Abstinence Violation Effect: How Does Relapse Impact Recovery?

It is, however, most commonly used to refer to a resumption of substance-use behavior after a period of abstinence from substances (Miller, 1996). The term relapse may be used to describe a prolonged return to substance use, whereas lapsemay be used to describe discrete,… There has been little research on the goals of non-treatment-seeking individuals; however, research suggests that nonabstinence goals are common even among individuals presenting to SUD treatment. Among those seeking treatment for alcohol use disorder (AUD), studies with large samples have cited rates of nonabstinence goals ranging from 17% (Berglund et al., 2019) to 87% (Enggasser et al., 2015).

• Relapse Prevention (RP) is another well-studied model used in both AUD and DUD treatment (Marlatt & Gordon, 1985).
• Positive memories of drinking, paired with the minimized recollection of negative consequences, lead to unrealistic expectations about drinking.
• The term relapse may be used to describe a prolonged return to substance use, whereas lapsemay be used to describe discrete,…

Relapse Prevention And Ongoing Treatment At Bedrock

Marlatt (1985) describes an abstinence violation effect (AVE) that leads people to respond to any return to drug or alcohol use after a period of abstinence with despair and a sense of failure. By undermining confidence, these negative thoughts and feelings increase the likelihood that an isolated “lapse” will lead to a full-blown relapse. If, however, individuals view lapses as temporary setbacks or errors in the process of learning a new skill, they can renew their efforts to remain abstinent.

Cognitive Behavioral Therapy for Substance use Disorders

Gordon as part of their cognitive-behavioral model of relapse prevention, and it is used particularly in the context of substance use disorders. Understanding the AVE is crucial for individuals in recovery and those focused on abstinence violation effect healthier lifestyle choices. Instead of surrendering to the negative spiral, individuals can benefit from reframing the lapse as a learning opportunity and teachable moment.

Historical context of nonabstinence approaches

Similar to the reward thought, you may have another common thought after a period of sobriety. When you’ve experienced some success in your recovery, you may think that you can return to drug or alcohol use and control it. You may think that this time will be different, but if your drinking and drug use has gotten out of control in the past, it’s unlikely to be different this time. There are many relapse prevention models used in substance abuse treatment to counter AVE and give those in recovery important tools and coping skills.

• More recent versions of RP have included mindfulness-based techniques (Bowen, Chawla, & Marlatt, 2010; Witkiewitz et al., 2014).
• Harm reduction may also be well-suited for people with high-risk drug use and severe, treatment-resistant SUDs (Finney & Moos, 2006; Ivsins, Pauly, Brown, & Evans, 2019).
• The AVE was introduced into the substance abuse literature within the context of the “relapse process” (Marlatt and Gordon 1985, p. 37).
• ” I refer to this as a case of the “screw-it’s” (although harsher language is not uncommon!); a sense of giving up.

Despite the intense controversy, the Sobell’s high-profile research paved the way for additional studies of nonabstinence treatment for AUD in the 1980s and later (Blume, 2012; Sobell & Sobell, 1995). Marlatt, in particular, became well known for developing nonabstinence treatments, such as BASICS for college drinking (Marlatt et al., 1998) and Relapse Prevention (Marlatt & Gordon, 1985). Like the Sobells, Marlatt showed that reductions in drinking and harm were achievable in nonabstinence treatments (Marlatt & Witkiewitz, 2002). In the 1970s, the pioneering work of a small number of alcohol researchers began to challenge the existing abstinence-based paradigm in AUD treatment research.

How The Abstinence Violation Effect Impacts Long-Term Recovery

Reach out to friends, family, or support groups for encouragement during difficult times. Feelings of guilt, shame, and self-blame may lead people to question their ability to overcome addiction and exacerbate underlying issues of low self-esteem. One of the key features of the AVE is its potential to trigger a downward spiral of further relapse and continued substance use. Alan Marlatt is a professor of Psychology and Director of the Addictive Behaviors Research Center at the University of Washington. He has received continuous funding for his research from a variety of agencies including the National Institute on Alcohol Abuse and Alcoholism, the National Institute on Drug Abuse, the Alcoholic Beverage Medical Research Foundation, and the Robert Wood Johnson Foundation. 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.

• The RP model views relapse not as a failure, but as part of the recovery process and an opportunity for learning.
• Thus, studies will need to emphasize measures of substance-related problems in addition to reporting the degree of substance use (e.g., frequency, quantity).
• In the 1980s and 1990s, the HIV/AIDS epidemic prompted recognition of the role of drug use in disease transmission, generating new urgency around the adoption of a public health-focused approach to researching and treating drug use problems (Sobell & Sobell, 1995).
• A mindset shift caused by triggers or stress may lead you to take that drink or start using drugs again.
• This model both accelerated the spread of AA and NA and helped establish the abstinence-focused 12-Step program at the core of mainstream addiction treatment.
• However, among individuals with severe SUD and high-risk drug or alcohol use, the urgency of reducing substance-related harms presents a compelling argument for engaging these individuals in harm reduction-oriented treatment and interventions.

Harm reduction psychotherapies, for example, incorporate multiple modalities that have been most extensively studied as abstinence-focused SUD treatments (e.g., cognitive-behavioral therapy; mindfulness). However, it is also possible that adaptations will be needed for individuals with nonabstinence goals (e.g., additional support with goal setting and monitoring drug use; ongoing care to support maintenance goals), and currently there is a dearth of research in this area. An additional concern is that the lack of research supporting the efficacy of established interventions for achieving nonabstinence goals presents a barrier to implementation. 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. We define nonabstinence treatments as those without an explicit goal of abstinence from psychoactive substance use, including treatment aimed at achieving moderation, reductions in use, and/or reductions in substance-related harms. We first provide an overview of the development of abstinence and nonabstinence approaches within the historical context of SUD treatment in the U.S., followed by an evaluation https://ecosoberhouse.com/halfway-house/ of literature underlying the theoretical and empirical rationale for nonabstinence treatment approaches.