Abstinence vs Harm Reduction Drug Treatment: Which Is Best?

About 10% of individuals who report cannabis use in the past year meet criteria for a cannabis use disorder, while this proportion increases to 18%, 19%, 58%, and 65% of those with past year use of cocaine, opioids (misuse), methamphetamine, and heroin, respectively. These data suggest that non-disordered drug use is possible, even for a substantial portion of individuals who use drugs such as heroin (about 45%). However, they do not elucidate patterns the abstinence violation effect refers to of non-disordered use over time, nor the likelihood of maintaining drug use without developing a DUD. It is essential to understand what individuals with SUD are rejecting when they say they do not need treatment. In this model, treatment success is defined as achieving and sustaining total abstinence from alcohol and drugs, and readiness for treatment is conflated with commitment to abstinence (e.g., Harrell, Trenz, Scherer, Martins, & Latimer, 2013).

What Can Clinicians Do To Counteract the AVE?

Rather, remember that relapse is a natural part of the journey and an opportunity for growth. Counteracting the effects of the AVE is necessary to support long-term recovery from addiction. One of the key features of the AVE is its potential to trigger a downward spiral of further relapse and continued substance use.

2. Established treatment models compatible with nonabstinence goals

• For example, Bandura, who developed Social Cognitive Theory, posited that perceived choice is key to goal adherence, and that individuals may feel less motivation when goals are imposed by others (Bandura, 1986).
• Harm reduction may also be well-suited for people with high-risk drug use and severe, treatment-resistant SUDs (Finney & Moos, 2006; Ivsins, Pauly, Brown, & Evans, 2019).
• An additional concern is that the lack of research supporting the efficacy of established interventions for achieving nonabstinence goals presents a barrier to implementation.
• AVE occurs when someone who is striving for abstinence from a particular behavior or substance experiences a setback, such as a lapse or relapse.
• This could include further evaluating established intervention models (e.g., MI and RP) among individuals with DUD who have nonabstinence goals, adapting existing abstinence-focused treatments (e.g., Contingency Management) to nonabstinence applications, and testing the efficacy of newer models (e.g., harm reduction psychotherapy).
• In Europe, about half (44–46%) of individuals seeking treatment for AUD have non-abstinence goals (Haug & Schaub, 2016; Heather, Adamson, Raistrick, & Slegg, 2010).

Additionally, individuals may engage in cognitive distortions or negative self-talk, such as believing that the relapse is evidence of personal weakness. The AVE describes the negative emotional response that often accompanies a failure to maintain abstinence from drugs or alcohol. Jim is a recovering alcoholic who successfully abstained from drinking for several months. One day, when he was faced with a stressful situation, he felt overwhelmed, gave in to the urge, and had a drink. I have lost all that time,” which can trigger a self-destructive mindset and potentially lead to further relapse. However, there is another treatment philosophy that has historically been at odds with these abstinence-based approaches.

steps to begin your journey in looking at addiction treatment options

This literature – most of which has been conducted in the U.S. – suggests a strong link between abstinence goals and treatment entry. For example, in one study testing the predictive validity of a measure of treatment readiness among non-treatment-seeking people who use drugs, the authors found that the only item in their measure that significantly predicted future treatment entry was motivation to quit using (Neff & Zule, 2002). The study was especially notable because most other treatment readiness measures have been validated on treatment-seeking samples (see Freyer et al., 2004).

• Together, this suggests a promising degree of alignment between goal selection and probability of success, and it highlights the potential utility of nonabstinence treatment as an “early intervention” approach to prevent SUD escalation.
• However, they do not elucidate patterns of non-disordered use over time, nor the likelihood of maintaining drug use without developing a DUD.
• For Jim and Taylor, this might involve acknowledging the months of sobriety and healthier lifestyle choices and understanding that a single incident does not erase that progress.

