The RP model developed by Marlatt [7,16] provides both a conceptual framework for understanding relapse and a set of treatment strategies designed to limit relapse likelihood and severity. Because detailed accounts of the model’s historical background and theoretical underpinnings have been published elsewhere (e.g., [16,22,23]), we limit the current discussion to a concise review of the model’s history, core concepts and clinical applications. The research team discussed whether fewer or more clusters would represent participants’ statements better, by evaluating the coherence between statements in each cluster. After defining the final number of clusters, each statement within a cluster was evaluated and allocated to a perceived predictor (e.g. the statement ‘lack of motivation’ was allocated to the perceived predictor ‘motivation’). Subsequently, the research team named all clusters, thereby keeping the names given by the participants in consideration.

• Often, it is not the lapse itself, but the subsequent breakdown in self-control that has the most severe effects on behavioral maintenance (Baumeister & Heatherton, 1996; Baumeister, Schmeichel, & Vohs, 2007).
• Ultimately, nonabstinence treatments may overlap significantly with abstinence-focused treatment models.
• 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.

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). While AUD treatment studies commonly rely on guidelines set by government agencies regarding a “low-risk” or “nonhazardous” level of alcohol consumption (e.g., Enggasser et al., 2015), no such guidelines exist for illicit drug use. Thus, studies will need to emphasize measures of substance-related problems in addition to reporting the degree of substance use (e.g., frequency, quantity). Despite the growth of the harm reduction movement globally, research and implementation of nonabstinence treatment in the U.S. has lagged. Furthermore, abstinence remains a gold standard treatment outcome in pharmacotherapy research for drug use disorders, even after numerous calls for alternative metrics of success (Volkow, 2020). Models of nonabstinence psychosocial treatment for drug use have been developed and promoted by practitioners, but little empirical research has tested their effectiveness.

1. Nonabstinence treatment effectiveness

These negative emotions are, unfortunately, often temporarily placated by a renewed pattern of substance abuse. AVE describes the negative, indulgent, or self-destructive feelings and behavior people often experience after lapsing during a period of abstinence. In a study by McCrady evaluating the effectiveness of psychological interventions for alcohol use disorder such as Brief Interventions and Relapse Prevention was classified as efficacious23. Lapse management includes drawing a contract with the client to limit use, to contact the therapist as soon as possible, and to evaluate the situation for factors that triggered the lapse6.

• As was the case for Marlatt’s original RP model, efforts are needed to systematically evaluate specific theoretical components of the reformulated model [1].
• AVE occurs when someone who is striving for abstinence from a particular behavior or substance experiences a setback, such as a lapse or relapse.
• Relapse has been variously defined, depending on theoretical orientation, treatment goals, cultural context, and target substance (Miller 1996; White 2007).
• It encourages people to see themselves as failures, attributing the cause of the lapse to enduring and uncontrollable internal factors, and feeling guilt and shame.

This preparation can empower a client to avoid relapse altogether or to lessen the impact of relapse if it occurs. Ecological momentary assessment, either via electronic device or interactive voice response methodology, could provide the data necessary to fully test the dynamic model of relapse19. Helping clients develop positive addictions or substitute indulgences (e.g. jogging, meditation, relaxation, exercise, hobbies, or creative tasks) also help to balance their lifestyle6. Global self-management strategy involves encouraging clients to pursue again those previously satisfying, nondrinking recreational activities. In addition, relaxation training, time management, and having a daily schedule can be used to help clients achieve greater lifestyle balance. Cognitive restructuring can be used to tackle cognitive errors such as the abstinence violation effect.

Participants

Therapists also can enhance self-efficacy by providing clients with feedback concerning their performance on other new tasks, even those that appear unrelated to alcohol use. In general, success in accomplishing even simple tasks (e.g., showing up for appointments on time) can greatly enhance a client’s feelings of self-efficacy. This success can then motivate abstinence violation effect the client’s effort to change his or her pattern of alcohol use and increase the client’s confidence that he or she will be able to successfully master the skills needed to change. Most importantly, 12-step programs tend to be abstinence-based, emphasizing that an authentic or high-quality recovery depends on abstaining completely from drugs and alcohol.

For dietary behavior, it found that people with lower self-efficacy had a higher risk of relapsing (Roordink et al., 2021). However, the review also showed that there is still insufficient evidence for most predictors of relapse. As of yet, current literature still lacks an in-depth understanding of key stakeholders’ personal perspectives on relapse after weight loss. These key stakeholders include adults attempting weight loss and health practitioners. This paper presents a narrative review of the literature and a call for increased research attention on the development of empirically supported nonabstinence treatments for SUD to engage and treat more people with SUD.