Expanding the continuum of substance use disorder treatment: Nonabstinence approaches PMC

Motivational Interviewing provides a means of facilitating the change process7. A high-risk situation is defined as a circumstance in which an individual’s attempt to refrain from a particular behaviour is threatened. While analysing high-risk situations the client is asked to generate a list of situations that are low-risk, and to determine what aspects of those situations differentiate them from the high-risk situations.

• This model notes that those who have the latter mindset are proactive and strive to learn from their mistakes.
• An individual who believes they’ve failed and violated their sobriety goals may begin to think that they’re not good enough to be considered a true abstainer.
• Vertava Health offers 100% confidential substance abuse assessment and treatment placement tailored to your individual needs.
• Although there is some debate about the best definitions of lapse and relapse from theoretical and conceptual levels, these definitions should suffice.

The Gerstein model reflects that health and health outcomes are equity-based as well. When you normalize what a person is feeling, when you can remove that sense of panic and then move to step one and just focus on that step one, and then you deal with step two after—it felt the way I imagined turning to your family for help would feel. So, you still have your independence and your sense of privacy, but there’s a warmth and a trust and a normalization of what you’re going through. A non-police non-coercive crisis response is so essential for being able to really provide an option to people that they in that moment make use of and feel like it could be helpful to them. Amanda Marinelli is a Board Certified psychiatric mental health nurse practitioner (PMHNP-BC) with over 10 years of experience in the field of mental health and substance abuse.

Medical Director, Board Certified in Addiction Medicine

Perhaps the most notable gap identified by this review is the dearth of research empirically evaluating the effectiveness of nonabstinence approaches for DUD treatment. Given low treatment engagement and high rates of health-related harms among individuals who use drugs, combined with evidence of nonabstinence goals among a substantial portion of treatment-seekers, testing nonabstinence treatment for drug use is a clear next step for the field. Ultimately, nonabstinence treatments may overlap significantly with abstinence-focused treatment models.

• John understands first hand the struggles of addiction and strives to provide a safe environment for clients.
• There has been little research on the goals of non-treatment-seeking individuals; however, research suggests that nonabstinence goals are common even among individuals presenting to SUD treatment.
• The Centre intentionally hires crisis responders who have lived experiences of mental health conditions and substance use, and who reflect the diversity of the communities they serve.
• When dealing with tense situations, it may be necessary to think about the safety of all the persons around (e.g. asking people whose presence is not necessary to leave the room or to stay at a safe distance).
• More recent versions of RP have included mindfulness-based techniques (Bowen, Chawla, & Marlatt, 2010; Witkiewitz et al., 2014).

Relapse occurs when this behavior accelerates back into prolonged and compulsive patterns of drug abuse. Despite this, lapsing is still a risk factor and makes a person more prone to relapse. Oxford English Dictionary defines motivation as “the conscious or unconscious stimulus for action towards a desired goal provided by psychological or social factors; that which gives purpose or direction to behaviour. Motivation may relate to the relapse process in two distinct ways, the motivation for positive behaviour change and the motivation to engage in the problematic behaviour. This illustrates the issue of ambivalence experienced by many patients attempting to change an addictive behaviour.

Self-awareness, task failure, and disinhibition: How attentional focus affects eating

An individual experiencing a crisis—or someone else concerned about an individual, such as a friend, family member, service provider, medical professional, doctor, police officer, or a stranger or—can call the crisis line and speak directly to a member of the crisis team. Regardless of the caller, any engagement requires the consent of the person experiencing a crisis. Most often, the crisis worker and the individual concerned address the crisis over the phone by creating and agreeing upon a crisis and safety plan. If more support is needed, and only if the caller consents, that same crisis worker will take a teammate with them to visit the caller in the community on a mobile crisis team visit. This section provides a case study on lessons learned and good practices, based on Gerstein Crisis Centre’s rights-respecting and community-based approach in Canada. The aim is to assist communities and service providers who are considering how best to establish rights-based, people-centered services for individuals experiencing mental health crises, taking each community’s unique context into account.

Rather, when people with SUD are surveyed about reasons they are not in treatment, not being ready to stop using substances is consistently the top reason cited, even among individuals who perceive a need for treatment (SAMHSA, 2018, 2019a). Indeed, about 95% of people with SUD say they do not need SUD treatment (SAMHSA, 2019a). Even among those who do perceive a need for treatment, less than half (40%) make any effort to get it (SAMHSA, 2019a). Although reducing practical barriers to treatment is essential, evidence suggests that these barriers do not fully account for low rates of treatment utilization. Instead, the literature indicates that most people with SUD do not want or need – or are not ready for – what the current treatment system is offering. These properties of the abstinence violation effect also apply to individuals who do not have a goal to abstain, but instead have a goal to restrict their use within certain self-determined limits.

II. The Emergence of Community-Based Mental Health Care in Canada

AA was established in 1935 as a nonprofessional mutual aid group for people who desire abstinence from alcohol, and its 12 Steps became integrated in SUD treatment programs in the 1940s and 1950s with the emergence of the Minnesota Model of treatment (White & Kurtz, 2008). The Minnesota Model involved inpatient SUD treatment incorporating principles of AA, with a mix of professional and peer support staff (many of whom abstinence violation effect definition were members of AA), and a requirement that patients attend AA or NA meetings as part of their treatment (Anderson, McGovern, & DuPont, 1999; McElrath, 1997). This model both accelerated the spread of AA and NA and helped establish the abstinence-focused 12-Step program at the core of mainstream addiction treatment. By 1989, treatment center referrals accounted for 40% of new AA memberships (Mäkelä et al., 1996).

In a prospective study among both men and women being treated for alcohol dependence using the Situational Confidence Questionnaire, higher self-efficacy scores were correlated to a longer interval for relapse to alcohol use8. The relationship between self-efficacy and relapse is possibly bidirectional, meaning that individuals who are more successful report greater self-efficacy and individuals who have lapsed report lower self-efficacy4. Chronic stressors may also overlap between self-efficacy and other areas of intrapersonal determinants, like emotional states, by presenting more adaptational strain on the treatment-seeking client4.

This is why many individuals who have been abstinent (or «clean») for awhile accidentally overdose by starting to use again at the same level of use they were at before their abstinence period. Equally bad can be the sense of failure and shame that a formerly «clean» individual can experience following a return to substance use. Toronto police services respond to about 33,000 mental health crisis calls every year. We need to flip our system as it exists right now from a sort of default position where police are responding to mental health crisis and actually purpose-build a system that allows people to access mental health support when and where they need it. Future research with a data set that includes multiple measures of risk factors over multiple days can help in validating the dynamic model of relapse. Elucidating the “active ingredients” of CBT treatments remains an important and challenging goal, Also, integration of neurocognitive parameters in relapse models as well as neural (such as functional circuitry involved in relapse) and genetic markers of relapse will be major challenges moving ahead19.

We instead view these emotions as justifications of the negative cognition experienced under AVE. Our hopelessness and our instinctive desire to give up were spot-on, or else we would be happy all the time. Giving up on sobriety should never feel like a justified response to vulnerability. Looking back does have its benefits in that it helps us identify weaknesses in our program. The problem is that abstinence violation effect magnifies these weaknesses and prevents us from seeking solutions. Our first instinct should be to figure out a relapse prevention plan that addresses the faults we have identified.