It should also teach a person how to stop the progression from a lapse into relapse. In order to cope or avoid these damaging thoughts, these individuals turn back to drugs or alcohol to numb the pain. This model notes that those who have the latter mindset are proactive and strive to learn from their mistakes. To do so, they adapt their coping strategies to better deal with future triggers should they arise.

1. Nonabstinence psychosocial treatment models

These examples are programmatically compiled from various online sources to illustrate current usage of the word ‘abstinence.’ Any opinions expressed in the examples do not represent those of Merriam-Webster or its editors. With all that said, there is a lot of nuance to each of these pieces, but use some of these questions and ideas as a starting point on your journey. Please continue to Google, research, and find programs and resources in your community. Although the benefits of 12-step participation may (and quite often do) outweigh the added AVE risk, clinicians should be aware of this particular risk and take steps to counteract it.

• While there have been calls for abstinence-focused treatment settings to relax punitive policies around substance use during treatment (Marlatt et al., 2001; White et al., 2005), there may also be specific benefits provided by nonabstinence treatment in retaining individuals who continue to use (or return to use) during treatment.
• These self-supported fellowships are the original abstinence-based intervention, dating back to 1935.
• The abstinence violation effect (AVE) describes the tendency of people recovering from addiction to spiral out of control when they experience even a minor relapse.
• Multiple theories of motivation for behavior change support the importance of self-selection of goals in SUD treatment (Sobell et al., 1992).
• To date, however, there has been little empirical research directly testing this hypothesis.
• Marlatt’s work inspired the development of multiple nonabstinence treatment models, including harm reduction psychotherapy (Blume, 2012; Denning, 2000; Tatarsky, 2002).

Learn From Relapse

Next, we review other established SUD treatment models that are compatible with non-abstinence goals. We focus our review on two well-studied approaches that were initially conceptualized – and have been frequently discussed in the empirical literature – as client-centered alternatives to abstinence-based treatment. Of note, other SUD treatment approaches that could be adapted to target nonabstinence goals (e.g., contingency management, behavioral activation) are excluded from the current review the abstinence violation effect refers to due to lack of relevant empirical evidence. 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. 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.

4. Consequences of abstinence-only treatment

Perhaps the most notable gap identified by this review is the dearth of research empirically evaluating the effectiveness of nonabstinence approaches for DUD treatment. Given low treatment engagement and high rates of health-related harms among individuals who use drugs, combined with evidence of nonabstinence goals among a substantial portion of treatment-seekers, testing nonabstinence treatment for drug use is a clear next step for the field. 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). Ultimately, nonabstinence treatments may overlap significantly with abstinence-focused treatment models. Harm reduction psychotherapies, for example, incorporate multiple modalities that have been most extensively studied as abstinence-focused SUD treatments (e.g., cognitive-behavioral therapy; mindfulness).

In the 1980s and 1990s, the HIV/AIDS epidemic prompted recognition of the role of drug use in disease transmission, generating new urgency around the adoption of a public health-focused approach to researching and treating drug use problems (Sobell & Sobell, 1995). The realization that HIV had been spreading widely among people who injected drugs in the mid-1980s led to the first syringe services programs (SSPs) in the U.S. (Des Jarlais, 2017). Early attempts to establish pilot SSPs were met with public outcry and were blocked by politicians (Anderson, 1991). In 1988 legislation was passed prohibiting the use of federal funds to support syringe access, a policy which remained in effect until 2015 even as numerous studies demonstrated the effectiveness of SSPs in reducing disease transmission (Showalter, 2018; Vlahov et al., 2001). Despite these obstacles, SSPs and their advocates grew into a national and international harm reduction movement (Des Jarlais, 2017; Friedman, Southwell, Bueno, & Paone, 2001). 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.

2. Controlled drinking

• The term relapse may be used to describe a prolonged return to substance use, whereas lapsemay be used to describe discrete,…
• 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.
• 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).

This model asserts that full-blown relapse is a transitional process based on a combination of factors. Administrative discharge due to substance use is not a necessary practice even within abstinence-focused treatment (Futterman, Lorente, & Silverman, 2004), and is likely linked to the assumption that continued use indicates lack of readiness for treatment, and that abstinence is the sole marker of treatment success. In the United Kingdom, where there is greater acceptance of nonabstinence goals and availability of nonabstinence treatment (Rosenberg et al., 2020; Rosenberg & Melville, 2005), the rate of administrative discharge is much lower than in the U.S. (1.42% vs. 6% of treatment episodes; Newham, Russell, & Davies, 2010; SAMHSA, 2019b). There has been little research on the goals of non-treatment-seeking individuals; however, research suggests that nonabstinence goals are common even among individuals presenting to SUD treatment. Among those seeking treatment for alcohol use disorder (AUD), studies with large samples have cited rates of nonabstinence goals ranging from 17% (Berglund et al., 2019) to 87% (Enggasser et al., 2015). In Europe, about half (44–46%) of individuals seeking treatment for AUD have non-abstinence goals (Haug & Schaub, 2016; Heather, Adamson, Raistrick, & Slegg, 2010).

• This standard persisted in SUD treatment even as strong evidence emerged that a minority of individuals who receive 12-Step treatment achieve and maintain long-term abstinence (e.g., Project MATCH Research Group, 1998).
• As a result, the AVE can trigger a cycle of further relapse and continued substance use, since people may turn to substances as a way to cope with the emotional distress.
• For example, in AUD treatment, individuals with both goal choices demonstrate significant improvements in drinking-related outcomes (e.g., lower percent drinking days, fewer heavy drinking days), alcohol-related problems, and psychosocial functioning (Dunn & Strain, 2013).
• Models of nonabstinence psychosocial treatment for drug use have been developed and promoted by practitioners, but little empirical research has tested their effectiveness.

