Mental Health Crisis Support Rooted in Community and Human Rights: A Case Study

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March 17, 2023

The most recent national survey assessing rates of illicit drug use and SUDs found that among individuals who report illicit drug use in the past year, approximately 15% meet criteria for one or more DUD (SAMHSA, 2019a). 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 of non-disordered use over time, nor the likelihood of maintaining drug use without developing a DUD.

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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). This finding supplements the numerous studies that identify lack of readiness for abstinence as the top reason for non-engagement in SUD treatment, even among those who recognize a need for treatment (e.g., Chen, Strain, Crum, & Mojtabai, 2013; SAMHSA, 2019a). Individuals with both abstinence and nonabstinence goals benefit from treatment. 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).

Building Trust with Service Users

This can include abstinence from substance abuse, overeating, gambling, smoking, or other behaviors a person has been working to avoid. AVE describes the negative, indulgent, or self-destructive feelings and behavior people often experience after lapsing during a period of abstinence. To understand relapse in this disorder, we highlight cognitive processes underlying the binge/purge cycle. Links are drawn between cognitions, causal perceptions, and the binge/purge cycle in a reformulation of the abstinence violation effect with a special focus on attributions. This reformulation is then applied to the lapse-relapse transition in bulimia nervosa. Finally, theoretical and clinical implications of the refrormulation are presented.

Indeed, a prominent harm reduction psychotherapist and researcher, Rothschild, argues that the harm reduction approach represents a “third wave of addiction treatment” which follows, and is replacing, the moral and disease models (Rothschild, 2015a). Specific intervention strategies include helping the person identify and cope with high-risk situations, eliminating myths regarding a drug’s effects, managing lapses, and addressing misperceptions about the relapse process. Other more general strategies include helping the person develop positive addictions and employing stimulus-control and urge-management techniques. Researchers continue to evaluate the AVE and the efficacy of relapse prevention strategies.

1. Nonabstinence treatment effectiveness

They all have a passion for physical activity, education, and social/community involvement. The Centre’s non-medical low-barrier approach, as well as its multiple access points, allow individuals to seek tailored support in the community when and where they need it. Many people who use the Centre’s services value having the choice to get crisis support without going to the hospital or involving law enforcement. They feel they can reach out as soon as they are struggling, not just when it becomes an emergency. Reaching out earlier allows the Centre to provide support, develop strategies, and facilitate community linkages to the resources needed to help prevent crises from escalating or taking place at all.

  • Outcomes in which relapse prevention may hold particular promise include reducing severity of relapses, enhanced durability of effects, and particularly for patients at higher levels of impairment along dimensions such as psychopathology or dependence severity21.
  • The abstinence violation effect occurs when an individual has a lapse in their recovery.
  • Overall, increased research attention on nonabstinence treatment is vital to filling gaps in knowledge.
  • Sometimes, it begins from the very moment we even consider the notion of using again.
  • Review of this body of literature suggests that, across substances of abuse but most strongly for smoking cessation, there is evidence for the effectiveness of relapse prevention compared with no treatment controls.
  • Gerstein Crisis Centre also offers short-term residential crisis beds and support in Toronto for individuals who are referred by police or other criminal justice sources.
  • These groups tend to include individuals who use a range of substances and who endorse a range of goals, including reducing substance use and/or substance-related harms, controlled/moderate use, and abstinence (Little, 2006).

This is an important measure, but it doesn’t do much for relapse prevention if we don’t forge a plan to deal with these disturbances when they arise. Sometimes, it begins from the very moment we even consider the notion of using again. If AVE sets in pre-emptively, it may actually lead us to the relapse we so desperately fear. Those who wish to become sober—and stay that way—must therefore learn to identify abstinence violation effect and the dangerous ways in which it might impact our recovery.

How Does The Abstinence Violation Effect Occur?

To that end, the Centre has created pathways and connections to support services that address some of the underlying issues that can contribute to a mental health crisis. This work is ongoing, and new pathways and partnerships are always being formed to address emerging gaps in services. The telephone crisis line is typically how people access support services at Gerstein.

the abstinence violation effect refers to

This dissonance can be reduced by either changing the behavior or changing the image, and characteristically in this population is resolved by the latter. Internal and stable attributes for the slip also lead to further lapse behavior. This model has received a good deal of empirical support and has the merit of dismantling the process of relapse and exploring subjective and cognitive variables in a manner that has important treatment implications. Individuals with fewer years of addiction and lower severity SUDs generally have the highest likelihood of achieving moderate, low-consequence substance use after treatment (Öjehagen & Berglund, 1989; Witkiewitz, 2008). Notably, these individuals are also most likely to endorse nonabstinence goals (Berglund et al., 2019; Dunn & Strain, 2013; Lozano et al., 2006; Lozano et al., 2015; Mowbray et al., 2013).

IV. Key Recommended Practices for Communities and Service Providers

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). However, it is also possible that adaptations will be needed for individuals with nonabstinence goals (e.g., additional support with goal setting and monitoring drug use; ongoing care to support maintenance goals), and currently there is a dearth of research in this area. An additional concern is that the lack of research supporting the efficacy of established interventions for achieving nonabstinence goals presents a barrier to implementation. Unfortunately, there has been little empirical research evaluating this approach among individuals with DUD; evidence of effectiveness comes primarily from observational research.

The dynamic model of relapse has generated enthusiasm among researchers and clinicians who have observed these processes in their data and their clients. [11] The Convention on the Rights of Persons with Disabilities (CRPD) reaffirms the abstinence violation effect definition autonomy and human rights of people with mental health conditions (or persons with psychosocial disabilities). The Convention obligates governments to respect the right of people with disabilities to make and pursue their own decisions.

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