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, https://ecosoberhouse.com/ 2010). In the U.S., about 25% of patients seeking treatment for AUD endorsed nonabstinence goals in the early 2010s (Dunn & Strain, 2013), while more recent clinical trials have found between 82 and 91% of those seeking treatment for AUD prefer nonabstinence goals (Falk et al., 2019; Witkiewitz et al., 2019). Rather, when people with SUD are surveyed about reasons they are not in treatment, not being ready to stop using substances is consistently the top reason cited, even among individuals who perceive a need for treatment (SAMHSA, 2018, 2019a).

According to AVE research, those who do chose to respond to their behavior with blame and a sense of lost perceived control are more likely to relapse than those who respond by attributing lapse to preventable events and not feeling as though they failed completely. So long as an individual maintains a perceived sense of self-control, he/she has a better chance at evading further lapses. AVE has been studied and supported for the cessation of sex offenses, heroin, marijuana, and other illicit drug use. While some assert that relapse occurs after the first sip of alcohol or use of another drug, certain scientists believe it is a process which more closely resembles a domino effect. Social-cognitive and behavioral theories believe relapse begins before the person actually returns to substance abuse.

2. Relationship between goal choice and treatment outcomes

In RP client and therapist are equal partners and the client is encouraged to actively contribute solutions for the problem. Client is taught that overcoming the problem behaviour is not about will power rather it has to do with skills acquisition. Another technique is that the road to abstinence is broken down to smaller achievable targets so that client can easily master the task enhancing self-efficacy. Also, therapists can provide positive feedback of achievements that the client has been able to make in other facets of life6. (a) When restrained eaters’ diets were broken by consumption of a high-calorie milkshake preload, they subsequently show disinhibited eating (e.g. increased grams of ice-cream consumed) compared to control subjects and restrained eaters who did not drink the milkshake (figure based on data from [30]). (b) Restrained eaters whose diets were broken by a milkshake preload showed increased activity in the nucleus accumbens (NAcc) compared to restrained eaters who did not consume the preload and satiated non-dieters [64].

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 abstinence violation effect 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. 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.

One more step…

Certainly, starting a diet or exercise plan with a friend is more fun than going it alone, and you can hold each other accountable too. However, telling your non-dieting partner to make sure you don’t snack after dinner is a set-up for a fight the first time you have a bad day and decide you need a treat. Sometimes the people in your life may even resist or impede your efforts to change. For example, a spouse who still smokes may be threatened by your quitting if they aren’t yet ready to make the effort themselves. If you find that the people around you don’t want you to make beneficial changes in your life, it may be time to seek therapy to figure out how to navigate those relationships. But let’s assume that you have identified a change you are committed to making and are motivated to start.

Fortunately, with the right planning, we can use some of those situational factors to foster the changes we want to make. Many formal weight-loss programs require people to limit their eating to one place, using only certain dishes, to facilitate portion control. So, if you want to stop off at the gym after work several days a week, leave some spare workout clothes in the car so you don’t have to remember to bring them on the right day. If your desk is so cluttered you can’t find your bills, never mind creating a budget; spend some time getting organized so that the mess doesn’t become a barrier to managing your finances. If you can never remember whether you took your vitamins, count them into a pill container every Sunday, so you have a way to keep track. The use of such situational inducements can make a big difference in your ability to follow through on a resolution.