Abstinence Violation Effect: How Does Relapse Impact Recovery?

Counteracting the drinker’s misperceptions about alcohol’s effects is an important part of relapse prevention. To accomplish this goal, the therapist first elicits the client’s positive expectations about alcohol’s effects using either standardized questionnaires or clinical interviews. Positive expectancies regarding alcohol’s effects often are based on myths or placebo effects of alcohol (i.e., effects that occur because the drinker expects them to, not because alcohol causes the appropriate physiological changes). In particular, considerable research has demonstrated that alcohol’s perceived positive effects on social behavior are often mediated by placebo effects, resulting from both expectations (i.e., “set”) and the environment (i.e., “setting”) in which drinking takes place (Marlatt and Rohsenow 1981). Subsequently, the therapist can address each expectancy, using cognitive restructuring (which is discussed later in this section) and education about research findings. The therapist also can use examples from the client’s own experience to dispel myths and encourage the client to consider both the immediate and the delayed consequences of drinking.

• Future research must test the effectiveness of nonabstinence treatments for drug use and address barriers to implementation.
• It is for this reason that someone’s tolerance declines following a period of abstinence and that they may overdose if they start using again at the same level as before.
• Understanding and addressing the abstinence violation effect is crucial in helping individuals break free from harmful behaviors and maintain long-term recovery.
• Become familiar with and advocate for needed recovery services and social services not available in the community.

Normalize Relapse

Addiction and related disorders are chronic lapsing and relapsing disorders where the combination of long term pharmacological and psychosocial managements are the mainstay approaches of management. Among the psychosocial interventions, the Relapse Prevention (RP), cognitive-behavioural approach, is a strategy for reducing the likelihood and severity of relapse following the cessation or reduction of problematic behaviours. 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 term “abstinence violation effect” refers to the emotional response experienced by individuals who have relapsed after committing to abstain from a certain behavior, such as substance abuse or unhealthy eating habits. This effect often involves feelings of guilt, shame, and self-blame, which can further perpetuate the cycle of relapse.

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Clinicians in relapse prevention programs and the field of clinical psychology as a whole point out that relapse occurs only after a long-term pattern of specific feelings, thoughts, and behavior. Triggers include cravings, problematic thought patterns, and external cues or situations, all of which can contribute to increased self-efficacy (a sense of personal confidence, identity, and control) when properly managed. This can include abstinence from substance abuse, overeating, gambling, smoking, or other behaviors a person has been working to avoid. By implementing certain strategies, people can develop resilience, self-compassion, and adaptive coping skills to counteract the effects of the AVE and maintain lifelong sobriety. The Abstinence Violation Effect is a psychological phenomenon that occurs when a person experiences relapse after attempting to abstain from drug or alcohol use.

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Collaboration with other providers from multiple disciplines who have a recovery-oriented approach to care. Opportunities to have better coordination with clients’ other providers, thereby promoting continuing, holistic care. Limited research has looked at the effects of intersecting identities on SUD treatment.513 More is known about the associations between intersecting identities and substance use, information that is useful for counselors. Lack of specialized programs for people with co-occurring conditions, including individualized treatment plans that account for diverse literacy or cognitive capabilities. Maintain communication with recovery resource partners (e.g., if a counselor links a client Sober living house to peer support services, the counselor should be available to the peer provider for consultation and feedback on how the client is doing).

To increase the likelihood that a client can and will utilize his or her skills when the need arises, the therapist can use approaches such as role plays and the development and modeling of specific coping plans for managing potential high-risk situations. SAMHSA recognizes that counselors in healthcare and behavioral health services must work within the realities and constraints of the payment systems that reimburse or fund their services. Variations in insurance plans and reimbursement rates and limitations on certain services can potentially act as barriers to receiving payment or make the payment process labor intensive and difficult, affecting the delivery of care. Being aware of these potential roadblocks can help providers who want to implement or increase recovery-oriented services plan and deliver care that not only meets the needs of the client but also can be reliably funded or paid for. Implicit bias is a prejudice or bias outside one’s conscious awareness that can lead to a negative evaluation of a person based on such characteristics as race or gender. Counselors should then use this self-awareness to address their biases and provide inclusive care.

