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). These groups tend to include individuals who use a range of substances and who endorse a range of goals, including reducing substance use and/or substance-related harms, controlled/moderate use, and abstinence (Little, 2006). Additionally, some groups target individuals with co-occurring psychiatric disorders (Little, Hodari, Lavender, & Berg, 2008). Important features common to these groups include low program barriers (e.g., drop-in groups, few rules) and inclusiveness of clients with difficult presentations (Little & Franskoviak, 2010). Labeling studies show Fos protein immunoreactivity is increased in cortical and subcortical areas involved in drug reward [18,19].
The Shortcomings of Sexual Offender Treatment: Are We Doing Something Wrong?
Importantly, there has also been increasing acceptance of non-abstinence outcomes as a metric for assessing treatment effectiveness in SUD research, even at the highest levels of scientific leadership (Volkow, 2020). Many advocates of harm reduction believe the SUD treatment field is at a turning point in acceptance of nonabstinence approaches. Indeed, a prominent harm reduction psychotherapist and researcher, Rothschild, argues that the harm reduction approach represents a “third wave of addiction treatment” which follows, and is replacing, the moral and disease models (Rothschild, 2015a).
- Rather than being viewed as a state or endpoint signaling treatment failure, relapse is considered a fluctuating process that begins prior to and extends beyond the return to the target behavior [8,24].
- Abstinence treatment with the low dose of WIN 55,212-2 (0.3 mg/kg) increased active lever responses in this relapse test; inactive lever presses were not altered.
- The evolution of cognitive-behavioral theories of substance use brought notable changes in the conceptualization of relapse, many of which departed from traditional (e.g., disease-based) models of addiction.
- Psychological addiction involves the mental and emotional aspects, such as cravings and preoccupation with the substance, while physical addiction includes physiological changes and the development of tolerance.
Immediate Determinants of Relapse
This study examined the role of attributions in the lapse and relapse process following substance abuse treatment. According to Marlatt and Gordon’s theoretical framework, attributions made after a lapse (e.g., the Abstinence Violation Effect [AVE]) determine whether it progresses to a relapse. Also examined were the attributions of recovering drug users who were tempted but remained abstinent (never lapsed). Ninety-seven participants were recruited from an inpatient treatment center for substance abuse and completed an interview 6 months after leaving treatment.
Stress, trauma, and adversity effects on addiction risk
The most promising pharmacogenetic evidence in alcohol interventions concerns the OPRM1 A118G polymorphism as a moderator of clinical response to naltrexone (NTX). An initial retrospective analysis of NTX trials found that OPRM1 influenced treatment response, such that individuals with the Asp40 variant (G allele) receiving NTX had a longer time until the first heavy drinking day and were half as likely to relapse compared to those homozygous for the Asn40 variant (A allele) [92]. This finding was later extended in the COMBINE study, such that G carriers showed a greater proportion of days abstinent and a lower proportion of heavy drinking days compared in response to NTX versus placebo, whereas participants homozygous for the A allele did not show a significant medication response [93].
When cortical BDNF infusions occurred before a 6 day abstinence period, cocaine seeking in response to cocaine-paired cues decreased; however, when BDNF was infused after 6 days of abstinence, cocaine seeking was not affected [72]. Combined, these studies demonstrate involvement of cortical pathways in relapse following abstinence periods and even more specifically suggest that BDNF may be important for diminishing cocaine-seeking behavior early in the abstinence period. Initial evidence suggests that implicit measures of expectancies are correlated with relapse outcomes, as demonstrated in one study of heroin users [61]. In another recent study, researchers trained participants in attentional bias modification (ABM) during inpatient treatment for alcohol dependence and measured relapse over the course of three months post-treatment [62]. Relative to a control condition, ABM resulted in significantly improved ability to disengage from alcohol-related stimuli during attentional bias tasks. While incidence of relapse did not differ between groups, the ABM group showed a significantly longer time to first heavy drinking day compared to the control group.
The role of therapeutic interventions, particularly CBT and group therapy, continues to be a critical component of comprehensive addiction treatment plans, offering individuals the tools and support necessary for successful recovery. Research-supported group treatments, such as those involving contingency management and motivational interviewing, have shown efficacy in treating drug use disorders. The collaborative nature of group therapy fosters a sense of community and accountability, which can be particularly beneficial in sustaining long-term recovery. With substance use disorders, relapse is the return to problematic substance use following a period of abstinence. It is argued that the central issue in the treatment of sexually aggressive behavior is the tendency to relapse shown by offenders.
Self-control and coping responses
Furthermore, research has revealed sex differences in the impact of stress and trauma on substance use, with females experiencing higher rates of childhood heavy use and consequently higher risks of heavy drinking and AUD. In a subsequent meta-analysis by Irwin, twenty-six published abstinence violation effect and unpublished studies representing a sample of 9,504 participants were included. Specifically, RP was most effective when applied to alcohol or polysubstance use disorders, combined with the adjunctive use of medication, and when evaluated immediately following treatment.
3. The harm reduction movement
Questionnaires such as the situational confidence test (Annis 1982b) can assess the amount of self-efficacy a person has in coping with drinking-risk situations. Those measures do not necessarily indicate, however, whether a client is actually able or willing to use his or her coping skills in a high-risk situation. To increase the likelihood that a client can and will utilize his or her skills when the need arises, the therapist can use approaches such as role plays and the development and modeling of specific coping plans for managing potential high-risk situations. The desire for immediate gratification can take many forms, and some people may experience it as a craving or urge to use alcohol.
- Conditions such as anxiety, depression, bipolar disorder, and post-traumatic stress disorder (PTSD) frequently coexist with substance misuse, creating a complex interplay that can challenge recovery efforts.
- Treatment during abstinence simulates an important and common aspect of the treatment situation that has received very little empirical attention.
- Recognizing the signs early can lead to more successful outcomes and help individuals avoid the severe consequences of advanced addiction.
- A person may experience a particularly stressful emotional event in their lives and may turn to alcohol and/or drugs to cope with these negative emotions.