On the other hand, if the reason for the violation is attributed to external, unstable, and/or local factors, such as an extremely tempting situation, then the individual is more likely to recover from the violation and get back onto the path of abstinence. They may not recognize that stopping use of a substance is only the first step in recovery—what must come after that is building or rebuilding a life, one that is not focused around use. They may falsely believe that their recovery is complete, or that cravings are a sign of failure, when in fact it takes time to rebuild a life and time for the brain to rewire itself and learn to respond to everyday pleasures. In general, the longer a person has not used a substance, the lower their desire to use.
Despite findings like these, many studies of treatment mechanisms have failed to show that theoretical mediators account for salutary effects of CBT-based interventions. Also, many studies that have examined potential mediators of outcomes have not provided a rigorous test  of mechanisms of change. These results suggest that researchers should strive to consider alternative mechanisms, improve assessment methods and/or revise theories about how CBT-based interventions work [77,130]. Recently, Magill and Ray  conducted a meta-analysis of 53 controlled trials of CBT for substance use disorders. As noted by the authors, the CBT studies evaluated in their review were based primarily on the RP model . Overall, the results were consistent with the review conducted by Irvin and colleagues, in that the authors concluded that 58% of individuals who received CBT had better outcomes than those in comparison conditions.
The problem is that abstinence violation effect magnifies these weaknesses and prevents us from seeking solutions. Our first instinct should be to figure out a relapse prevention plan that addresses the faults we have identified. This is an important measure, but it doesn’t do much for relapse prevention if we don’t forge a plan to deal with these disturbances when they arise. The weight of this guilt often correlates to the amount of time spent in recovery leading up to the relapse. Those with only a few weeks of sobriety will not feel as bad as those with years under their belt. Not out of the same warped practicality mentioned above, but because they simply feel as if they are hopeless.
Conversely, the hypothesized result of a failure to cope with a high-risk situation is a decrease in a sense of self-efficacy, which in turn increases the probability of relapse. Each experience of successful or unsuccessful coping with a high-risk situation builds up a greater or lesser sense of self-efficacy, which determines the future risk of relapse in similar circumstances. Marlatt and Gordon (1985) contend that individuals’ reactions to the initial slip and their attributions regarding the cause of the slip are the determining factors in the escalation of a lapse or setback into a full-blown relapse. The transition from slip or lapse to relapse involves the “abstinence violation effect,” which results from a state of cognitive dissonance regarding the nonabstinent behavior and the individual’s image of being abstinent. This dissonance can be reduced by either changing the behavior or changing the image, and characteristically in this population is resolved by the latter. This model has received a good deal of empirical support and has the merit of dismantling the process of relapse and exploring subjective and cognitive variables in a manner that has important treatment implications.
Does 12-Step Contribute to the AVE?
Marlatt (1985) describes an abstinence violation effect (AVE) that leads people to respond to any return to drug or alcohol use after a period of abstinence with despair and a sense of failure. By undermining confidence, these negative thoughts and feelings increase the likelihood that an isolated “lapse” will lead to a full-blown relapse. If, however, individuals view lapses as temporary setbacks or errors in the process of learning a new skill, they can renew their efforts to remain abstinent. Preventing people from relapsing into unhealthy habits requires insight into predictors of relapse in weight loss maintenance behaviors. We aimed to explore predictors of relapse in physical activity and dietary behavior from the perspectives of health practitioners and persons who regained weight, and identify new predictors of relapse beyond existing knowledge. 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.
- Rather than signaling weaknesses of the model, these issues could simply reflect methodological challenges that researchers must overcome in order to better understand dynamic aspects of behavior .
- Broadly speaking, there are at least three primary contexts in which genetic variation could influence liability for relapse during or following treatment.
- Rather than labeling oneself as a failure, weak, or a loser, recognizing the effort and progress made before the lapse can provide a more balanced perspective.
- NEATC will always strive to offer the highest quality of care in the Northeast region, while priding itself on a foundation of integrity, transparency, and compassion.
Similarly, twin studies have shown a higher concordance for the eating disorders in monozygotic twins in comparison to dizygotic twins. These studies suggest that heritable biological characteristics contribute to the onset of the eating disorders, although the potential role of familial environmental factors must also be considered. Prolonged stress during childhood dysregulates the normal stress response and can lastingly impair emotion regulation and cognitive development. What is more, it can alter the sensitivity of the stress response system so that it overresponds to low levels of threat, making people feel easily overwhelmed by life’s normal difficulties. Research shows a strong link between ACEs and opioid drug abuse as well as alcoholism.
1. Nonabstinence treatment effectiveness
Those who wish to become sober—and stay that way—must therefore learn to identify abstinence violation effect and the dangerous ways in which it might impact our recovery. Explore the benefits of an individualized treatment plan for addiction counseling and why it’s a game-changer on the path to recovery. Distraction is a time-honored way of interrupting unpleasant thoughts of any kind, and particularly valuable for derailing thoughts of using before they reach maximum intensity. A behavioral strategy is to call and engage in conversation with a friend or other member of your support network.
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. The desire for immediate gratification can take many forms, and some people may experience it as a craving or urge to use alcohol.
Relapse prevention for addictive behaviors
Relapse is most likely in the first 90 days after embarking on recovery, but in general it typically happens within the first year. Recovery is a developmental process and relapse is a risk before a person has acquired a suite of strategies for coping not just with cravings but life stresses and established new and rewarding daily routines. One of the biggest problems with the AVE is that periods of abstinence from opioids increase a person’s risk of overdose and today’s heroin is often tainted with super-potent fentanyl analogs. Because of heightened overdose risk, treatment providers can offer naloxone and overdose prevention training to all clients, even those whose “drug of choice” does not include opioids. Rather than communicating pessimism about a client’s potential to recover, these overdose prevention measures acknowledge the existence of the AVE and communicate that safety is more important than maintaining perfect abstinence. More information on overdose prevention strategies in treatment settings is available here.