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. This resistance to nonabstinence treatment persists despite strong theoretical and empirical arguments in favor of harm reduction approaches. The harm reduction movement, and the wider shift toward addressing public health impacts of drug use, had both specific and diffuse effects on SUD treatment research.

If you do not have effective coping skills, you may think about and eventually lapse into abusing alcohol or illicit drugs to deal with this stress. You may feel happy, relaxed, or energetic in this state, but also feel guilty for breaking your abstinence. The negative emotions and cognitive dissonance that can happen after a lapse or relapse is known as the abstinence violation effect (AVE). These strategies also focus on enhancing the client’s awareness of cognitive, emotional, and behavioral reactions in order to prevent a lapse from escalating into a relapse. The first step in this process is to teach clients the RP model and to give them a “big picture” view of the relapse process.

Is Trazodone Habit-Forming Or Addictive?

I have lost all that time,” which can trigger a self-destructive mindset and potentially lead to further relapse. We can’t keep our urges from occurring, nor can we change past events in which we have acted on them. We can use our experiences to help others by telling them how relapse and abstinence violation effect caused us torment. If we can keep others from making the same mistakes, our experiences will serve a wonderful purpose.

abstinence violation effect

Cognitive therapy seeks to identify and challenge maladaptive thoughts and ideas such as I can never be 100% sober, the stress of my job makes me drink, if I only felt better and less stressed I would be able to stop drinking. Therapy also supports and encourages positive protective thoughts and ideas such as sobriety is hard and I will work hard to get there, but it is much better than the alternative, drinking used to be fun, now it just causes me problems, and I can do this if I take it one day, one moment at a time. If an individual uses a substance after experiencing a remission, he/she may be vulnerable to the abstinence violation effect (AVE), which refers to an individual’s response to the recognition that he/she has broken a self-imposed rule by engaging in substance use or other unwanted behavior. This response often creates a feeling of self-blame and loss of perceived control due to breaking a self-imposed rule regarding substance use. 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.

III.D. Abstinence Violation Effect

One study [74] found evidence suggesting a feedback cycle of mood and drinking whereby elevated daily levels of NA predicted alcohol use, which in turn predicted spikes in NA. Other studies have similarly found that relationships between daily events and/or mood and drinking can vary based on intraindividual or situational factors [73], suggesting dynamic interplay between these influences. A specific process has been described regarding attributions that follow relapse after an extended period of abstinence or moderation. The abstinence violation effect can be defined as a tendency to continue to engage in a prohibited behavior following the violation of a personal goal to abstain. For example, an individual who has successfully abstained from alcohol, after having one beer, may drink an entire case of beer, thinking that since he or she has “fallen off the wagon,” he or she might as well go the whole way. When an abstinence violation occurs, the attributions an individual makes play an important part in determining the trajectory of subsequent use.

The study of implicit cognition and neurocognition in models of relapse would likely require integration of distal neurocognitive factors (e.g., baseline performance in cognitive tasks) in the context of treatment outcomes studies or EMA paradigms. Additionally, lab-based studies will be needed to capture dynamic processes involving cognitive/neurocognitive influences on lapse-related phenomena. AVE occurs when someone who is striving for abstinence from a particular behavior or substance experiences a setback, such as a lapse or relapse.

What Can Clinicians Do To Counteract the AVE?

Finally, the results of Miller and colleagues (1996) support the role of the abstinence violation effect in predicting which participants would experience a full-blown relapse following an initial lapse. Specifically, those participants who had a greater belief in the disease model of alcoholism and a higher commitment to absolute abstinence (who were most likely to experience feelings of guilt over their lapse) were most likely to experience relapse in that study. In a recent review of the literature on relapse precipitants, Dimeff and Marlatt (1998) also concluded that considerable support exists for the notion that an abstinence violation effect can precipitate a relapse. Marlatt and Gordon (1980, 1985) have described a type of reaction by the drinker to a lapse called the abstinence violation effect, which may influence whether a lapse leads to relapse. This reaction focuses on the drinker’s emotional response to an initial lapse and on the causes to which he or she attributes the lapse.

abstinence violation effect

An abstinence violation can also occur in individuals with low self-efficacy, since they do not feel very confident in their ability to carry out their goal of abstinence. The abstinence violation effect (AVE) highlights the distinction between a lapse and relapse. Put simply, the AVE occurs when a client perceives no intermediary step between a lapse and a relapse. For example, overeaters may have an AVE when they express to themselves, “one slice of cheesecake is a lapse, so I may as well go all-out, and have the rest of the cheesecake.” That is, since they have violated the rule of abstinence, they “may as well” get the most out of the lapse. Treatment in this component involves describing the AVE, and working with the client to learn alternative coping skills for when a lapse occurs, such that a relapse is prevented. The AVE occurs when a client is in a high-risk situation and views the potential lapse as so severe, that he or she may as well relapse.

Systematic reviews and large-scale treatment outcome studies

Although reducing practical barriers to treatment is essential, evidence suggests that these barriers do not fully account for low rates of treatment utilization. Instead, the literature indicates that most people with SUD do not want or need – or are not ready for – what the current treatment system is offering. As the foregoing review suggests, validation of the reformulated RP model will likely progress slowly at first because researchers are only beginning to evaluate dynamic relapse processes. Currently, the dynamic model can be viewed as a hypothetical, theory-driven framework that awaits empirical evaluation. Testing the model’s components will require that researchers avail themselves of innovative assessment techniques (such as EMA) and pursue cross-disciplinary collaboration in order to integrate appropriate statistical methods. Irrespective of study design, greater integration of distal and proximal variables will aid in modeling the interplay of tonic and phasic influences on relapse outcomes.

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