Abstinence Violation Effect AVE What It Is & Relapse Prevention Strategies

Lapse-management strategies focus on halting the lapse and combating the abstinence violation effect to prevent an uncontrolled relapse episode. Lapse management includes contracting with the client to limit the extent of use, to contact the therapist as soon as possible after the lapse, and to evaluate the situation for clues to the factors that triggered the lapse. Often, the therapist provides the client with simple written instructions to refer to in the event of a lapse. These instructions reiterate the importance of stopping alcohol consumption and (safely) leaving the lapse-inducing situation. Lapse management is presented to clients as an “emergency preparedness” kit for their “journey” to abstinence.

The reformulated cognitive-behavioral model of relapse

Instead of continuing with recovery, AVE refers to relapsing heavily after a single violation. Results of a preliminary nonrandomized trial supported the potential utility of MBRP for reducing substance use. In this study incarcerated individuals were offered the chance to participate in an intensive 10-day course in Vipassana meditation (VM). Those participating in VM were compared to a treatment as usual (TAU) group on measures of post-incarceration substance use and psychosocial functioning. Relative to the TAU group, the VM group reported significantly lower levels of substance use and alcohol-related consequences and improved psychosocial functioning at follow-up [116]. A key contribution of the reformulated relapse model is to highlight the need for non-traditional assessment and analytic approaches to better understand relapse.

• In contrast to the former group of people, the latter group realizes that one needs to “learn from one’s mistakes” and, thus, they may develop more effective ways to cope with similar trigger situations in the future.
• Therapy not only gives people insight into their vulnerabilities but teaches them  healthy tools for handling emotional distress.
• Based on the classification of relapse determinants and high-risk situations proposed in the RP model, numerous treatment components have been developed that are aimed at helping the recovering alcoholic cope with high-risk situations.
• AVE also involves cognitive dissonance, a distressing experience people go through when their internal thoughts, beliefs, actions, or identities are put in conflict with one another.

Relapse road maps

Taylor uses an app to watch her intake of calorie limit and does see positive outcomes to her new lifestyle. 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. Explore the benefits of an individualized treatment plan for addiction counseling and why it’s a https://ecosoberhouse.com/ game-changer on the path to recovery. Getting through the holidays while maintaining recovery, especially for people newer to this life-changing process, is an accomplishment worthy of celebration in its own right. Distraction is a time-honored way of interrupting unpleasant thoughts of any kind, and particularly valuable for derailing thoughts of using before they reach maximum intensity.

Continued empirical evaluation of the RP model

To date, however, there has been little empirical research directly testing this hypothesis. Advocates of nonabstinence approaches often point to indirect evidence, including research examining reasons people with SUD do and do not enter treatment. This literature – most of which has been conducted in the U.S. – suggests a strong link between abstinence goals and treatment entry. For example, in one study testing the abstinence violation effect predictive validity of a measure of treatment readiness among non-treatment-seeking people who use drugs, the authors found that the only item in their measure that significantly predicted future treatment entry was motivation to quit using (Neff & Zule, 2002). The study was especially notable because most other treatment readiness measures have been validated on treatment-seeking samples (see Freyer et al., 2004).

• They see setbacks as failures because the accompanying disappointment sets off cascades of negative thinking and feeling, on top of the guilt and shame that most already feel about having succumbed to addiction.
• 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.
• About 26% of all U.S. treatment episodes end by individuals leaving the treatment program prior to treatment completion (SAMHSA, 2019b).
• Furthermore, 12-step programs often celebrate abstinence milestones and encourage participants to count abstinent days, leading to a perception that someone who resumes substance use is “going back to the beginning” and has not made progress in recovery.

Recovery is an opportunity for creating a life that is more fulfilling than what came before. Attention should focus on renewing old interests or developing new interests, changing negative thinking patterns, and developing new routines and friendship groups that were not linked to substance use. The belief that addiction is a disease can make people feel hopeless about changing behavior and powerless to do so. Seeing addiction instead as a deeply ingrained and self-perpetuating habit that was learned and can be unlearned doesn’t mean it is easy to recover from addiction—but that it is possible, and people do it every day. It is in accord with the evidence that the longer a person goes without using, the weaker the desire to use becomes. Note that these script ideas were pulled from a UN training on cognitive behavioral therapy that is available online.

Financial support and sponsorship

Nevertheless, the study provides relatively good support for other aspects of the RP model. For example, Miller and colleagues (1996) found that although mere exposure to specific high-risk situations did not predict relapse, the manner in which people coped with those situations strongly predicted subsequent relapse or continued abstinence. Furthermore, in that study the majority of relapse episodes after treatment occurred during situations involving negative emotional states, a finding that has been replicated in other studies (Cooney et al. 1997; McKay 1999; Shiffman 1992). Finally, the results of Miller and colleagues (1996) support the role of the abstinence violation effect in predicting which participants would experience a full-blown relapse following an initial lapse. Specifically, those participants who had a greater belief in the disease model of alcoholism and a higher commitment to absolute abstinence (who were most likely to experience feelings of guilt over their lapse) were most likely to experience relapse in that study.

Critiques of the RP Model

Outcome Studies for Relapse Prevention