More recent versions of RP have included mindfulness-based techniques (Bowen, Chawla, & 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). As a newer iteration of RP, Mindfulness-Based Relapse Prevention (MBRP) has a less extensive research base, though it has been tested in samples with a range of SUDs (e.g., Bowen et al., 2009; Bowen et al., 2014; Witkiewitz et al., 2014). Multiple theories of motivation for behavior change support the importance of self-selection of goals in SUD treatment (Sobell et al., 1992). For example, Bandura, who developed Social Cognitive Theory, posited that perceived choice is key to goal adherence, and that individuals may feel less motivation when goals are imposed by others (Bandura, 1986).
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If you’re currently lost within the confusion of the abstinence violation effect, we can help. In order to cope or avoid these damaging thoughts, these individuals turn back to drugs or alcohol to numb the pain. Additionally, the support of a solid social abstinence violation effect network and professional help can play a pivotal role.
The Abstinence Violation Effect and What It Means in Recovery
- Have you ever wondered why the gym is so crowded on January 2 and 3rd and has emptied out by about January 10th?
- Here we provide a brief review of existing models of nonabstinence psychosocial treatment, with the goal of summarizing the state of the literature and identifying notable gaps and directions for future research.
- One day, when he was faced with a stressful situation, he felt overwhelmed, gave in to the urge, and had a drink.
- With an online therapy platform like BetterHelp, for instance, you can get matched with a licensed provider who meets your needs and preferences, and you can speak with them via phone, video call, and/or online chat.
This standard persisted in SUD treatment even as strong evidence emerged that a minority of individuals who receive 12-Step treatment achieve and maintain long-term abstinence (e.g., Project MATCH Research Group, 1998). In the multifaceted journey of overcoming addiction and living a healthier life, individuals often encounter a psychological phenomenon known as the abstinence violation effect (AVE). It sheds light on the challenges individuals face when attempting to maintain abstinence and how a single lapse can trigger a surge of negative emotions, potentially leading to a full relapse or a return to unhealthy living (Collins & Witkiewitz, 2013; Larimer, Palmer, & Marlatt, 1999). Thus, while it is vital to empirically test nonabstinence treatments, implementation research examining strategies to obtain buy-in from agency leadership may be just as impactful. Researchers have long posited that offering goal choice (i.e., non-abstinence and abstinence treatment options) may be key to engaging more individuals in SUD treatment, including those earlier in their addictions (Bujarski et al., 2013; Mann et al., 2017; Marlatt, Blume, & Parks, 2001; https://thefabbalancecheck-ae.com/quitting-alcohol-timeline-what-to-expect-in-weeks/ Sobell & Sobell, 1995).
- In our era of heightened overdose risk, the AVE is more likely than ever to have tragic effects.
- Miller, whose seminal work on motivation and readiness for treatment led to multiple widely used measures of SUD treatment readiness and the development of Motivational Interviewing, also argued for the importance of goal choice in treatment (Miller, 1985).
- One day, they feel overwhelmed by stress and turn to binge eating as a coping mechanism, consuming large quantities of food in a short period.
- Another limitation is that our operational definition of relapse was necessarily arbitrary (Miller, 1996), and is more conservative than the 7-days’ smoking criterion used in other studies.
Theoretical and Practical Support for the RP Model
As with all things 12-step, the emphasis on accumulating “time” and community reaction to a lapse varies profoundly from group to group, which makes generalizations somewhat unhelpful. However, broadly speaking, there are clear features of 12-step programs that can contribute to the AVE. This is an open-access report distributed under the terms heroin addiction of the Creative Commons Public Domain License. You can copy, modify, distribute and perform the work, even for commercial purposes, all without asking permission.
The RP model proposed by Marlatt and Gordon suggests that both immediate determinants (e.g., high-risk situations, coping skills, outcome expectancies, and the abstinence violation effect) and covert antecedents (e.g., lifestyle factors and urges and cravings) can contribute to relapse. The RP model also incorporates numerous specific and global intervention strategies that allow therapist and client to address each step of the relapse process. Specific interventions include identifying specific high-risk situations for each client and enhancing the client’s skills for coping with those situations, increasing the client’s self-efficacy, eliminating myths regarding alcohol’s effects, managing lapses, and restructuring the client’s perceptions of the relapse process. Global strategies comprise balancing the client’s lifestyle and helping him or her develop positive addictions, employing stimulus control techniques and urge-management techniques, and developing relapse road maps. The relapse prevention model (RPM) developed by Marlatt was the first to establish an integrative framework for understanding the cognitive-behavioral processes that drive progression from lapses to relapse (Marlatt & Gordon, 1985), and has been prominent in clinical thinking about relapse. Nearly all other prominent models of addiction and relapse focus on the psychophysiological determinants of drug priming and reinforcement (e.g., Baker et al., 1986; Kalivas & Volkow, 2005; Koob & Le Moal, 1997; Robinson & Berridge, 2003).
- Abstinence can be considered a decision to avoid behaviors that are risky in and of themselves, like using drugs.
- In addition to evaluating nonabstinence treatments specifically, researchers could help move the field forward by increased attention to nonabstinence goals more broadly.
- For example, an individual who has successfully abstained from alcohol, after having one beer, may engage in binge drinking, thinking that since he has “fallen off the wagon” he might as well drink an entire case of beer.
- Treatment components stemming from the RPM have been incorporated into behavioral interventions for relapse prevention (Brandon, Vidrine, & Litvin, 2007), not only for smoking cessation (Abrams et al., 2003), but also for other addictions and health-related behavior change targets (Marlatt & Donovan, 2005).
- One recent large-scale research effort assessing the RP model was the Relapse Replication and Extension Project (RREP), which was funded by the National Institute on Alcohol Abuse and Alcoholism (Lowman et al. 1996).
- Understanding its mechanisms and implications is valuable for anyone involved in the recovery process.
According to the RPM (Marlatt & Gordon, 1985; Witkiewitz & Marlatt, 2004), the primary determinants of whether an individual who has lapsed will progress towards relapse or towards reestablishing abstinence are that person’s explicit (i.e., subject to conscious awareness) cognitive and emotional responses to lapsing. Specifically, relapse is predicted to be more likely when lapses produce an abstinence violation effect (AVE), characterized by internal attribution of blame, reduced abstinence self-efficacy, and feelings of guilt. This constellation of responses, coupled with the subjective effects of drug ingestion, is posited to predispose the person to further lapses, thus driving the lapse-relapse process in an accelerating downward spiral (Marlatt & Gordon, 1985). Treatment components stemming from the RPM have been incorporated into behavioral interventions for relapse prevention (Brandon, Vidrine, & Litvin, 2007), not only for smoking cessation (Abrams et al., 2003), but also for other addictions and health-related behavior change targets (Marlatt & Donovan, 2005).
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 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). 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).
Countering The Abstinence Violation Effect: Supporting Recovery Through Relapse
Next, we review other established SUD treatment models that are compatible with non-abstinence goals. We focus our review on two well-studied approaches that were initially conceptualized – and have been frequently discussed in the empirical literature – as client-centered alternatives to abstinence-based treatment. Of note, other SUD treatment approaches that could be adapted to target nonabstinence goals (e.g., contingency management, behavioral activation) are excluded from the current review due to lack of relevant empirical evidence. Individuals with fewer years of addiction and lower severity SUDs generally have the highest likelihood of achieving moderate, low-consequence substance use after treatment (Öjehagen & Berglund, 1989; Witkiewitz, 2008).