• Counselors can also help clients identify goals and objectives that will help them avoid a recurrence.
• Of note, other SUD treatment approaches that could be adapted to target nonabstinence goals (e.g., contingency management, behavioral activation) are excluded from the current review due to lack of relevant empirical evidence.
• By 1989, treatment center referrals accounted for 40% of new AA memberships (Mäkelä et al., 1996).
• This reaction focuses on the drinker’s emotional response to an initial lapse and on the causes to which he or she attributes the lapse.
• This paper presents a narrative review of the literature and a call for increased research attention on the development of empirically supported nonabstinence treatments for SUD to engage and treat more people with SUD.

If the person succumbs the abstinence violation effect refers to to the urge and violates their self-imposed rule, the Abstinence Violation Effect is activated. Cognitive restructuring can be used to tackle cognitive errors such as the abstinence violation effect. Clients are taught to reframe their perception of lapses, to view them not as failures but as key learning opportunities resulting from an interaction between various relapse determinants, both of which can be modified in the future. Lapse management includes drawing a contract with the client to limit use, to contact the therapist as soon as possible, and to evaluate the situation for factors that triggered the lapse6.

• Collaboration with other providers from multiple disciplines who have a recovery-oriented approach to care.
• Many clients may never need to use their lapse-management plan, but adequate preparation can greatly lessen the harm if a lapse does occur.
• A study published by Hunt and colleagues demonstrated that nicotine, heroin, and alcohol produced highly similar rates of relapse over a one-year period, in the range of 80-95%2.
• About 10% of individuals who report cannabis use in the past year meet criteria for a cannabis use disorder, while this proportion increases to 18%, 19%, 58%, and 65% of those with past year use of cocaine, opioids (misuse), methamphetamine, and heroin, respectively.
• Harm reduction therapy has also been applied in group format, mirroring the approach and components of individual harm reduction psychotherapy but with added focus on building social support and receiving feedback and advice from peers (Little, 2006; Little & Franskoviak, 2010).

Thus, this perspective considers only a dichotomous treatment outcome—that is, a person is either abstinent or relapsed. In contrast, several models of relapse that are based on social-cognitive or behavioral theories emphasize relapse as a transitional process, a series of events that unfold over time (Annis 1986; Litman et al. 1979; Marlatt and Gordon 1985). According to these models, the relapse process begins prior to the first posttreatment alcohol use and continues after the initial use. This conceptualization provides a broader conceptual framework for intervening in the relapse process to prevent or reduce relapse episodes and thereby improve treatment outcome. 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).

• Relapse Prevention (RP) is another well-studied model used in both AUD and DUD treatment (Marlatt & Gordon, 1985).
• Early attempts to establish pilot SSPs were met with public outcry and were blocked by politicians (Anderson, 1991).
• Thirty-two states now have legally authorized SSPs, a number which has doubled since 2014 (Fernández-Viña et al., 2020).
• It is, however, most commonly used to refer to a resumption of substance use behavior after a period of abstinence from substances (Miller 1996).
• It involves the degree of balance in the person’s life between perceived external demands and internally fulfilling or enjoyable activities.
• This reframing of lapse episodes can help decrease the clients’ tendency to view lapses as the result of a personal failing or moral weakness and remove the self-fulfilling prophecy that a lapse will inevitably lead to relapse.

Further, the more non-drinking friends a person with an AUD has, the better outcomes tend to be. Negative social support in the form of interpersonal conflict and social pressure to use substances has been related to an increased risk for relapse. Social pressure may be experienced directly, such as peers trying to convince a person to use, or indirectly through modelling (e.g. a friend ordering a drink at dinner) and/or cue exposure.