Countering The Abstinence Violation Effect: Supporting Recovery Through Relapse

How these experiences are handled can have important implications for sustaining recovery. Our mental health professionals at ReachLink communicate the reality of mental health challenges—they’re not simply matters of willpower or determination. Many conditions involve neurological and biological factors that take time to address. Recovery typically includes changing external elements rather than finding some internal reserve of willpower.

Models of nonabstinence psychosocial treatment for SUD

In realistic, healthy approaches to recovery, setbacks are acknowledged as possibilities, and strategies are developed to minimize their impact. An essential part of this process involves developing self-awareness and understanding what triggers certain thoughts, emotions, or behaviors. Cognitive processes may include self-blame, rumination, and heightened self-awareness. These emotional and cognitive reactions intensify the Abstinence Violation Effect, which may lead to a further loss of control and increased vulnerability to subsequent relapses or deviations from the established rule.

Physical Relapse

With the right help, preparation, and support, you and your loved ones can still continue to build a long-lasting recovery from substance abuse. The Abstinence Violation Effect (AVE – think the abbreviation for avenue to help you remember it) is what happens when an individual deviates from his/her plan – and then continues to remain off that path due to frustration, shame, guilt, etc. When that person takes even one drink (”violating” their abstinence), the tendency is to think, “I really blew it…I’m a failure…might as well keep on drinking now!

Changing how recovery is viewed

• Gordon as part of their cognitive-behavioral model of relapse prevention, and it is used particularly in the context of substance use disorders.
• It’s an important part of any recovery program to address these preconceived notions of addiction and paint a more accurate portrait with the level of compassion, self-awareness, and support that is so essential to addiction recovery.
• While such responses are understandable, they often reflect unrealistic, unhealthy, or inaccurate views of mental health recovery and can potentially cause more harm than good.
• This finding supplements the numerous studies that identify lack of readiness for abstinence as the top reason for non-engagement in SUD treatment, even among those who recognize a need for treatment (e.g., Chen, Strain, Crum, & Mojtabai, 2013; SAMHSA, 2019a).
• Social pressure may be experienced directly, such as peers trying to convince a person to use, or indirectly through modelling (e.g. a friend ordering a drink at dinner) and/or cue exposure.

Ark Behavioral Health offers 100% confidential substance abuse assessment and treatment placement tailored to your individual needs. It’s important to establish that a one-time lapse in a person’s recovery from drugs or alcohol is not considered a full blown relapse. It includes thoughts and feelings like shame, guilt, anger, failure, depression, and recklessness as well as a return to addictive behaviors and drug use. As a result of stress, high-risk situations, or inborn anxieties, you are experiencing negative emotional responses. Emotional the abstinence violation effect refers to relapses can be incredibly difficult to recognize because they occur so deeply below the surface in your mind. The harm reduction movement, and the wider shift toward addressing public health impacts of drug use, had both specific and diffuse effects on SUD treatment research.

They can help you reframe your recovery journey and develop healthier coping mechanisms for triggers and relapses. The “abstinence violation effect” (AVE) describes the “may as well” response that often accompanies a perceived failure in recovery. Examples might include someone who has been managing anxiety symptoms well suddenly abandoning all their coping techniques after one panic attack, or someone who maintained sobriety for months returning to substance use patterns after a single lapse. In conclusion, the abstinence violation effect is a psychological effect that impacts those in recovery, as well as those who are focused on making more positive behavioral choices in their lives. By reframing lapses as learning opportunities and teachable moments, cultivating self-compassion, and seeking support, individuals can navigate these challenges more effectively, increasing their chances of leading a healthier lifestyle.

• 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).
• That’s why adopting a more realistic, compassionate view of the recovery journey can be helpful, in addition to seeking the appropriate mental health support as needed.
• It is for this reason that someone’s tolerance declines following a period of abstinence and that they may overdose if they start using again at the same level as before.
• It includes thoughts and feelings like shame, guilt, anger, failure, depression, and recklessness as well as a return to addictive behaviors and drug use.
• Relapse Prevention (RP) is another well-studied model used in both AUD and DUD treatment (Marlatt & Gordon, 1985).

