13 Oct Abstinence Violation Effect AVE
His wife brought him for treatment and he was not keen on taking help He did not believe it was a problem (stage of change). He believed that drinking helped him across many domains of life (positive outcome expectancies regarding alcohol use and its effects, stage of change). Early learning theories and later social cognitive and cognitive theories have had a significant influence on the formulation CBT for addictive behaviours. Theoretical constructs such as self-efficacy, appraisal, outcome expectancies related to addictions arising out these models have impacted treatment models considerably. 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.
Nevertheless, the first and most important thing to know is that all hope is not lost. Relapse triggers a sense of failure, shame, and a slew of other negative feelings. It’s fine to acknowledge them, but not to dwell on them, because they could hinder the most important action to take immediately—seeking help.
Abstinence Violation Effect (AVE)
It was at these meetings that he finally decided that he was an alcoholic and that he needed to stop drinking. After six successful months of recovery, Joe believed he was well on his way to being sober for life; however, one evening, he got into a major argument with his wife regarding her relationship with another man. He was hoping that he could get back together with her, but realized that this was impossible. If you’re like me, you may have recently watched the Netflix show, Cheer, and thought, “I’ve got to start working out more…” But surely that isn’t the first time you’ve told yourself that. From New Year’s resolutions to the start of a new school year in September, we seem to be obsessed with clean, fresh starts where we can completely transform ourselves and our habits. However, this mentality may be just the thing that keeps us from achieving our goals.
A recent qualitative study found that concern about missing substances was significantly correlated with not completing treatment (Zemore, Ware, Gilbert, & Pinedo, 2021). Unfortunately, few quantitative, survey-based studies have included substance use during treatment as a potential reason for treatment noncompletion, representing a significant gap in this body of literature (for a review, see Brorson, Ajo Arnevik, Rand-Hendriksen, & Duckert, https://ecosoberhouse.com/ 2013). Additionally, no studies identified in this review compared reasons for not completing treatment between abstinence-focused and nonabstinence treatment. Mindfulness based interventions or third wave therapies have shown promise in addressing specific aspects of addictive behaviours such as craving, negative affect, impulsivity, distress tolerance. These interventions integrate both cognitive behavioural and mindfulness based strategies.
In RP client and therapist are equal partners and the client is encouraged to actively contribute solutions for the problem. Client is taught that overcoming the problem behaviour is not about will power rather abstinence violation effect it has to do with skills acquisition. Another technique is that the road to abstinence is broken down to smaller achievable targets so that client can easily master the task enhancing self-efficacy.
The article provides an overview of cognitive behavioural approaches to managing addictions. Unfortunately, there has been little empirical research evaluating this approach among individuals with DUD; evidence of effectiveness comes primarily from observational research. The current review highlights a notable gap in research empirically evaluating the effectiveness of nonabstinence approaches for DUD treatment. While multiple harm reduction-focused treatments for AUD have strong empirical support, there is very little research testing models of nonabstinence treatment for drug use.
A Lapse Vs. A Relapse
To date there has been limited research on retention rates in nonabstinence 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. Self-efficacy is defined as the degree to which an individual feels confident and capable of performing certain behaviour in a specific situational context5.
- A significant proportion (40–80%) of patients receiving treatment for alcohol use disorders have at least one drink, a “lapse,” within the first year of after treatment, whereas around 20% of patients return to pre-treatment levels of alcohol use3.
- Positive social support is highly predictive of long-term abstinence rates across several addictive behaviours.
- If you are an alcoholic in early recovery, is it safe to take a cruise where alcohol will be all around you?
- 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.
The RP model has been studied among individuals with both AUD and DUD (especially Cocaine Use Disorder, e.g., Carroll, Rounsaville, & Gawin, 1991); with the largest effect sizes identified in the treatment of AUD (Irvin, Bowers, Dunn, & Wang, 1999). As a newer iteration of RP, Mindfulness-Based Relapse Prevention (MBRP) has a less extensive research base, though it has been tested in samples with a range of SUDs (e.g., Bowen et al., 2009; Bowen et al., 2014; Witkiewitz et al., 2014). 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.