Abstinence Violation Effect: How Does Relapse Impact Recovery?

We evaluated abstinence violation effects (AVEs) (a constellation of negative reactions to a lapse) following an initial lapse to smoking in 105 recent lapsers, and in temptation episodes from these lapsers and from 35 maintainers. Participants used palm-top computers to record AVE data within minutes of the episode, thus avoiding retrospective bias. Lapses resulted in increased negative affect and decreased self-efficacy; participants also felt guilty and discouraged. 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.

A Lapse Vs. A Relapse

However, they do not elucidate patterns of non-disordered use over time, nor the likelihood of maintaining drug use without developing a DUD. It is essential to understand what individuals with SUD are rejecting when they say they do not need treatment. 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). 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). The Abstinence Violation Effect is a concept originally introduced by psychologist Alan Marlatt in the context of treating substance abuse.

4. Consequences of abstinence-only treatment

Positive memories of drinking, paired with the minimized recollection of negative consequences, lead to unrealistic expectations about drinking. We begin to believe we can handle “just one drink” because the good times are remembered vividly, while the bad times fade into the background. Nonabstinence approaches to SUD treatment have a complex and contentious history, and significant social and political barriers have impeded research and implementation of alternatives to abstinence-focused treatment. We summarize historical factors relevant to non-abstinence treatment development to illuminate reasons these approaches are understudied.

Abstinence Violation Effect (AVE)

By 1989, treatment center referrals accounted for 40% of new what is alcoholism AA memberships (Mäkelä et al., 1996). 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). The Abstinence Violation Effect can have both positive and negative effects on behavior change.

Develop Coping Skills

• Although reducing practical barriers to treatment is essential, evidence suggests that these barriers do not fully account for low rates of treatment utilization.
• Consistent with the broader literature, it can be anticipated that most genetic associations with relapse outcomes will be small in magnitude and potentially difficult to replicate.
• In sum, research suggests that achieving and sustaining moderate substance use after treatment is feasible for between one-quarter to one-half of individuals with AUD when defining moderation as nonhazardous drinking.
• Nonabstinence approaches to SUD treatment have a complex and contentious history, and significant social and political barriers have impeded research and implementation of alternatives to abstinence-focused treatment.

It stems from the belief that individuals who establish strict rules of abstinence may be more vulnerable to relapse when faced with a violation of those rules. AVE can be observed in various areas, including addictions, dietary restrictions, and impulse control. The Abstinence Violation Effect (AVE) is a psychological phenomenon that refers to a person’s abstinence violation effect reaction to breaking a self-imposed rule of abstinence or self-control.

Set realistic expectations for your recovery journey, understanding that progress may not always be linear. Rather than only focusing on the end goal, celebrate small victories and all positive steps you’ve taken thus far. There are several factors that can contribute to the development of the AVE in people recovering from addiction. One of the key features of the AVE is its potential to trigger a downward spiral of further relapse and continued substance use. For example, I am a failure (labeling) and will never be successful with abstaining from drinking, eating healthier, or exercising (jumping to conclusions). Rather than labeling oneself as a failure, weak, or a loser, recognizing the effort and progress made before the lapse can provide a more balanced perspective.

Understand The Relapse Process

These findings may be informative for researchers who wish to incorporate genetic variables in future studies of relapse and relapse prevention. 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). 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).

In sum, the RP framework emphasizes high-risk contexts, coping responses, self-efficacy, affect, expectancies and the AVE as primary relapse antecedents. Most notably, we provide a recent update of the RP literature by focusing primarily on studies conducted within the last decade. We also provide updated reviews of research areas that have seen notable growth in the last few years; in particular, the application of advanced statistical modeling techniques to large treatment outcome datasets and the development of mindfulness-based relapse prevention. Additionally, we review the nascent but rapidly growing literature on genetic predictors of relapse following substance use interventions. For example, offering nonabstinence treatment may provide a clearer path forward for those who are ambivalent about or unable to achieve abstinence, while such individuals would be more likely to drop out of abstinence-focused treatment. This suggests that individuals with non-abstinence goals are retained as well as, if not better than, those working toward abstinence, though additional research is needed to confirm these results and examine the effect of goal-matching on retention.

Genetic influences on treatment response and relapse

Additionally, no studies identified in this review compared reasons for not completing treatment between abstinence-focused and nonabstinence treatment. 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). 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).