Lastly, we review existing models of nonabstinence psychosocial treatment for SUD among adults, with a special focus on interventions for drug use, to identify gaps in the literature and directions for future research. We identify a clear gap in research examining nonabstinence psychosocial treatment for drug use disorders and suggest that increased research attention on these interventions represents the logical next step for the field. For policy writers and legal advocates, this Gerstein Crisis Centre / Human Rights Watch case study offers a viable roadmap to provide safe and humane community-based care through rights-respecting services for individuals experiencing a mental health crisis. In many jurisdictions where under-investment and de-prioritization of rights-based community services are commonplace, this case study offers hope and guidance on transforming theory into practice.

• Researchers continue to evaluate the AVE and the efficacy of relapse prevention strategies.
• An early CBT approach to addictions is relapse prevention (RP; Marlatt, 1985).
• It includes thoughts and feelings like shame, guilt, anger, failure, depression, and recklessness as well as a return to addictive behaviors and drug use.

Conversely, the hypothesized result of a failure to cope with a high-risk situation is a decrease in a sense of self-efficacy, which in turn increases the probability of relapse. Each experience of successful or unsuccessful coping with a high-risk situation builds up a greater or lesser sense of self-efficacy, which determines the future risk of relapse in similar circumstances. Marlatt and Gordon (1985) contend that individuals’ reactions to the initial slip and their attributions regarding the cause of the slip are the determining factors in the escalation of a lapse or setback into a full-blown relapse. The transition from slip or lapse to relapse involves the “abstinence violation effect,” which results from a state of cognitive dissonance regarding the nonabstinent behavior and the individual’s image of being abstinent.

2. Controlled drinking

Miller, whose seminal work on motivation and readiness for treatment led to multiple widely used measures of SUD treatment readiness and the development of Motivational Interviewing, also argued for the importance of goal choice in treatment (Miller, 1985). Drawing from Intrinsic Motivation Theory (Deci, 1975) and the controlled drinking literature, Miller (1985) argued that clients benefit most when offered choices, both for drinking goals and intervention approaches. A key point in Miller’s theory is that motivation for change is “action-specific”; he argues that no one is “unmotivated,” but that people are motivated to specific actions or goals (Miller, 2006).

We feel an urge or encounter a trigger, and suddenly we decide that our attempts at recovery have failed. It doesn’t seem logical that we would still experience cravings when we were only just recently hurt by a relapse. We fail to realize that putting drugs and alcohol back in our system was likely what reignited our cravings in the first place. Learning to recognize this will be one of our greatest tasks as we move forward. Using a wave metaphor, urge surfing is an imagery technique to help clients gain control over impulses to use drugs or alcohol. In this technique, the client is first taught to label internal sensations and cognitive preoccupations as an urge, and to foster an attitude of detachment from that urge.

Behavioral Treatments for Smoking

This document provides examples of how this is being done in Canada, and we invite you to consider their applicability to your current and future work. An important part of RP is the notion of Abstinence violation effect (AVE), which refers to an individual’s response to a relapse abstinence violation effect definition where often the client blames himself/herself, with a subsequent loss of perceived control4. It occurs when the client perceives no intermediary step between a lapse and relapse i.e. since they have violated the rule of abstinence, “they may get most out” of the lapse5.