Abstinence Violation Effect AVE What It Is & Relapse Prevention Strategies
Seemingly irrelevant decisions (SIDs) are those behaviours that are early in the path of decisions that place the client in a high-risk situation. 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. Miller and Hester reviewed more than 500 alcoholism outcome studies and reported that more than 75% of subjects relapsed within 1 year of treatment1.
Systematic reviews and large-scale treatment outcome studies
Next, we review other established SUD treatment models that are compatible with non-abstinence goals. We focus our review on two well-studied approaches that were initially conceptualized – and have been frequently discussed in the empirical literature – as client-centered alternatives to abstinence-based treatment. Of note, other SUD treatment approaches that could be adapted to target nonabstinence goals (e.g., contingency management, behavioral activation) are excluded from the current review due to lack of relevant empirical evidence.
Self-control and coping responses
Given data demonstrating a clear link between abstinence goals and treatment engagement in a primarily abstinence-based SUD treatment system, it is reasonable to hypothesize that offering nonabstinence treatment would increase overall engagement by appealing to those with nonabstinence goals. Indeed, there is anecdotal evidence that this may be the case; for example, a qualitative study of nonabstinence drug treatment in Denmark described a client saying that he would not have presented to abstinence-only treatment due to his goal of moderate use (Järvinen, 2017). Additionally, in the United Kingdom, where there is greater access to nonabstinence treatment (Rosenberg & Melville, 2005; Rosenberg & Phillips, 2003), the proportion of individuals with opioid use disorder engaged in treatment is more than twice that of the U.S. (60% vs. 28%; Burkinshaw et al., 2017).
Specific Intervention Strategies
- This suggests that individuals with non-abstinence goals are retained as well as, if not better than, those working toward abstinence, though additional research is needed to confirm these results and examine the effect of goal-matching on retention.
- In the absence of triggers, or cues, cravings are headed toward extinction soon after quitting.
- For example, clients can be encouraged to increase their engagement in rewarding or stress-reducing activities into their daily routine.
- A person’s coping behavior in a high-risk situation is a particularly critical determinant of the likely outcome.
- Because the volume and scope of this work precludes an exhaustive review, the following section summarizes a select body of findings reflective of the literature and relevant to RP theory.
An abstinence violation increases the likelihood that a single lapse will lead to a full relapse into negative behavioral or mental health symptoms if abstinence violation effects are present. Those who break sobriety with a single drink or use of a drug are at a high risk of a full relapse into addiction. When one returns to substance use after a period of abstinence, they experience a negative cognitive and affective reaction known as an abstinence violation effect in psychotherapy. An individual may experience uncontrollable, stable attributions and feelings of shame and guilt after relapsing as a result of AVE. The initial transgression of problem behaviour after a quit attempt is defined as a “lapse,” which could eventually lead to continued transgressions to a level that is similar to before quitting and is defined as a “relapse”. 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.
AVE in the Context of the Relapse Process
Rather, remember that relapse is a natural part of the journey and an opportunity for growth. When people don’t have the proper tools to navigate the challenges of recovery, the AVE is more abstinence violation effect likely to occur, which can make it difficult to achieve long-term sobriety. There are several factors that can contribute to the development of the AVE in people recovering from addiction.
Moreover, an emphasis on post-treatment maintenance renders RP a useful adjunct to various treatment modalities (e.g., cognitive-behavioral, twelve step programs, pharmacotherapy), irrespective of the strategies used to enact initial behavior change. Although high-risk situations can be conceptualized as the immediate determinants of relapse episodes, a number of less obvious factors also influence the relapse process. These covert antecedents include lifestyle factors, such as overall stress level, as well as cognitive factors that may serve to “set up” a relapse, such as rationalization, denial, and a desire for immediate gratification (i.e., urges and cravings) (see figure 2).
- When one returns to substance use after a period of abstinence, they experience a negative cognitive and affective reaction known as an abstinence violation effect in psychotherapy.
- Those ways are essential skills for everyone, whether recovering from addiction or not—it’s just that the stakes are usually more immediate for those in recovery.
- The last decade has seen numerous developments in the RP literature, including the publication of Relapse Prevention, Second Edition [29] and its companion text, Assessment of Addictive Behaviors, Second Edition [30].
- Although specific intervention strategies can address the immediate determinants of relapse, it is also important to modify individual lifestyle factors and covert antecedents that can increase exposure or reduce resistance to high-risk situations.
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