Abstinence Violation Effect AVE What It Is & Relapse Prevention Strategies

She served in Operations and HR for a finance company for ten years, before returning to healthcare and eventually arriving at USR. As of 2020, the number of drug-involved overdose deaths reached an all-time high of 91,799, according to the National Institute on Drug Abuse. At least 74.8% of those deaths involved opioids, 14% involved heroin, 26% involved psychostimulants, primarily…

• Laurel, as the Director of Corporate Compliance for USR, is responsible for ensuring that the facility follows all federal and state regulatory requirements, accreditation standards and industry best practices.
• Such positive initial results are reflected in recent best-practices guidelines, which have specified motivational enhancement style and components as being key to brief intervention delivery for health care professionals—particularly with smokers who are not ready to quit.
• Serotonin plays an important role in postingestive satiety, and appears to be important in regulation of mood and anxiety-related symptoms.
• Inaction has typically been interpreted as the acceptance of substance cues which can be described as “letting go” and not acting on an urge.
• Approach oriented participants may see themselves as more responsible for their actions, including lapse, while avoidance-based coping may focus more on their environment than on their own actions14.

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 abstinence violation effect definition 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. Because relapse is the most common outcome of treatment for addictions, it must be addressed, anticipated, and prepared for during treatment. The RP model views relapse not as a failure, but as part of the recovery process and an opportunity for learning.

G. Alan Marlatt

The abstinence violation effect (AVE) highlights the distinction between a lapse and relapse. Put simply, the AVE occurs when a client perceives no intermediary step between a lapse and a relapse. For example, overeaters may have an AVE when they express to themselves, “one slice of cheesecake is a lapse, so I may as well go all-out, and have the rest of the cheesecake.” That is, since they have violated the rule of abstinence, they “may as well” get the most out of the lapse. Treatment in this component involves describing the AVE, and working with the client to learn alternative coping skills for when a lapse occurs, such that a relapse is prevented. The AVE occurs when a client is in a high-risk situation and views the potential lapse as so severe, that he or she may as well relapse. The treatment is not lapse prevention; lapses are to be expected, planned for, and taken as opportunities for the client to demonstrate learning.

With regard to addictive behaviours Cognitive Therapy emphasizes psychoeducation and relapse prevention. Therefore, many of the techniques discussed under relapse prevention that aim at modification of dysfunctional beliefs related to outcomes of substance use, coping or self-efficacy are relevant and overlapping. It is now believed that relapse prevention strategies must be taught to the individual during the course of therapy, and various strategies to enhance patient involvement and adherence such as increasing patient responsibility, promoting internal attributions to events are to be introduced in therapy.

An analysis of the abstinence violation effect in a sample of illicit drug users

Thirty-two states now have legally authorized SSPs, a number which has doubled since 2014 (Fernández-Viña et al., 2020). Regarding SUD treatment, there has been a significant increase in availability of medication for opioid use disorder, especially buprenorphine, over the past two decades (opioid agonist therapies including buprenorphine are often placed under the “umbrella” of harm reduction treatments; Alderks, 2013). Nonabstinence goals have become more widely accepted in SUD treatment in much of Europe, and evidence suggests that acceptance of controlled drinking has increased among U.S. treatment providers since the 1980s and 1990s (Rosenberg, Grant, & Davis, 2020).

• She is a current member of the Golden Key International Honor Society and the Delta Epsilon Iota Honor Society.
• Brie graduated as a high school valedictorian with a major in Health Technologies and continued her studies at Springfield Technical Community College with a focus on healthcare.
• That said, extensive meta-analyses and research studies have indicated that there are various efficacious smoking interventions that can both support smoking cessation and relapse prevention efforts.
• These patterns can be actively identified and corrected, helping participants avoid lapses before they occur and continue their recovery from substance use disorder.
• Behavioral therapy components have become an established part of various smoking cessation and relapse prevention approaches.
• After thorough review, the authors concluded that a focus on sustaining initial smoking cessation efforts, by preparing smokers for relapse prior to cessation and providing booster sessions and extended pharmacologic support, may be the most effective in preventing relapse.

She is a current member of the Golden Key International Honor Society and the Delta Epsilon Iota Honor Society. The first thing we must do after a relapse is check our thinking for signs of irrationality. Sometimes we must be hard on ourselves, but we must never view ourselves through a lens of hatred and self-loathing. Marlatt notes that one of the most important aspects of handling abstinence violation effect is the need to develop our coping mechanisms. The result of this lackluster planning is that we recognize future disturbances, yet do nothing to truly resolve them.

Relapse and Lapse

The dynamic model of relapse has generated enthusiasm among researchers and clinicians who have observed these processes in their data and their clients. Internet-based, computerized, and tailored treatments have become increasingly important in smoking cessation and treatment for other health-related behaviors [45•]. Computerized and Internet-based tailored interventions often include advice to quit, assistance with a quit plan, arrangements for follow-up, and/or recommendations for pharmacotherapy. Internet-based interventions often provide avenues for social support (eg, via live chat), whereas many computerized interventions are offered in conjunction with other in-person intervention components [46, 47•].

Review of this body of literature suggests that, across substances of abuse but most strongly for smoking cessation, there is evidence for the effectiveness of relapse prevention compared with no treatment controls. However, evidence regarding its superiority relative to other active treatments has been less consistent. Outcomes in which relapse prevention may hold particular promise include reducing severity of relapses, enhanced durability of effects, and particularly for patients at higher levels of impairment along dimensions such as psychopathology or dependence severity21. Despite various treatment programmes for substance use disorders, helping individuals remain abstinent remains a clinical challenge. Cognitive behavioural therapies are empirically supported interventions in the management of addictive behaviours. CBT comprises of heterogeneous treatment components that allow the therapist to use this approach across a variety of addictive behaviours, including behavioural addictions.

If an individual uses a substance after experiencing a remission, he/she may be vulnerable to the abstinence violation effect (AVE), which refers to an individual’s response to the recognition that he/she has broken a self-imposed rule by engaging in substance use or other unwanted behavior. This response often creates a feeling of self-blame and loss of perceived control due to breaking a self-imposed rule regarding substance use. According to AVE research, those who do chose to respond to their behavior with blame and a sense of lost perceived control are more likely to relapse than those who respond by attributing lapse to preventable events and not feeling as though they failed completely. So long as an individual maintains a perceived sense of self-control, he/she has a better chance at evading further lapses. AVE has been studied and supported for the cessation of sex offenses, heroin, marijuana, and other illicit drug use. Over the past few decades, there has been increasing public awareness of smoking-related morbidity and mortality and the health benefits of smoking cessation.

Long-term smoking cessation can drastically reduce people’s risk for developing smoking-related disease. The research literature points to a need for clearer operationalization and differentiation between smoking cessation and relapse prevention interventions and outcomes. That said, extensive meta-analyses and research studies have indicated that there are various efficacious smoking interventions that can both support smoking cessation and relapse prevention efforts. Although these methods vary on reach, they are relatively efficacious, particularly in combined formats. The past 20 years has seen growing acceptance of harm reduction, evidenced in U.S. public health policy as well as SUD treatment research.