What Is The Abstinence Violation Effect AVE?

Helping the client to develop “positive addictions” (Glaser 1976)—that is, activities (e.g., meditation, exercise, or yoga) that have long-term positive effects on mood, health, and coping—is another way to enhance lifestyle balance. Self-efficacy often increases as a result of developing positive addictions, largely caused by the experience of successfully acquiring new skills by performing the activity. Another efficacy-enhancing strategy involves breaking down the overall task of behavior change into smaller, more manageable subtasks that can be addressed one at a time (Bandura 1977). Thus, instead of focusing on a distant end goal (e.g., maintaining lifelong abstinence), the client is encouraged to set smaller, more manageable goals, such as coping with an upcoming high-risk situation or making it through the day without a lapse. Because an increase in self-efficacy is closely tied to achieving preset goals, successful mastery of these individual smaller tasks is the best strategy to enhance feelings of self-mastery. It is important to highlight that most of the studies cited above did not provide goal-matched treatment; thus, these outcomes generally reflect differences between individuals with abstinence vs. non-abstinence goals who participated in abstinence-based AUD treatment.

Ark Behavioral Health

Here the assessment and management of both the intrapersonal and interpersonal determinants of relapse are undertaken. This article discusses the concepts of relapse prevention, relapse determinants and the specific interventional strategies. Cognitive restructuring, or reframing, is used throughout the RP treatment process to assist clients in modifying their attributions for and perceptions of the relapse process. In particular, cognitive restructuring is a critical component of interventions to lessen the abstinence violation effect. Thus, clients are taught to reframe their perception of lapses—to view them not as failures or indicators of a lack of willpower but as mistakes or errors in learning that signal the need drug addiction for increased planning to cope more effectively in similar situations in the future.

Lifestyle Factors

Unfortunately, a single lapse can cause you to fall into a full relapse because of something called the abstinence violation effect (AVE). It is not necessarily a failure of self-control nor a permanent failure to abstain from using a substance of abuse. Those in addiction treatment or contemplating treatment can benefit from this aspect of relapse prevention. Even when alcohol’s perceived positive effects are based on actual drug effects, often only the immediate effects are positive (e.g., euphoria), whereas the delayed effects are negative (e.g., sleepiness), particularly at higher alcohol doses. Asking clients questions designed to assess expectancies for both immediate and delayed consequences of drinking versus not drinking (i.e., using a decision matrix) (see table, p. 157) often can be useful in both eliciting and modifying expectancies.

Outcome Studies for Relapse Prevention

This can create a cycle of self-recrimination and further substance use, making it challenging to maintain long-term abstinence. A relapse is the result of a series of events that occur over time, according to psychologist and researcher Alan Marlatt, Ph.D. For instance, a person recovering from alcohol use disorder who has a drink may feel a sense of confusion or a lack of control and they may make unhealthy attributions or rationalizations to try to define and understand what they’re doing. AVE also involves cognitive dissonance, a distressing experience people go through when their internal thoughts, beliefs, actions, or identities are put in conflict with one another.

Identifying and Coping With High-Risk Situations

Alternatively, researchers who conduct trials in community-based treatment centers will need to obtain buy-in to test nonabstinence approaches, which may necessitate waiving facility policies regarding drug use during treatment – a significant hurdle. 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). 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).

• Researchers have long posited that offering goal choice (i.e., non-abstinence and abstinence treatment options) may be key to engaging more individuals in SUD treatment, including those earlier in their addictions (Bujarski et al., 2013; Mann et al., 2017; Marlatt, Blume, & Parks, 2001; Sobell & Sobell, 1995).
• Again, many experts agree that a one-time lapse into using drugs or alcohol does not equally relapse.
• Although the RP model considers the high-risk situation the immediate relapse trigger, it is actually the person’s response to the situation that determines whether he or she will experience a lapse (i.e., begin using alcohol).
• Often, the therapist provides the client with simple written instructions to refer to in the event of a lapse.

The Abstinence Violation Effect Refers To

Studies which have interviewed participants and staff of SUD treatment centers have cited ambivalence about abstinence as among the top reasons for premature treatment termination (Ball, Carroll, Canning-Ball, & Rounsaville, 2006; Palmer, Murphy, Piselli, & Ball, 2009; Wagner, Acier, & Dietlin, 2018). One study found that among those who did not complete an abstinence-based (12-Step) SUD treatment program, ongoing/relapse to substance use was the most frequently-endorsed reason for leaving treatment early (Laudet, Stanick, & Sands, 2009). A recent qualitative study found that concern about missing substances was significantly correlated with not completing treatment (Zemore, Ware, Gilbert, & Pinedo, 2021). Unfortunately, few quantitative, survey-based studies have included the abstinence violation effect refers to substance use during treatment as a potential reason for treatment noncompletion, representing a significant gap in this body of literature (for a review, see Brorson, Ajo Arnevik, Rand-Hendriksen, & Duckert, 2013). Additionally, no studies identified in this review compared reasons for not completing treatment between abstinence-focused and nonabstinence treatment.

Harm reduction may also be well-suited for people with high-risk drug use and severe, treatment-resistant SUDs (Finney & Moos, 2006; Ivsins, Pauly, Brown, & Evans, 2019). These individuals are considered good candidates for harm reduction interventions because of the severity of substance-related negative consequences, and thus the urgency of reducing these harms. Indeed, this argument has been central to advocacy around harm reduction interventions for people who inject drugs, such as SSPs and safe injection facilities (Barry et al., 2019; Kulikowski & Linder, 2018). It has also been used to advocate for managed alcohol and housing first programs, which represent a harm reduction approach to high-risk drinking among people with severe AUD (Collins et al., 2012; Ivsins et al., 2019).

Immediate Determinants of Relapse

One of the most notable developments in the last decade has been the emergence and increasing application of Mindfulness-Based Relapse Prevention (MBRP) for addictive behaviours. By providing comprehensive care, our treatment programs create a supportive environment in which our clients can build a solid foundation for lasting sobriety. Twelve-month relapse rates following alcohol or drug cessation attempts can range from 60 to 90 percent, and https://srsystemsus.com/halfway-houses-for-alcohol-dependents-from-2/ the AVE can contribute to extended relapses. Identify triggers that may have contributed to the relapse and develop strategies to address them proactively in the future. It’s important to challenge negative beliefs and cognitive distortions that may arise following a relapse.

Relapse prevention includes understanding what triggers substance abuse, which varies from person to person. As an example, when out with friends at their favorite hangout, someone with alcohol use disorder may feel like having a drink. A person’s guilt is a difficult emotion to carry, one that can constantly replay in their minds, causing them to use substances again to ease their guilt. Ark Behavioral Health offers 100% confidential substance abuse assessment and treatment placement tailored to your individual needs. Clinicians in relapse prevention programs and the field of clinical psychology as a whole point out that relapse occurs only after a long-term pattern of specific feelings, thoughts, and behavior.