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). 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. 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).
Who might experience the AVE?
Typically among those mechanisms are negative emotional states like shame, misunderstanding, and blame. People may sometimes feel that relapse is an indication of an inherent flaw or an entirely uncontrollable aspect of their disease, causing them to experience cognitive dissonance and feel ashamed, hopeless, or unable to combat relapse. It became the work of the individuals who identified the abstinence violation effect to mitigate the negative impacts of this flawed thought process through cognitive therapy and encourage healthier coping mechanisms in those who are in the process of recovery by adjusting outcome expectancies. Despite the growth of the harm reduction movement globally, research and implementation of nonabstinence treatment in the U.S. has lagged. Furthermore, abstinence remains a gold standard treatment outcome in pharmacotherapy research for drug use disorders, even after numerous calls for alternative metrics of success (Volkow, 2020).
Mental health professionals work to counter these flawed thought patterns through cognitive therapy and promote healthier coping mechanisms by adjusting outcome expectations. While there have been calls for abstinence-focused treatment settings to relax punitive policies around substance use during treatment (Marlatt et al., 2001; White et al., 2005), there may also be specific benefits provided by nonabstinence treatment in retaining individuals who continue to use (or return to use) during treatment. For example, offering nonabstinence treatment may provide a clearer path forward for those who are ambivalent about or unable to achieve abstinence, while such individuals would be more likely to drop out of abstinence-focused treatment. 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. AA was established in 1935 as a the abstinence violation effect refers to nonprofessional mutual aid group for people who desire abstinence from alcohol, and its 12 Steps became integrated in SUD treatment programs in the 1940s and 1950s with the emergence of the Minnesota Model of treatment (White & Kurtz, 2008).
5. Feasibility of nonabstinence goals
It often takes the form of a binge following a lapse in sobriety from alcohol or drugs, but it can also occur in other contexts. For example, someone who has been on a diet might have a small slip-up and then binge on unhealthy foods. Similarly, someone trying to quit smoking might smoke a whole pack of cigarettes after just having one. When a lapse or relapse has occurs, seeking appropriate mental health support from a qualified professional can be a helpful first step toward resuming your journey on the road to recovery and decreasing the likelihood of repeated lapses. This is at least partly because relapses may signify gaps in the coping and recovering process that might have been there to begin with.
Getting support for substance use disorders and/or relapses
A number of studies have examined psychosocial risk reduction interventions for individuals with high-risk drug use, especially people who inject drugs. In contrast to the holistic approach of harm reduction psychotherapy, risk reduction interventions are generally designed to target specific HIV risk behaviors (e.g., injection or sexual risk behaviors) without directly addressing mechanisms of SUD, and thus are quite limited in scope. However, these interventions also typically lack an abstinence focus and sometimes result in reductions in drug use. The past 20 years has seen growing acceptance of harm reduction, evidenced in U.S. public health policy as well as SUD treatment research. Thirty-two states now have legally authorized SSPs, a number which has doubled since 2014 (Fernández-Viña et al., 2020).
Examples might include someone who has been managing anxiety symptoms well suddenly abandoning all their coping techniques after one panic attack, or someone who maintained sobriety for months returning to substance use patterns after a single lapse. That said, the effectiveness of abstinence can depend on the person’s own self-efficacy, their reason for abstaining, their support system, and various other factors. Oxford English Dictionary defines motivation as “the conscious or unconscious stimulus for action towards a desired goal provided by psychological or social factors; that which gives purpose or direction to behaviour. Motivation may relate to the relapse process in two distinct ways, the motivation for positive behaviour change and the motivation to engage in the problematic behaviour. This illustrates the issue of ambivalence experienced by many patients attempting to change an addictive behaviour. However, it can sometimes lead to the thought that you have earned a drink or a night of using drugs.
Counselors should engage clients in this exploration with compassion and understanding, while encouraging them to learn from the experience so that they can identify new coping strategies. Our telehealth https://heizhaus-gebesee.de/wordpress/?p=2187 platform makes it convenient to connect with mental health professionals who understand that recovery isn’t linear. Through secure video sessions, we provide personalized support that acknowledges your individual circumstances and helps you develop resilience in the face of challenges. For behaviors that carry health risks, like smoking or drug use, abstinence can also be an effective way to improve health outcomes. Abstinence can be considered a decision to avoid behaviors that are risky in and of themselves, like using drugs. That said, abstinence can also come from a desire to avoid a potential high-risk situation later on.
- A relapse is the result of a series of events that occur over time, according to psychologist and researcher Alan Marlatt, Ph.D.
- An essential part of this process involves developing self-awareness and understanding what triggers certain thoughts, emotions, or behaviors.
- In 1990, Marlatt was introduced to the philosophy of harm reduction during a trip to the Netherlands (Marlatt, 1998).
- Additionally, individuals are most likely to achieve the outcomes that are consistent with their goals (i.e., moderation vs. abstinence), based on studies of both controlled drinking and drug use (Adamson, Heather, Morton, & Raistrick, 2010; Booth, Dale, & Ansari, 1984; Lozano et al., 2006; Schippers & Nelissen, 2006).
- 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.
2. Controlled drinking
Along with the client, the therapist needs to explore past circumstances and triggers of relapse. Also, the client is asked to keep a current record where s/he can self-monitor thoughts, emotions or behaviours prior to a binge. One is to help clients identify warning signs such as on-going stress, seemingly irrelevant decisions and significant positive outcome expectancies with the substance so that they can avoid the high-risk situation. The second is assessing coping skills of the client and imparting general skills such as relaxation, meditation or positive self-talk or dealing with the situation using drink refusal skills in social contexts when under peer pressure through assertive communication6.
Treatment Programs
In realistic, healthy approaches to recovery, setbacks are acknowledged as possibilities, and strategies are developed to minimize their impact. An essential part of this process involves developing self-awareness and understanding what triggers certain thoughts, emotions, or Sober living home behaviors. If you were initially treated for an addiction disorder, that therapist can provide additional help. Some people feel more comfortable or supported by meeting with this type of professional in person.
1. Nonabstinence treatment effectiveness
Marlatt differentiates between slipping into abstinence for the first time and totally abandoning the goal. Altogether, these thoughts and attributions are frequently driven by strong feelings of personal failure, defeat, and shame. These negative emotions are, unfortunately, often temporarily placated by a renewed pattern of substance abuse. Lapses are, however, a major risk factor for relapse as well as overdose and other potential social, personal, and legal consequences of drug or alcohol abuse. For example, Joe thinks he started smoking after his third quit attempt because he lacks willpower.