Abstinence Violation Effect SpringerLink
Harm reduction psychotherapies, for example, incorporate multiple modalities that have been most extensively studied as abstinence-focused SUD treatments (e.g., cognitive-behavioral therapy; mindfulness). However, it is also possible that adaptations will be needed for individuals with nonabstinence goals (e.g., additional support with goal setting and monitoring drug use; ongoing care to support maintenance goals), https://ecosoberhouse.com/ and currently there is a dearth of research in this area. An additional concern is that the lack of research supporting the efficacy of established interventions for achieving nonabstinence goals presents a barrier to implementation. Unfortunately, there has been little empirical research evaluating this approach among individuals with DUD; evidence of effectiveness comes primarily from observational research.
- The memories of our slips may always sting a bit, but at least we can sleep easy at night knowing that we used them to do some good.
- Sometimes, it begins from the very moment we even consider the notion of using again.
- They suggest that the redeployment of attention utilized in stress-reduction procedures based on the techniques of mindfulness meditation (Kabat-Zinn, 1990) can be integrated with cognitive therapy procedures into a system of attentional control training.
- The abstinence violation effect (AVE) describes the tendency of people recovering from addiction to spiral out of control when they experience even a minor relapse.
Thus, studies will need to emphasize measures of substance-related problems in addition to reporting the degree of substance use (e.g., frequency, quantity). The current review highlights multiple important directions for future research related to nonabstinence SUD treatment. Overall, increased research attention on nonabstinence 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.
AVE in the Context of the Relapse Process
Goals of cognitive therapy as it pertains to RP include identification of, insight into, and modification of an individual’s maladaptive thoughts and ideas as they relate to achieving sobriety and avoiding relapse. Cognitive therapy seeks to identify and challenge maladaptive thoughts and ideas such as I can never be 100% sober, the stress of my job makes me drink, if I only felt better and less stressed I would be able to stop drinking. Therapy also supports and encourages positive protective thoughts and ideas such as sobriety is hard and I will work hard to get there, but it is much better than the alternative, drinking used to be fun, now it just causes me problems, and I can do this if I take it one day, one moment at a time. John’s key responsibilities include maintaining the day-to-day operations from both a clinical and housing perspective.
Teasdale and colleagues (1995) have proposed a model of depressive relapse which attempts to explain the process of relapse in depression and also the mechanisms by which cognitive therapy achieves its prophylactic effects in the treatment of depression. It hypothesizes that following recovery, mild states of depression can reactivate depressogenic cycles of cognitive processing similar to those found during a major depressive episode. Teasdale et al. suggest that preventive interventions such as cognitive therapy operate by changing the patterns of cognitive processing that become active in states of mild negative affect preceding a full relapse into major depression. They suggest that the redeployment of attention utilized in stress-reduction procedures based on the techniques of mindfulness meditation (Kabat-Zinn, 1990) can be integrated with cognitive therapy procedures into a system of attentional control training. This approach would be applicable to recovered depressed patients and would serve as a means of preventing relapse.
Cognitive Behavioural model of relapse
We instead view these emotions as justifications of the negative cognition experienced under AVE. Our hopelessness and our instinctive desire to give up were spot-on, or else we would be happy all the time. At start of therapy, Rajiv was not confident of being able to help himself (self-efficacy and lapse- relapse pattern). Approach coping may involve attempts abstinence violation effect to accept, confront, or reframe as a means of coping, whereas avoidance coping may include distraction from cues or engaging in other activities. 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.
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. 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). Importantly, there has also been increasing acceptance of non-abstinence outcomes as a metric for assessing treatment effectiveness in SUD research, even at the highest levels of scientific leadership (Volkow, 2020).
ABSTINENCE VIOLATION EFFECT (AVE)
Lifestyle factors have been proposed as the covert antecedents most strongly related to the risk of relapse. It involves the degree of balance in the person’s life between perceived external demands and internally fulfilling or enjoyable activities. Urges and cravings precipitated by psychological or environmental stimuli are also important6.