What Is The Abstinence Violation Effect AVE?

All the individual matrices were then transformed into one matrix representing all the individuals in that subgroup. This matrix was used as input for the Principal Component Analysis (PCA), which translated the distance (i.e. correlations) between statements into coordinates in a multi-dimensional space (Sleddens et al., 2015). The statements were further classified by completing a cluster analysis with the coordinates of the statements.

Links to NCBI Databases

Rather than undermining self-efficacy after a lapse, results indicate that longer periods of pre-lapse abstinence potentiated the effect of self-efficacy in protecting against subsequent progression. In such instances, the individual’s feeling of confidence may be better grounded in real experience; i.e., their ability to maintain abstinence for a longer time before the lapse event. In contrast, high self-efficacy following a very short period of abstinence may be less realistic and more brittle in the face of challenge, and hence have a weaker association with subsequent behavior. Parametric survival analyses that allowed for recurrent events within-subjects treated each lapse episode as the beginning of an interval during which the participant was at risk for having another lapse, and examined how AVE responses to each lapse affected the likelihood of progression. Survival analysis assesses risk for an event by analyzing the incidence of the event over a specified period of time, referred to as the event’s hazard.

Future research

• Perspectives from these key stakeholders could provide new and important insights from daily practice on predictors of relapse in weight loss maintenance behaviors, which can inform future relapse prevention interventions.
• If the reason for the violation is attributed to internal, stable, and/or global factors, such as lack of willpower or possession of an underlying disease, then the individual is more likely to have a full-blown relapse after the initial violation occurs.
• The analysis was based on data from a randomized, double-blind, placebo-controlled clinical trial of high-dose nicotine patch for smoking cessation.
• The overarching goal of the present research was to examine the way psychological responses to lapses influenced quitters’ ability to maintain abstinence.
• Ecological momentary assessment, either via electronic device or interactive voice response methodology, could provide the data necessary to fully test the dynamic model of relapse19.
• Any smoking after initial cessation, ranging from a single puff to multiple cigarettes, can be considered a lapse (Brownell et al., 1986; Shiffman et al., 1986).

For example, in this study self-value and resilience received high importance ratings, but these are not reflected in current models. We believe a theoretical framework based on the latest insights would be of added value to the field of relapse prevention and can inform future weight loss maintenance interventions. To the extent that the AVE is bound to a series of recurrent lapses, the timing, frequency and severity of each lapse should also synergistically influence AVE dynamics and lapse progression.

Factors That Contribute To The Abstinence Violation Effect

Self-efficacy is defined as the degree to which an individual feels confident and capable of performing certain behaviour in a specific situational context5. The RP model proposes that at the cessation of a habit, a client feels self-efficacious with regard to the unwanted behaviour and that this perception of self-efficacy stems from learned and practiced skills3. In a prospective study among both men and women being treated for alcohol dependence using the Situational Confidence Questionnaire, higher self-efficacy scores were correlated to a longer interval for relapse to alcohol use8. The relationship between self-efficacy and relapse is possibly bidirectional, meaning that individuals who are more successful report greater self-efficacy and individuals who have lapsed report lower self-efficacy4.

Furthermore, the use of FDA-approved medications (which not all clients will view as “abstinence”) has been shown to produce the best health and recovery outcomes for people with opioid use disorders. Although there may be practical reasons for your client to choose abstinence as a goal (e.g., being on probation), it is inaccurate to characterize abstinence-based recovery as the only path to wellness. When abstinence is violated, individuals typically also have an emotional response consisting of guilt, shame, hopelessness, loss of control, and/or a sense of failure; they may use drugs or alcohol in an attempt to cope with the negative feelings that resulted from their abstinence violation. A person may experience a particularly stressful emotional event in their lives and may turn to alcohol and/or drugs to cope with these negative emotions.

AVE in the Context of the Relapse Process

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 abstinence violation effect 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.

Specific Intervention strategies in Relapse Prevention

Outcomes in which relapse prevention may hold particular promise include reducing severity of relapses, enhanced durability of effects, and particularly for patients at higher levels of impairment along dimensions such as psychopathology or dependence severity21. The strengths of the study lie in its use of near-real-time EMA reports of AVE responses, recorded soon after each lapse, and the ability to use a stream of EMA reports over many lapses to characterize the prospective influence of AVE responses on progression to subsequent lapses. No study conducted to date has leveraged this methodology to empirically examine the AVE as a cascading phenomenon that affects lapse progression during the smoking cessation process. The role of pre-lapse abstinence appears to be more subtle, interacting with AVE responses in a way that influences progression to additional lapses.

The treatment is not lapse prevention; lapses are to be expected, planned for, and taken as opportunities for the client to demonstrate learning. Most often, relapse tends to be construed as a return to pretreatment levels of occurrence of the targeted behavior. Although there is some debate about the best definitions of lapse and relapse from theoretical and conceptual levels, these definitions should suffice. 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. It occurs when the client perceives no intermediary step between a lapse and relapse i.e. since they have violated the rule of abstinence, “they may get most out” of the lapse5.