The healthy alternative to seeing relapse as personal defeat is to regard it as a steppingstone, a marker of progress—a chance to learn more about one’s individual susceptibilities, about the kinds of situations that are problematic, and about the most workable means of support in a crisis. Reflect on what triggered the relapse—the emotional, physical, situational, or relational experiences that immediately preceded the lapse. Inventory not only the feelings you had just before it occurred but examine the environment you were in when you decided to use again.
Having a solid support system of friends and family who are positive influences can help you to remain steady within your recovery. Access to aftercare support and programs can also help you to avoid and recover from the AVE. Other research reveals there may be some benefits to abstinence—some abstinence programs have been positively correlated with reduced teen pregnancy. One study published in the Journal of Health Communication found the “Not Me, Not Now” campaign in Monroe County, New York, was strongly connected to a decline in teen pregnancy rates for that county.
What Is The Abstinence Violation Effect?
Going to the front of the room to grab a new one-day chip after months or years of sobriety makes us feel like complete failures. We feel ashamed of ourselves, and fear that everybody else must be ashamed of us as well. Family support is critical to long-term success in recovery from a substance use disorder. A better understanding of one’s motives, one’s vulnerabilities, and one’s strengths helps to overcome addiction. Experts in the recovery process believe that relapse is a process and that identifying its stages can help people take preventative action. In a study by McCrady evaluating the effectiveness of psychological interventions for alcohol use disorder such as Brief Interventions and Relapse Prevention was classified as efficacious23.
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, https://ecosoberhouse.com/ Scott, Dennis, & Boyle, 2005). In order to understand AVE, it is important to realize the difference between a lapse and relapse. Again, many experts agree that a one-time lapse into using drugs or alcohol does not equally relapse. Relapse occurs when this behavior accelerates back into prolonged and compulsive patterns of drug abuse. Despite this, lapsing is still a risk factor and makes a person more prone to relapse.
The Abstinence Violation Approach
Therapeutic effects of antidepressant medications in bulimia nervosa are thought to be related to their capacity to restore more normal signaling patterns in serotonergic pathways. If an individual uses a substance after experiencing a remission, he/she may be vulnerable to the abstinence violation effect (AVE), which refers to an individual’s response to the recognition that he/she has broken a self-imposed rule by engaging in substance use or other unwanted behavior. This response often creates a feeling of self-blame and loss of perceived control due to breaking a self-imposed rule regarding substance use. According to AVE research, those who do chose to respond to their behavior with blame and a sense of lost perceived control are more likely to relapse than those who respond by attributing lapse to preventable events and not feeling as though they failed completely.
Here the assessment and management of both the intrapersonal and interpersonal determinants of relapse are undertaken. This article discusses the concepts of relapse prevention, relapse determinants and the specific interventional strategies. The results of the Sobell’s studies challenged the prevailing understanding of abstinence as the only acceptable outcome for SUD treatment and raised a number of conceptual and methodological issues (e.g., the Sobell’s liberal definition of controlled drinking; see McCrady, 1985).
Outcome Studies for Relapse Prevention
A common pattern of self-regulation failure occurs for addicts and chronic dieters when they ‘fall off the wagon’ by consuming the addictive substance or violating their diets . Marlatt coined the term abstinence violation effect to refer to situations in which addicts respond to an initial indulgence by consuming even more of the forbidden substance . In one of the first studies to examine this effect, Herman and Mack experimentally violated the diets of dieters by requiring them to drink a milkshake, a high-calorie food, as part of a supposed taste perception study . Although non-dieters ate less after consuming the milkshakes, presumably because they were full, dieters paradoxically ate more after having the milkshake (Figure 1a).
I’ve heard of AA meetings where a member with over 10 years of sobriety ends up drinking (let’s say as an attempt to cope with the loss of a loved one or other tragic event). Many would rather keep on drinking rather than come back to a primary source of support in shame. It seems akin to failing one exam during senior year in high abstinence violation effect school and being sent back to first grade as a result! Hopefully, one does not lose all the knowledge and experience gained along the journey. Mark’s key responsibilities include handling day-to-day maintenance matters and oversees our Environment of Care management plan in conjunction with Joint Commission and DCF regulations.
(b) Restrained eaters whose diets were broken by a milkshake preload showed increased activity in the nucleus accumbens (NAcc) compared to restrained eaters who did not consume the preload and satiated non-dieters . As AVE is a form of all-or-nothing thinking, some may argue that it is a person’s outlook, not abstinence itself, that is harmful. But in cases in which a person is prone to this cognitive distortion, abstinence may not be the healthiest approach to take. Abstinence from sex is the most reliable way to avoid sexually transmitted infections and pregnancy. Many high schools and religious programs in the United States teach abstinence-only sex education, advocating for abstaining from sex until marriage.
- And the approaches can encompass both behavioral strategies—it is sometimes wisest to just walk away from a challenging situation or to call on one’s support network—and cognitive ones, such as distancing oneself from one’s thoughts unil h dure to use dissipates.
- We summarize historical factors relevant to non-abstinence treatment development to illuminate reasons these approaches are understudied.
- While a person may physically abstain from using drugs or alcohol, their thoughts and emotions may have already returned to substance abuse.
- Cognitions—specifically, thoughts and expectations about drinking behavior and sobriety—contribute importantly to the process of relapse.