Even among those who do perceive a need for abstinence violation effect treatment, less than half (40%) make any effort to get it (SAMHSA, 2019a). Although reducing practical barriers to treatment is essential, evidence suggests that these barriers do not fully account for low rates of treatment utilization. Instead, the literature indicates that most people with SUD do not want or need – or are not ready for – what the current treatment system is offering. Future research with a data set that includes multiple measures of risk factors over multiple days can help in validating the dynamic model of relapse. 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.

People may sometimes feel that relapse is an indication of an inherent flaw or an entirely uncontrollable aspect of their disease, causing them to experience cognitive dissonance and feel ashamed, hopeless, or unable to combat relapse. It became the work of the individuals who identified the abstinence violation effect to mitigate the negative impacts of this flawed thought process through cognitive therapy and encourage healthier coping mechanisms in those who are in the process of recovery by adjusting outcome expectancies. Lack of consensus around target outcomes also presents a challenge to evaluating the effectiveness of nonabstinence treatment. Experts generally recommend that SUD treatment studies report substance use as well as related consequences, and select primary outcomes based on the study sample and goals (Donovan et al., 2012; Kiluk et al., 2019).

Inaction has typically been interpreted as the acceptance of substance cues which can be described as “letting go” and not acting on an urge. 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.

• Moreover, people who have coped successfully with high-risk situations are assumed to experience a heightened sense of self-efficacy4.
• This can lead to a full relapse by making someone believe that because they’ve already messed up, there is no hope of achieving sobriety.
• A single lapse does not have to result in a downward spiral of additional lapses and prolonged relapse, and a significant period of relapse does not have to culminate in a lifelong powerlessness over addictive behavior.
• In this model, treatment success is defined as achieving and sustaining total abstinence from alcohol and drugs, and readiness for treatment is conflated with commitment to abstinence (e.g., Harrell, Trenz, Scherer, Martins, & Latimer, 2013).

It is not necessarily a failure of self-control nor a permanent failure to abstain from using a substance of abuse. Relapse Prevention (RP) is another well-studied model used in both AUD and DUD treatment (Marlatt & Gordon, 1985). In its original form, RP aims to reduce risk of relapse by teaching participants cognitive and behavioral skills for coping in high-risk situations (Marlatt & Gordon, 1985). More recent versions of RP have included mindfulness-based techniques (Bowen, Chawla, & Sobriety Marlatt, 2010; Witkiewitz et al., 2014). 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).

How does ReachLink’s virtual therapy platform support recovery?

With compassionate guidance and evidence-based strategies, you can transform setbacks into opportunities for deeper healing and more sustainable recovery. Life situations, relationships, and commitments should be carefully evaluated and continually reassessed for balance and harmony. This enables individuals to avoid common triggers for setbacks and the potential resulting AVE.

When should I seek professional help for dealing with setbacks?

The current review highlights multiple important directions for future research related to nonabstinence SUD treatment. Overall, increased research attention on nonabstinence https://shararaco.ly/?p=1300 treatment is vital to filling gaps in knowledge. For example, despite being widely cited as a primary rationale for nonabstinence treatment, the extent to which offering nonabstinence options increases treatment utilization (or retention) is unknown. In addition to evaluating nonabstinence treatments specifically, researchers could help move the field forward by increased attention to nonabstinence goals more broadly. For example, all studies with SUD populations could include brief questionnaires assessing short-and long-term substance use goals, and treatment researchers could report the extent to which nonabstinence goals are honored or permitted in their study interventions and contexts, regardless of treatment type. There is also a need for updated research examining standards of practice in community SUD treatment, including acceptance of non-abstinence goals and facility policies such as administrative discharge.