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Expanding the continuum of substance use disorder treatment: Nonabstinence approaches PMC

Lapsers who attributed their lapse to more controllable causes felt worse and more guilty; attributions did not otherwise moderate affective or efficacy reactions. AVE intensity was unrelated to amount smoked, length of abstinence, or performance of immediate or restorative coping. Temptations neither provoked an AVE nor enhanced self-efficacy in either lapsers or maintainers. Maintainers’ reactions to temptations were nearly identical to lapsers’, except that maintainers abstinence violation effect felt worse. The data demonstrate the reality of AVE reactions, but do not support hypotheses about their structure or determinants. The abstinence violation effect (AVE) refers to the negative cognitive (i.e., internal, stable, uncontrollable attributions; cognitive dissonance) and affective responses (i.e., guilt, shame) experienced by an individual after a return to substance use following a period of self-imposed abstinence from substances (Curry et al. 1987).

A step-by-step exploration may help clients learn how to interrupt the relapse process at various points to avoid future lapses, the AVE, and/or relapses (Larimer et al. 1999). Further, the clinician may elicit and positively reinforce clients’ existing coping skills to support the clients’ self-efficacy and may teach clients additional behavioral and cognitive coping strategies for application in future high-risk situations, as necessary (Witkiewitz and Marlatt 2007). Finally, clinicians should assess whether clients are coping adequately with the negative affective component of the AVE, which may otherwise precipitate future lapses or relapses. The past 20 years has seen growing acceptance of harm reduction, evidenced in U.S. public health policy as well as SUD treatment research. 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).

AVE: Cognitive and Affective Responses to a Lapse

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). In Europe, about half (44–46%) of individuals seeking treatment for AUD have non-abstinence goals (Haug & Schaub, 2016; Heather, Adamson, Raistrick, & Slegg, 2010). In the U.S., about 25% of patients seeking treatment for AUD endorsed nonabstinence goals in the early 2010s (Dunn & Strain, 2013), while more recent clinical trials have found between 82 and 91% of those seeking treatment for AUD prefer nonabstinence goals (Falk et al., 2019; Witkiewitz et al., 2019). Individuals with greater SUD severity tend to be most receptive to therapist input about goal selection (Sobell, Sobell, Bogardis, Leo, & Skinner, 1992). This suggests that treatment experiences and therapist input can influence participant goals over time, and there is value in engaging patients with non-abstinence goals in treatment.

which of the following is an example of the abstinence violation effect

These patterns can be actively identified and corrected, helping participants avoid lapses before they occur and continue their recovery from substance use disorder. In other words, AVE describes the thoughts, feelings, and actions a person goes through after they make a mistake and have a drink or abuse a substance, despite trying to quit. Twelve-month relapse rates following alcohol or drug cessation attempts can range from 60 to 90 percent, and the AVE can contribute to extended relapses. Identify triggers that may have contributed to the relapse and develop strategies to address them proactively in the future. Some examples of proven coping skills include practicing mindfulness, engaging in exercise, or pursuing activities that bring you fulfillment.

How The Abstinence Violation Effect Occurs

Clinicians may help clients interrupt the relapse process at various points and ultimately avoid the AVE. First, clinicians can help clients identify and apply effective behavioral and cognitive strategies in high-risk situations to avoid the initial lapse altogether. If a lapse occurs, clinicians should be empathetic and nonjudgmental in their approach (Miller and Rollnick 2002) and should help clients reframe the lapse as the product of multiple factors (versus only internal factors), as being controllable (versus uncontrollable), and as situation specific (versus global; Larimer et al. 1999).

  • Taylor uses an app to watch her intake of calorie limit and does see positive outcomes to her new lifestyle.
  • Most U.S. treatment providers still utilize abstinence-focused approaches such as 12 Step Facilitation and AA/NA groups as a mandatory aspect of treatment (SAMHSA, 2017), and while providers demonstrate growing acceptance of controlled drinking, acceptance of nonabstinence outcomes for drug use remains very low (Rosenberg et al., 2020).
  • In the United Kingdom, where there is greater acceptance of nonabstinence goals and availability of nonabstinence treatment (Rosenberg et al., 2020; Rosenberg & Melville, 2005), the rate of administrative discharge is much lower than in the U.S. (1.42% vs. 6% of treatment episodes; Newham, Russell, & Davies, 2010; SAMHSA, 2019b).

If you relapse on drugs or alcohol and experience guilt, shame, or despair after relapsing, a substance use disorder treatment program can help. In CBT sessions, you work with a mental health professional to understand the risk factors that lead to relapse, including external factors and your own mental health. If you or a loved one are worried about relapsing into alcohol or drug abuse, contact Northeast Addictions Treatment Center today. We provide comprehensive treatment for drug and alcohol use disorders, including relapse prevention programs, management of your cravings, and other evidence-based options.

Abstinence Violation Effect (AVE) What It Is & Relapse Prevention Strategies

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. They found that their controlled drinking intervention produced significantly better outcomes compared to usual treatment, and that about a quarter of the individuals in this condition maintained controlled drinking for one year post treatment (Sobell & Sobell, 1973). AVE occurs when someone who is striving for abstinence from a particular behavior or substance experiences a setback, such as a lapse or relapse. Instead of viewing the incident as a temporary setback, the individual perceives it as evidence of personal failure, leading to increased feelings of guilt, shame, and hopelessness (Collins & Witkiewitz, 2013; Larimer, Palmer, & Marlatt, 1999). It can impact someone who is trying to be abstinent from alcohol and drug use in addition to someone trying to make positive changes to their diet, exercise, and other aspects of their lives.

The Abstinence Violation Effect is a psychological phenomenon that occurs when a person experiences relapse after attempting to abstain from drug or alcohol use. One day, when he was faced with a stressful situation, he felt overwhelmed, gave in to the urge, and had a drink. I have lost all that time,” which can trigger a self-destructive mindset and potentially lead to further relapse. Note that these script ideas were pulled from a UN training on cognitive behavioral therapy that is available online. First characterized as an important ingredient in the relapse process in the mid-1980s, the AVE has profound relevance for addiction professionals today.

Relapse Prevention And Ongoing Treatment At Bedrock

In our era of heightened overdose risk, the AVE is more likely than ever to have tragic effects. Ark Behavioral Health offers 100% confidential substance abuse assessment and treatment placement tailored to your individual needs. Altogether, these thoughts and attributions are frequently driven by strong feelings of personal failure, defeat, and shame. These negative emotions are, unfortunately, often temporarily placated by a renewed pattern of substance abuse. As a result, it’s important that those in recovery internalize this difference and establish the proper mental and behavioral framework to avoid relapse and continue moving forward even if lapses occur.

which of the following is an example of the abstinence violation effect


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