When an abstinence violation occurs, the attributions an individual makes play an important part in determining the trajectory of subsequent use. When abstinence violation occurs, individuals typically enter a state of cognitive dissonance, defined as an aversive experience resulting from the discrepancy created by having two or more simultaneous and inconsistent cognitions. Abstinence violators realize that their actions (e.g. “I drank”) do not line up with their personal goal (e.g. “I want to abstain”) and feel compelled to resolve the discrepancy. In this case, individuals try to explain to themselves why they violated their goal of abstinence.
Factors That Contribute To The Abstinence Violation Effect
- Coping is defined as the thoughts and behaviours used to manage the internal and external demands of situations that are appraised as stressful.
- This lapse, in turn, can result in feelings of guilt and failure (i.e., an abstinence violation effect).
- By reframing lapses as learning opportunities and teachable moments, cultivating self-compassion, and seeking support, individuals can navigate these challenges more effectively, increasing their chances of leading a healthier lifestyle.
Moreover, these people often have positive expectations regarding the effects of alcohol (i.e., outcome expectancies). These factors can lead to initial alcohol use (i.e., a lapse), which can induce an abstinence violation effect that, in turn, influences the risk of progressing to a full relapse. Self-monitoring, behavior assessment, analyses of relapse fantasies, and descriptions of past relapses can help identify a person’s high-risk situations.
- In contrast, individuals with greater SUD severity, who are more likely to have abstinence goals, generally have the best outcomes when working toward abstinence (Witkiewitz, 2008).
- If you are worried that you might be headed for a relapse, you don’t have to wait until it happens to reach out for help.
- 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.
- Unfortunately, a single lapse can cause you to fall into a full relapse because of something called the abstinence violation effect (AVE).
- More recent versions of RP have included mindfulness-based techniques (Bowen, Chawla, & Marlatt, 2010; Witkiewitz et al., 2014).
2. Established treatment models compatible with nonabstinence goals
The Abstinence Violation Effect is a concept originally introduced by psychologist Alan Marlatt in the context of treating substance abuse. It stems from the belief that individuals who establish strict rules of abstinence may be more vulnerable to relapse when faced with a violation of those rules. AVE can be observed in various areas, including addictions, dietary restrictions, and impulse control.
Relapse Prevention
- People with effective coping responses have confidence that they can cope with the situation (i.e., increased self-efficacy), thereby reducing the probability of a relapse.
- This resistance to nonabstinence treatment persists despite strong theoretical and empirical arguments in favor of harm reduction approaches.
These emotional and cognitive reactions intensify the Abstinence Violation Effect, which may lead to a further loss of control and increased vulnerability to subsequent relapses or deviations from the established rule. The AVE was introduced into the substance abuse literature within the context of the “relapse abstinence violation effect process” (Marlatt and Gordon 1985, p. 37). Relapse has been variously defined, depending on theoretical orientation, treatment goals, cultural context, and target substance (Miller 1996; White 2007).
Physical Relapse
- Advocates of nonabstinence approaches often point to indirect evidence, including research examining reasons people with SUD do and do not enter treatment.
- It is, however, most commonly used to refer to a resumption of substance-use behavior after a period of abstinence from substances (Miller, 1996).
- The abstinence violation effect can be defined as a tendency to continue to engage in a prohibited behavior following the violation of a personal goal to abstain.
- Clients are expected to monitor substance use (see Table 8.1) and complete homework exercises between sessions.
Most adults with SUD do not seek treatment because they do not wish to stop using substances, though many also recognize a need for help. This narrative review considers the need for increased research attention on nonabstinence psychosocial treatment of SUD – especially drug use disorders – as a potential way to engage and retain more people in treatment, to engage people in treatment earlier, and to improve treatment effectiveness. Despite significant empirical support for nonabstinence alcohol interventions, there is a clear gap in research examining nonabstinence psychosocial treatment for drug use disorders. Future research must test the effectiveness of nonabstinence treatments for drug use and address barriers to implementation.
The term relapse may be used to describe a prolonged return to substance use, whereas lapsemay be used to describe discrete,… AVE occurs when someone who is striving for abstinence from a particular behavior or substance experiences a setback, such as a lapse or relapse. Instead of viewing the incident as a temporary setback, the individual perceives it as evidence of personal failure, leading to increased feelings of guilt, shame, and hopelessness (Collins & Witkiewitz, 2013; Larimer, Palmer, & Marlatt, 1999). It can impact someone who is trying to be abstinent from alcohol and drug use in addition to someone trying to make positive changes to their diet, exercise, and other aspects of their lives. In the 1980s and 1990s, the HIV/AIDS epidemic prompted recognition of the role of drug use in disease transmission, generating new urgency around the adoption of a public health-focused approach to researching and treating drug use problems (Sobell & Sobell, 1995). The realization that HIV had been spreading widely among people who injected drugs in the mid-1980s led to the first syringe services programs (SSPs) in the U.S. (Des Jarlais, 2017).
