How Key Early Ideas Helped Shape Today’s Harm Reduction Movement


Negative emotions play a larger role in relapse among adults. Such feelings sabotage recovery in other ways as well—negative feelings are disquieting and are often what drive people to seek relief or escape in substances to begin with. In addition, feelings of guilt and shame are isolating and discourage people from getting the support that that could be of critical help.

  • In the 1970s, the pioneering work of a small number of alcohol researchers began to challenge the existing abstinence-based paradigm in AUD treatment research.
  • Finally, we demonstrate that the depressive behaviors observed do not require a sucrose fade and that this drinking paradigm may favor the development of habit-like EtOH consumption.
  • Thus, studies will need to emphasize measures of substance-related problems in addition to reporting the degree of substance use (e.g., frequency, quantity).
  • Imagination techniques to replace negative thoughts with positive ones .

A randomized controlled trial to assess the effects of reimbursing the costs of smoking cessation therapy on sustained abstinence . The majority of people who decide to end addiction have at least one lapse or relapse during the recovery process. Studies show that those who detour back to substance use are responding to drug-related cues in their surroundings—perhaps seeing a hypodermic needle or a whiskey bottle or a person or a place where they once obtained or used drugs.

What causes relapse?

We present time-dependent alterations in decision-making, emotional state, and the incubation of cue-induced craving in METH-dependent individuals, which might have significant clinical implications for the prevention of relapse. Barriers to accessing drug treatment may worsen negative abstinence violation effect health outcomes and further exacerbate health inequalities in the United States. Stigmatization of drug use, the War on Drugs and criminalization, and the social determinants of health should all be considered when discussing access to drug treatment and potential barriers.

When an urge to use hits, it can be helpful to engage the brain’s reward pathway in an alternative direction by quickly substituting a thought or activity that’s more beneficial or fun— taking a walk, listening to a favorite piece of music. Possible substitutes can be designated in advance, made readily available, listed in a relapse prevention plan, and swiftly summoned when the need arises. Distraction is a time-honored way of interrupting unpleasant thoughts of any kind, and particularly valuable for derailing thoughts of using before they reach maximum intensity. One cognitive strategy is to recite a mantra selected and rehearsed in advance.

Drug rehabilitation

Blunted striatal response to monetary reward anticipation during smoking abstinence predicts lapse during a contingency-managed quit attempt. Smokers may benefit from discussing aspirations for physical health within autonomy-supportive interventions. Patients may benefit from discussing aspirations during counseling about therapeutic lifestyle change and medication use. Negative affect subtypes and craving differentially predict long-term cessation success among smokers achieving initial abstinence .

A “controlled drinking controversy” followed, in which the Sobells as well as those who supported them were publicly criticized due to their claims about controlled drinking, and the validity of their research called into question (Blume, 2012; Pendery, Maltzman, & West, 1982). Despite the intense controversy, the Sobell’s high-profile research paved the way for additional studies of nonabstinence treatment for AUD in the 1980s and later (Blume, 2012; Sobell & Sobell, 1995). Marlatt, in particular, became well known for developing nonabstinence treatments, such as BASICS for college drinking (Marlatt et al., 1998) and Relapse Prevention (Marlatt & Gordon, 1985).

Adult Obesity Therapy, Michael D. LeBow, New York: Pergamon, 1989, 139pp., US$23.50 hard cover, $13.95 soft cover.

Thinking about and romanticizing past drug use, hanging out with old friends, lying, and thoughts about relapse are danger signs. Individuals may be bargaining with themselves about when to use, imagining that they can do so in a controlled way. Coping skills can keep thoughts from escalating into substance use. It might seem that the best treatment for addictions would be to encourage addicts to use more willpower. Rehearsing particular choice contingencies in advance and specifying “implementation intentions” in response to them has been reported to increase impulse control in people with poor control, including opium addicts (Brandstätter, Lengfelder, & Gollwitzer, 2001). However, willpower is not the unqualified good imagined by Victorian optimists.


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