Participants with controlled use goals in this center are typically able to achieve less problematic (38%) or non-problematic (32%) use, while a minority achieve abstinence with (8%) or without (6%) incidental relapse (outcomes were not separately assessed for those with AUD vs. DUD; Schippers & Nelissen, 2006). A number of studies have examined psychosocial risk reduction interventions for individuals with high-risk drug use, especially people who inject drugs. In contrast to the holistic approach of harm reduction psychotherapy, risk reduction interventions are generally designed to target specific HIV risk behaviors (e.g., injection or sexual risk behaviors) without directly addressing mechanisms of SUD, and thus are quite limited in scope. However, these interventions also typically lack an abstinence focus and sometimes result in reductions in drug use. Multiple versions of harm reduction psychotherapy for alcohol and drug use have been described in detail but not yet studied empirically.

• We define nonabstinence treatments as those without an explicit goal of abstinence from psychoactive substance use, including treatment aimed at achieving moderation, reductions in use, and/or reductions in substance-related harms.
• Regard Healthcare offers 100% confidential substance abuse assessment and treatment placement tailored to your individual needs.
• One night, she craves pizza and wings, orders out, and goes over her calories for the day.
• Despite compatibility with harm reduction in established SUD treatment models such as MI and RP, there is a dearth of evidence testing these as standalone treatments for helping patients achieve nonabstinence goals; this is especially true regarding DUD (vs. AUD).

Understanding the AVE is crucial for individuals in recovery and those focused on healthier lifestyle choices. Instead of surrendering to the negative spiral, individuals can benefit from reframing the lapse as a learning opportunity and teachable moment. Recognizing the factors that contributed to the lapse, such as stressors or triggers, helps individuals to develop strategies and techniques to navigate similar challenges in the future. Twelve-step can certainly contribute to extreme and negative reactions to drug or alcohol use. This does not mean that 12-step is an ineffective or counterproductive source of recovery support, but that clinicians should be aware that 12-step participation may make a client’s AVE more pronounced. It was written based on peer-reviewed medical research, reviewed by medical and/or clinical experts, and provides objective information on the disease and treatment of addiction (substance use disorders).

Acknowledging your triggers and developing the appropriate coping skills should be a part of a solid relapse prevention program. Lastly, treatment staff should help you to learn how to recognize the signs of an impending lapse or relapse so that you can ask for help before it happens. In order to understand AVE, it is important to realize the difference between a lapse and relapse. Again, many experts agree that a one-time lapse into using drugs or alcohol does not equally relapse. Relapse occurs when this behavior accelerates back into prolonged and compulsive patterns of drug abuse.

• Little attention was given to whether people in abstinence-focused treatments endorsed abstinence goals themselves, or whether treatment could help reduce substance use and related problems for those who did not desire (or were not ready for) abstinence.
• These are all familiar acronyms that reflect the various 12-step, abstinence-based treatments that are designed to help an individual maintain sobriety.
• 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.
• Previous reviews have described nonabstinence pharmacological approaches (e.g., Connery, 2015; Palpacuer et al., 2018), which are outside the scope of the current review.
• It includes thoughts and feelings like shame, guilt, anger, failure, depression, and recklessness as well as a return to addictive behaviors and drug use.

4. Current status of nonabstinence SUD treatment

These negative emotions are, unfortunately, often temporarily placated by a renewed pattern of substance abuse. RehabCenter.net is intended for educational purposes only and is not designed to provide medical advice of any kind. Any information found on RehabCenter.net should never be used to diagnose a disease or health problem, and in no way replaces or substitutes professional care. The producers, contributors, sponsors, editors, and authors of RehabCenter.net have no responsibility or obligation to anyone (person or entity) for any harmful consequences that may happen, directly or indirectly, as a result of the content or information provided on RehabCenter.net. Creating, implementing, and adhering to a relapse prevention plan helps to protect your sobriety and prevent the AVE response. A good clinician can recognize the signs of an impending AVE and help you to avoid it.

2. Relationship between goal choice and treatment outcomes