Abstinence Violation Effect AVE What It Is & Relapse Prevention Strategies

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 129 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. Findings concerning possible genetic moderators of response to acamprosate have been reported 99, but are preliminary. Additionally, other findings suggest the influence of a DRD4 variable number of tandem repeats (VNTR) polymorphism on response to olanzapine, a dopamine antagonist that has been studied as an experimental treatment for alcohol problems. Olanzapine was found to reduce alcohol-related craving those with the long-repeat VNTR (DRD4 L), but not individuals with the short-repeat version (DRD4 S; 100,101).

False Sense of Control – One Drink Won’t Hurt

• 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).
• Unfortunately, there has been little empirical research evaluating this approach among individuals with DUD; evidence of effectiveness comes primarily from observational research.
• While a lapse might prompt a full-blown relapse, another possible outcome is that the problem behavior is corrected and the desired behavior re-instantiated–an event referred to as prolapse.
• Related work has also stressed the importance of baseline levels of neurocognitive functioning (for example as measured by tasks assessing response inhibition and working memory; 56) as predicting the likelihood of drug use in response to environmental cues.
• Additionally, in the United Kingdom, where there is greater access to nonabstinence treatment (Rosenberg & Melville, 2005; Rosenberg & Phillips, 2003), the proportion of individuals with opioid use disorder engaged in treatment is more than twice that of the U.S. (60% vs. 28%; Burkinshaw et al., 2017).
• Shiffman and colleagues 68 found that restorative coping following a smoking lapse decreased the likelihood of a second lapse the same day.
• Relapse prevention includes understanding what triggers substance abuse, which varies from person to person.

Finally, an intriguing direction is to evaluate whether providing clients with personalized genetic information can facilitate reductions in substance use or improve treatment adherence 110,111. A key feature of the dynamic model is its emphasis on the complex interplay between tonic and phasic processes. As indicated in Figure 2, distal risks may influence relapse either directly or indirectly (via what is alcoholism phasic processes). For instance, the return to substance use can have reciprocal effects on the same cognitive or affective factors (motivation, mood, self-efficacy) that contributed to the lapse. Lapses may also evoke physiological (e.g., alleviation of withdrawal) and/or cognitive (e.g., the AVE) responses that in turn determine whether use escalates or desists. The dynamic model further emphasizes the importance of nonlinear relationships and timing/sequencing of events.

Normalize Relapse

Still, you should also realize that relapse isn’t guaranteed, especially if you stay vigilant in managing your continued recovery. There may be an internal conflict between resisting thoughts about drugs and compulsions to use them. There is a possibility that you might rationalize why you might not experience the same consequences if you continue to use. Nevertheless, 40 to 60% of people who once were addicted to a substance and achieved sobriety relapse at some point, based on estimates from the National Institute on Drug Abuse (NIDA).

How The Abstinence Violation Effect Impacts Long-Term Recovery

AVE also involves cognitive dissonance, a distressing experience people go through when their internal thoughts, beliefs, actions, or identities are put in conflict with abstinence violation effect one another.

• Because the scope of this literature precludes an exhaustive review, we highlight select findings that are relevant to the main tenets of the RP model, in particular those that coincide with predictions of the reformulated model of relapse.
• We also take the perspective that relapse is best conceptualized as a dynamic, ongoing process rather than a discrete or terminal event (e.g., 1,8,10).
• Conversely, a return to the target behavior can undermine self-efficacy, increasing the risk of future lapses.
• In this study incarcerated individuals were offered the chance to participate in an intensive 10-day course in Vipassana meditation (VM).
• Advocates of nonabstinence approaches often point to indirect evidence, including research examining reasons people with SUD do and do not enter treatment.

Second, the likelihood of abstinence following a behavioral or pharmacological intervention can be moderated by genetic influences on metabolic processes, receptor activity/expression, and/or incentive value specific to the addictive substance in question. Third, variants implicated in broad traits relevant for addictive behaviors–for instance, executive cognitive functioning (e.g., COMT) or externalizing traits (e.g., GABRA2, DRD4)–could influence relapse proneness via general neurobehavioral mechanisms, irrespective of drug class or treatment modality. Some researchers propose that the self-control required to maintain behavior change strains motivational resources, and that this “fatigue” can undermine subsequent self-control efforts 78. Consistent with this idea, EMA studies have shown that social drinkers report greater alcohol consumption and violations of self-imposed drinking limits on days when self-control demands are high 79.

1. Nonabstinence psychosocial treatment models

By providing comprehensive care, our treatment programs create a supportive environment in which our clients can build a solid foundation for lasting sobriety. Learning healthy coping mechanisms can help you manage stress, cravings, and triggers without resorting to substance use. Feelings of guilt, shame, and self-blame may lead people to question their ability to overcome addiction and exacerbate underlying issues of low self-esteem. Overall, the Abstinence Violation Effect is a complex phenomenon influenced by a combination of cognitive, emotional, and biological factors. Taylor may think, “All that good work down the drain, I am never going to be able to keep this up for my life.” Like Jim, this may also trigger a negative mindset and a return to unhealthy eating and a lack of physical exercise.