Why Falling Off the Wagon Isn’t Fatal TIME

Between 40 percent and 60 percent of individuals relapse within their first year of treatment, according to the National Institute on Drug Abuse. Relapse in addiction is of particular concern because it poses the risk of overdose if someone uses as much of the substance as they did before quitting. More and more, behavioral health organizations are moving away from “kicking people out of treatment” if they return to substance use. This type of policy is increasingly recognized as scientifically un-sound, given that continued substance use despite consequences is a hallmark symptom of the disease of addiction.

This approach would be applicable to recovered depressed patients and would serve as a means of preventing relapse. Teasdale and colleagues provide a description of this training which teaches generic psychological, self-control skills and can be used on a continuing basis to maintain skills after initial training. While no data on the effectiveness of this approach in preventing relapse exist to date, this appears to be a useful and stimulating conceptualization of relapse and relapse prevention that deserves further attention. Lack of consensus around target outcomes also presents a challenge to evaluating the effectiveness of nonabstinence treatment. Experts generally recommend that SUD treatment studies report substance use as well as related consequences, and select primary outcomes based on the study sample and goals (Donovan et al., 2012; Kiluk et al., 2019).

Continued empirical evaluation of the RP model

Nonabstinence goals have become more widely accepted in SUD treatment in much of Europe, and evidence suggests that acceptance of controlled drinking has increased among U.S. treatment providers since the 1980s and 1990s (Rosenberg, Grant, & Davis, 2020). Importantly, there has also been increasing acceptance abstinence violation effect 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.

Marlatt and Gordon’s (1985) model of the relapse process in addictive disorders has had a major impact in the field of relapse prevention since the late 1980s. Marlatt and Gordon postulate that newly abstinent patients experience a sense of perceived control up to the point at which they encounter a high-risk situation, which most commonly entails a negative emotional state, an interpersonal conflict, or an experience of social pressure. If individuals cope effectively in the high-risk situation, perceived control and self-efficacy increase, which in turn makes the probability of relapse decrease.

Historical context of nonabstinence approaches

However, previous research indicates that environmental factors, such as a tempting environment, also influence relapse (Roordink et al., 2021). It is possible that individuals do not know or like to admit they are being influenced by their social or physical environment. In addition, the influence of the social or physical environment is often felt in combination with individual factors (e.g. not being able to cope with the social pressure at a party), which might make environmental factors more distal and therefore harder to recall. This remoteness of environmental factors is also reflected in the so-called fundamental attribution error, which is defined as ‘the tendency for attributors to underestimate the impact of situational factors and to overestimate the role of dispositional factors in controlling behavior’ (Ross, 1977). Participants’ greater focus on individual factors could furthermore be stimulated by the current stigma surrounding overweight and obese individuals and the notion that they are to blame for their weight (Puhl & Heuer, 2010).