to unpleasant emotional states that are experienced when a behavior is abruptly ceased.

Ecological momentary assessment [44], either via electronic device or interactive voice response methodology, could provide the data necessary to fully test the dynamic model of relapse. Ideally, assessments of coping, interpersonal stress, self-efficacy, craving, mood, and other proximal factors could be collected multiple times per day over the course of several months, and combined with a thorough pre-treatment assessment abstinence violation effect battery of distal risk factors. Future research with a data set that includes multiple measures of risk factors over multiple days could also take advantage of innovative modeling tools that were designed for estimating nonlinear time-varying dynamics [125]. Broadly speaking, there are at least three primary contexts in which genetic variation could influence liability for relapse during or following treatment.

Learn From Relapse

• However, despite findings that coping can prevent lapses there is scant evidence to show that skills-based interventions in fact lead to improved coping [75].
• Counteracting the effects of the AVE is necessary to support long-term recovery from addiction.
• It sounds counterintuitive, and it is, but it is a common thought that many people have to recognize to avoid relapse.
• Still, some have criticized the model for not emphasizing interpersonal factors as proximal or phasic influences [122,123].
• We are dedicated to transforming the despair of addiction into a purposeful life of confidence, self-respect and happiness.

1. Nonabstinence treatment effectiveness