Abstinence Violation Effect AVE
Specifically, RP was most effective when applied to alcohol or polysubstance use disorders, combined with the adjunctive use of medication, and when evaluated immediately following treatment. Moderation analyses suggested that RP was consistently efficacious across treatment modalities (individual vs. group) and settings (inpatient vs. outpatient)22. These covert antecedents include lifestyle factors, such as overall stress level, one’s temperament and personality, as well as cognitive factors. These may serve to set up a relapse, for example, using rationalization, denial, or a desire for immediate gratification. Lifestyle factors have been proposed as the covert antecedents most strongly related to the risk of relapse.
These variables are essential in developing distress tolerance and reducing impulsivity, which are important variables in relapse process. One helpful cognitive strategy in the initial phase of CBT includes using the Advantage/disadvantage technique with the patient29. abstinence violation effect definition The therapist and patient collaboratively review the advantages/disadvantages of engaging in substance use or addictive behaviour. Vertava Health offers 100% confidential substance abuse assessment and treatment placement tailored to your individual needs.
Behavioral Treatments for Smoking
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. A more recent development in the area of managing addictive behaviours is the application of the construct of mindfulness to managing experiences related to craving, negative affect and other emotional states that are believed to impact the process of relapse34.
- Nonabstinence approaches to SUD treatment have a complex and contentious history, and significant social and political barriers have impeded research and implementation of alternatives to abstinence-focused treatment.
- If we feel stress, anger or depression, we do not find healthy ways of confronting these feelings.
- Therapy focuses on providing the individual the necessary skills to prevent a lapse from escalating into a relapse31.
MET adopts several social cognitive as well as Rogerian principles in its approach and in keeping with the social cognitive theory, personal agency is emphasized. Lack of consensus around target outcomes also presents a challenge to evaluating the effectiveness of nonabstinence treatment. Experts generally recommend that SUD treatment studies report substance use as well as related consequences, and select primary outcomes based on the study sample and goals (Donovan et al., 2012; Kiluk et al., 2019). While AUD treatment studies commonly rely on guidelines set by government agencies regarding a “low-risk” or “nonhazardous” level of alcohol consumption (e.g., Enggasser et al., 2015), no such guidelines exist for illicit drug use. Thus, studies will need to emphasize measures of substance-related problems in addition to reporting the degree of substance use (e.g., frequency, quantity). The current review highlights multiple important directions for future research related to nonabstinence SUD treatment.
How Do You Prevent The Abstinence Violation Effect?
These alcohol-related cognitions are placed in the relapse prevention model within the overlap of the tonic stable processes and the phasic fluid responses. As such, these cognitive constructs have both a stable and enduring effect emanating from the individual’s general cognitive beliefs as well as a malleable and plastic effect emanating from upon the individual’s moment-to-moment experiences. Interventions designed to match the needs of specific smoker subpopulations have received increasing attention over the past few years.
Cori’s goal is to ensure all patient’s needs are met in an accurate and timely manner. She is a Certified Recovery Residence Administrator with The Florida Certification Board and licensed Notary Public in the state of Florida. As noted above, one possible characteristic of abstinence violation effect is the decision to give up entirely. But if they still have drugs left, they decide to go ahead and deplete their supply before quitting again. This isn’t the only way in which our thinking might become twisted when we experience a lapse in sobriety. Abstinence violation effect fuels our negative cognition, causing us to judge ourselves quite harshly.
3. The harm reduction movement
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). It is essential to understand what individuals with SUD are rejecting when they say they do not need treatment. In this model, treatment success is defined as achieving and sustaining total abstinence from alcohol and drugs, and readiness for treatment is conflated with commitment to abstinence (e.g., Harrell, Trenz, Scherer, Martins, & Latimer, 2013). Additionally, the system is punitive to those who do not achieve abstinence, as exemplified by the widespread practice of involuntary treatment discharge for those who return to use (White, Scott, Dennis, & Boyle, 2005). By the end of treatment, most gamblers will have experienced a prolonged abstinence from gambling. Marlatt & Gordon’s (1985) approach to relapse prevention with alcoholics provides a very useful framework within which to prevent relapse with gamblers (for a full discussion see Marlatt & Gordon, 1985).The most important aspect of this is to have gamblers understand that a lapse is not equivalent to a relapse.
In this technique, the client is first taught to label internal sensations and cognitive preoccupations as an urge, and to foster an attitude of detachment from that urge. The focus is on identifying and accepting the urge, not acting on the urge or attempting to fight it4. Another factor that may occur is the Problem of Immediate Gratification where the client settles for shorter positive outcomes and does not consider larger long term adverse consequences when they lapse. This can be worked on by creating a decisional matrix where the pros and cons of continuing the behaviour versus abstaining are written down within both shorter and longer time frames and the therapist helps the client to identify unrealistic outcome expectancies5. Relapse prevention initially evolved as a calculated response to the longer-term treatment failures of other therapies. The assumption of RP is that it is problematic to expect that the effects of a treatment that is designed to moderate or eliminate an undesirable behaviour will endure beyond the termination of that treatment.
Despite this, lapsing is still a risk factor and makes a person more prone to relapse. Defining relapse prevention in the context of smoking cessation is a challenging task. The abstinence violation effect (AVE) occurs when an individual, having made a personal commitment to abstain from using a substance or to cease engaging in some other unwanted behavior, has an initial lapse whereby the substance or behavior is engaged in at least once. The AVE occurs when the person attributes the cause of the initial lapse (the first violation of abstinence) to internal, stable, and global factors within (e.g., lack of willpower or the underlying addiction or disease). In a subsequent meta-analysis by Irwin, twenty-six published and unpublished studies representing a sample of 9,504 participants were included. Results indicated that RP was generally effective, particularly for alcohol problems.
While a person may physically abstain from using drugs or alcohol, their thoughts and emotions may have already returned to substance abuse. This model asserts that full-blown relapse is a transitional process based on a combination of factors. An important part of RP is the notion of Abstinence violation effect (AVE), which refers to an individual’s response to a relapse where often the client blames himself/herself, with a subsequent loss of perceived control4. It occurs when the client perceives no intermediary step between a lapse and relapse i.e. since they have violated the rule of abstinence, “they may get most out” of the lapse5.