What Is The Difference Between A Lapse And Relapse?

Does 12-Step Contribute to the AVE?

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Having an occasional glass of alcohol may not cause any harmful effects if your kidney functions regularly. Still, you should talk with your doctor about the safety and impact of drinking alcohol if you already have kidney disease https://ecosoberhouse.com/article/how-alcohol-affects-your-kidneys/ or kidney cancer. Heavy drinking can also cause liver disease, which makes your kidneys have to work harder. When you have liver disease, your body doesn’t balance the flow and filtering of blood as well as it should.

• Excessive alcohol consumption can have profound negative effects on the kidneys and their function in maintaining the body’s fluid, electrolyte, and acid-base balance, leaving alcoholic people vulnerable to a host of kidney-related health problems.
• Ethanol administration in rats showed particular alterations in the renal antioxidant system and glutathione status [4,5].
• Both of these factors affect hormones that regulate kidney function, just as changes in fluid volume and electrolyte balance do.
• They regulate water intake and outtake, they balance the amount of minerals in the body, and they produce vital hormones, according to the Kidney Foundation of Canada.

The damage can usually be reversed if you stop drinking and allow your kidneys to recover, but it can sometimes cause irreversible damage to the kidneys. Although the mechanism of alcoholic myopathy is not fully understood, it is likely that disruption of mitochondria-related energy homeostasis is important in promoting muscle cell (myocyte) injury (Eisner https://ecosoberhouse.com/ et al. 2014). Studies historically have shown that alcohol consumption markedly increases magnesium excretion in the urine and may affect magnesium levels in other ways as well. For example, when rats are given alcohol, they also require significant magnesium in their diets, suggesting that alcohol disrupts absorption of this nutrient from the gut.

Special Benefits and Confounding Factors of Alcohol Consumption

In other words, the kidneys’ ability to excrete excess fluid by way of dilute urine is impaired, and too much fluid is reabsorbed. Hyponatremia probably is the single most common electrolyte disturbance encountered in the management of patients with cirrhosis of the liver (Vaamonde 1996). This abnormality may reflect the severity of liver disease, but the available data do not allow correlation of kidney impairment with the degree of clinical signs of liver disease, such as ascites or jaundice. The few studies focusing on alcohol’s direct effects on perfusion in human kidneys suggest that regulatory mechanisms retain control over this component of kidney function despite alcohol consumption. Even at high blood alcohol levels, only minor fluctuations were found in the rates of plasma flow and filtration through the kidneys (Rubini et al. 1955). This may result from high levels of toxins leading to tissue injury and inflammation.

However, other studies found that long-term alcohol consumption aggravates renal fibrosis, which may be related to epithelial mesenchymal transdifferentiation and fibrosis induced by ethanol [33,47,56]. In the kidneys, ROS is generated via both enzymatic and non-enzymatic processes [22,23,27,32,36,37]. In addition, Das et al. reported that alcohol consumption impairs the ability of CAT to catalyze the decomposition of H2O2 in the kidneys [41]. This subsequently promotes the conversion of H2O2 to the more reactive hydroxyl radicals, which cause damage in antioxidant capacities and mitochondria in renal cells [34,42,43].

Can I still have an occasional drink if I have kidney cancer?

Alcohol consumption, including vodka and red wine, also reduced serum insulin concentrations and enhanced the insulin sensitivity index [24,25]. A moderate amount of alcohol drinking decreases the risk of developing diabetes, showing a U-shaped association [26]. Binge drinking aside, regular heavy drinking can damage kidneys over time. Consistent excessive alcohol consumption has been found to double the risk of developing chronic kidney disease, which does not go away on its own. Those who drink heavily and smoke are about five times more likely to develop chronic kidney disease than those who do not have those habits. Other studies found that alcohol combined with energy drinks, caffeine, or soft drinks can disturb the physiological redox reaction and cause lipoperoxidation in the liver and nephrotoxicity [30,118].

Your doctor may prescribe proton pump inhibitors or H2 antagonists to reduce the production of stomach acid. See your doctor to treat kidney stones or a kidney infection if they are the cause. Severe or recurring kidney infections may require hospitalization or surgery.

How Can Kidney Disease Be Prevented?

In addition to contributing to the development of high blood pressure, alcohol also has the potential to affect certain high blood pressure medications. Promote healthy kidney function and blood pressure by limiting the amount of alcohol you consume. WebMD also recommends getting tested regularly, especially if you have a higher chance of developing kidney disease than the general population. Cancer experts strongly recommend not drinking alcohol at all due to its potentially harmful effects on the body. Alcohol is known to increase your risk for several different types of cancer and cause kidney damage over time. Several epidemiological studies have shown that mild alcohol consumption benefits cardiovascular health (Coate 1993; Kannel and Ellison 1996) by reducing the risk of coronary heart disease (Mukamal et al. 2006).

• We think that the enhancement of CAT activities may not come from high concentration of ethanol, but rather from the compensatory improvement of antioxidant capacity after the intervention with low-concentration ethanol in the early stage.
• Even at high blood alcohol levels, only minor fluctuations were found in the rates of plasma flow and filtration through the kidneys (Rubini et al. 1955).
• We also realize that previous studies did not include an adequate number of heavy drinkers, especially female heavy drinkers.
• Specific effects of drinking patterns have been demonstrated in a study of ischemic heart diseases [76].