The Abstinence Violation Effect and Overcoming It

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). A more recent development in the area of managing addictive behaviours is the application of the construct of mindfulness to managing experiences related to craving, negative affect and other emotional states that are believed to impact the process of relapse34. Relapse is a process in which a newly abstinent patient experiences a sense of perceived control over his/her behaviour up to a point at which there is a high risk situation and for which the person may not have adequate skills or a sense of self-efficacy.

For Jim and Taylor, this might involve acknowledging the months of sobriety and healthier lifestyle choices and understanding that a single incident does not erase that progress. There are no specific time frames within which a person navigates through the stages, and may also remain at stage for a long time before moving forwards or backwards (for example a person may remain in the stage of contemplation or preparation for years without moving on to action). RP has also been used in eating disorders in combination with other interventions such as CBT and problem-solving skills4. 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. Rajiv’s unsuccessful attempts at abstinence lead to a low sense of self-confidence and a belief that he would not be able help himself (low perceived self- efficacy) setting up a vicious cycle. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Overcoming the Abstinence Violation Effect:

Substance use and its immediate consequences (e.g., impaired decision-making, the AVE) are additional phasic processes that are set into motion once a lapse occurs. Thus, whereas tonic processes can determine who is vulnerable for relapse, phasic processes determine when relapse occurs [8,31]. 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 https://ecosoberhouse.com/ future relapse prevention interventions. We therefore aimed to identify predictors of relapse in physical activity and dietary behavior, from the perspective of health practitioners who coach individuals during their weight loss process and the perspective of individuals who have experienced relapses themselves. In addition, we aimed to identify possible new predictors of relapse in physical activity and dietary behavior beyond existing knowledge, using concept mapping.

• This suggests that treatment experiences and therapist input can influence participant goals over time, and there is value in engaging patients with non-abstinence goals in treatment.
• The assumption of RP is that it is problematic to expect that the effects of a treatment that is designed to moderate or eliminate an undesirable behaviour will endure beyond the termination of that treatment.
• In 1988 legislation was passed prohibiting the use of federal funds to support syringe access, a policy which remained in effect until 2015 even as numerous studies demonstrated the effectiveness of SSPs in reducing disease transmission (Showalter, 2018; Vlahov et al., 2001).
• Ultimately, individuals who are struggling with behavior change often find that making the initial change is not as difficult as maintaining behavior changes over time.
• Despite significant empirical support for nonabstinence alcohol interventions, there is a clear gap in research examining nonabstinence psychosocial treatment for drug use disorders.
• For example, at a large outpatient SUD treatment center in Amsterdam, goal-aligned treatment for drug and alcohol use involves a version of harm reduction psychotherapy that integrates MI and CBT approaches, and focuses on motivational enhancement, self-control training, and relapse prevention (Schippers & Nelissen, 2006).

His therapist identified strategies to enhance his motivation, to help him engage in therapy, deal with craving, reducing social anxiety, assertiveness and beliefs and positive expectancies about alcohol use, and confidence or sense of self-efficacy in remaining abstinent. The wife was involved in therapy, to support his abstinence and help him engage in alternate activities. Rajiv’s problem is an illustration of how various psychological, environmental and situational factors are involved in the acquisition and maintenance of substance use.

Treatment strategies in the relapse prevention

As noted by the authors, the CBT studies evaluated in their review were based primarily on the RP model [29]. Overall, the results were consistent with the review conducted by Irvin and colleagues, in that the authors concluded that 58% of individuals who received CBT had better outcomes than those in comparison conditions. In contrast with the findings of Irvin and colleagues [36], Magill and Ray [41] found that CBT was most effective for individuals with marijuana use disorders. abstinence violation effect Another factor that may occur is the Problem of Immediate Gratification where the client settles for shorter positive outcomes and does not consider larger long term adverse consequences when they lapse. This can be worked on by creating a decisional matrix where the pros and cons of continuing the behaviour versus abstaining are written down within both shorter and longer time frames and the therapist helps the client to identify unrealistic outcome expectancies5.

The research team discussed whether fewer or more clusters would represent participants’ statements better, by evaluating the coherence between statements in each cluster. After defining the final number of clusters, each statement within a cluster was evaluated and allocated to a perceived predictor (e.g. the statement ‘lack of motivation’ was allocated to the perceived predictor ‘motivation’). Subsequently, the research team named all clusters, thereby keeping the names given by the participants in consideration. Within the groups, each cluster represented multiple perceived predictors; this made it impossible to do a group comparison on cluster level.

Health practitioners

Elucidating the “active ingredients” of CBT treatments remains an important and challenging goal, Also, integration of neurocognitive parameters in relapse models as well as neural (such as functional circuitry involved in relapse) and genetic markers of relapse will be major challenges moving ahead19. Shiffman and colleagues describe stress coping where substance use is viewed as a coping response to life stress that can function to reduce negative affect or increase positive affect. They assume a distinction between stress coping skills, which are responses intended to deal with general life stress, and temptation coping skills, which are coping responses specific to situations in which there are temptations for substance which could contribute to relapse13.