Countering The Abstinence Violation Effect: Supporting Recovery Through Relapse

This cue leads to a cognitive conflict, as the individual struggles between their desire to maintain abstinence and the urge to engage in the prohibited behavior. If the person succumbs to the urge and violates their self-imposed rule, the Abstinence Violation Effect is activated. When someone abuses a substance for a long time, they will have a higher tolerance for its effects. It is for this reason that someone’s tolerance declines following a period of abstinence and that they may overdose if they start using again at the same level as before.

• In these situations, the drinker focuses primarily on the anticipation of immediate gratification, such as stress reduction, neglecting possible delayed negative consequences.
• People who attribute the lapse to their own personal failure are likely to experience guilt and negative emotions that can, in turn, lead to increased drinking as a further attempt to avoid or escape the feelings of guilt or failure.
• Another possible outcome of a lapse is that the client may manage to abstain and thus continue to go forward in the path of positive change, “prolapse”4.

A positive outcome expectancy for substance use is associated with increased relapse rates.

• For example, if the client understands that using alcohol in the day time triggers a binge, agreeing for a meeting in the afternoon in a restaurant that serves alcohol would be a SID5.
• 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.
• You may think that this time will be different, but if your drinking and drug use has gotten out of control in the past, it’s unlikely to be different this time.
• A recent review of the quality of 23 smoking-cessation websites indicated adequate quality and accuracy of information regarding smoking and smoking cessation 46.

In psychotherapy, an abstinence violation effect refers to the negative cognitive and affective reactions one experiences after returning to substance use after a period of abstinence. As a result of AVE, a person may experience uncontrollable, stable attributions, and feelings of shame and guilt after a relapse. Given the abstinence focus of many SUD treatment centers, studies may need to recruit using community outreach, which can yield fewer participants compared to recruiting from treatment (Jaffee et al., 2009). However, this approach is consistent with the goal of increasing treatment utilization by reaching those who may not otherwise present to treatment. 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. 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.

Lapse management

On the other hand, the increased attention to stage-based research has highlighted challenges in operationalizing and delineating between interventions focusing on helping smokers attain (smoking cessation) versus maintain (relapse prevention) abstinence. The culmination of the evidence would suggest that attention to the initial smoking cessation effort bolstered by booster contacts and ongoing pharmacologic support may be effective means of supporting relapse prevention over the long term 20•. Relapse prevention psychotherapy is a cognitive-behavioral approach that teaches clients various skills that they can employ to the abstinence violation effect refers to avoid—and/or learn and recover from—lapses and relapses.

2. Controlled drinking

It’s important to establish that a one-time lapse in a person’s recovery from drugs or alcohol is not considered a full blown relapse. Therapists also can enhance self-efficacy by providing clients with feedback concerning their performance on other new tasks, even those that appear unrelated to alcohol use. In general, success in accomplishing even simple tasks (e.g., showing up for appointments on time) can greatly enhance a client’s feelings of self-efficacy. This success can then motivate the client’s effort to change his or her pattern of alcohol use and increase the client’s confidence that he or she will be able to successfully master the skills needed to change.

• Ultimately, nonabstinence treatments may overlap significantly with abstinence-focused treatment models.
• Additionally, while early studies of SUD treatment used abstinence as the single measure of treatment effectiveness, by the late 1980s and early 1990s researchers were increasingly incorporating psychosocial, health, and quality of life measures (Miller, 1994).
• This success can then motivate the client’s effort to change his or her pattern of alcohol use and increase the client’s confidence that he or she will be able to successfully master the skills needed to change.
• However, those who chose cutting down to quit did postpone their quit day longer than those in the other two groups 38.

Self-monitoring, behavior assessment, analyses of relapse fantasies, and descriptions of past relapses can help identify a person’s high-risk situations. Specific alcoholism symptoms intervention strategies (e.g., skills training, relapse rehearsal, education, and cognitive restructuring) and general strategies (e.g., relaxation training, stress management, efficacy-enhancing imagery, contracts to limit the extent of alcohol use, and reminder cards) can help reduce the impact of relapse determinants. Shaded boxes indicate steps in the relapse process and intervention measures that are specific to each client and his or her ability to cope with alcohol-related situations.

Defining and Differentiating Smoking Cessation and Relapse Prevention

This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms. For example, I am a failure (labeling) and will never be successful with abstaining from drinking, eating healthier, or exercising (jumping to conclusions).