What Is The Abstinence Violation Effect?

Lastly, we review existing models of nonabstinence psychosocial treatment for SUD among adults, with a special focus on interventions for drug use, to identify gaps in the literature and directions for future research. We identify a clear gap in research examining nonabstinence psychosocial treatment for drug use disorders and suggest that increased research attention on these interventions represents the logical next step for the field. Cognitive behaviour therapy is a structured, time limited, psychological intervention that has is empirically supported across a wide variety of psychological disorders.

• If you can never remember whether you took your vitamins, count them into a pill container every Sunday, so you have a way to keep track.
• 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.
• Although MI incorporates the principles of the trans theoretical model, it has been distinguished from both trans theoretical model and CBT21.

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. Marlatt’s relapse prevention model also identifies certain factors called covert antecedents which don’t stand out as clearly. Examples include denial, rationalization of why it’s okay to use (i.e. to reduce stress), and/or urges and cravings. Instead of learning and growing from their mistake, an individual may believe that they are unable to complete a successful recovery and feel shame and guilt.

Social learning theory

These variables are essential in developing distress tolerance and reducing impulsivity, which are important variables in relapse process. Relapse is a process in which a newly abstinent patient experiences a sense of perceived control over his/her behaviour up to a point at which there is a high risk situation and for which the person may not have adequate skills or a sense of self-efficacy. Self- efficacy increases abstinence violation effect and the probability of relapsing decreases when one is able to cope with this situation31. In order to cope or avoid these damaging thoughts, these individuals turn back to drugs or alcohol to numb the pain. This model notes that those who have the latter mindset are proactive and strive to learn from their mistakes. To do so, they adapt their coping strategies to better deal with future triggers should they arise.

• In this process, after experiencing a trigger, an individual will make a series of choices and thoughts that will lead to being placed in a high-risk situation or not.
• Given supportive data for the efficacy of mindfulness-based interventions in other behavioral domains, especially in prevention of relapse of major depression [114], there is increasing interest in MBRP for addictive behaviors.
• However, many of the treatments ranked in the top 10 (including brief interventions, social skills training, community reinforcement, behavior contracting, behavioral marital therapy, and self-monitoring) incorporate RP components.
• These groups tend to include individuals who use a range of substances and who endorse a range of goals, including reducing substance use and/or substance-related harms, controlled/moderate use, and abstinence (Little, 2006).

Elucidating the “active ingredients” of CBT treatments remains an important and challenging goal. Consistent with the RP model, changes in coping skills, self-efficacy and/or outcome expectancies are the primary putative mechanisms by which CBT-based interventions work [126]. One study, in which substance-abusing individuals were randomly assigned to RP or twelve-step (TS) treatments, found that RP participants showed increased self-efficacy, which accounted for unique variance in outcomes [69].

Relapse prevention

Abstinence rates became the primary outcome for determining SUD treatment effectiveness (Finney, Moyer, & Swearingen, 2003; Kiluk, Fitzmaurice, Strain, & Weiss, 2019; Miller, 1994; Volkow, 2020), a standard which persisted well into the 1990s (Finney et al., 2003). Little attention was given to whether people in abstinence-focused treatments endorsed abstinence goals themselves, or whether treatment could help reduce substance use and related problems for those who did not desire (or were not ready for) abstinence. When abstinence is violated, individuals typically https://ecosoberhouse.com/article/boredom-drinking-and-how-to-stop-it/ also have an emotional response consisting of guilt, shame, hopelessness, loss of control, and/or a sense of failure; they may use drugs or alcohol in an attempt to cope with the negative feelings that resulted from their abstinence violation. A person may experience a particularly stressful emotional event in their lives and may turn to alcohol and/or drugs to cope with these negative emotions. An abstinence violation can also occur in individuals with low self-efficacy, since they do not feel very confident in their ability to carry out their goal of abstinence.

Strengthening coping skills is a goal of virtually all cognitive-behavioral interventions for substance use [75]. One study [76] found that momentary coping differentiated smoking lapses from temptations, such that coping responses were reported in 91% of successful resists vs. 24% of lapses. Shiffman and colleagues [68] found that restorative coping following a smoking lapse decreased the likelihood of a second lapse the same day. One study found that momentary coping reduced urges among smokers, suggesting a possible mechanism [76].

Negative affect

Although there is some debate about the best definitions of lapse and relapse from theoretical and conceptual levels, these definitions should suffice. Modifying social and environmental antecedents and consequences another approach to working with addictive behaviours18. Therapeutic strategies such as contingency management, differential reinforcement of incompatible and alternate behaviours and rearrangement of environmental cues that set the occasion for addictive behaviour, including emotional triggers are used in this approach. Family members are counselled so as identify potential risk factors for relapse, such as emotional and behavioural changes.

CBT for addictive behaviours can be traced back to the application of learning theories in understanding addiction and subsequently to social cognitive theories. The focus of CBT is manifold and the focus is on targeting maintaining factors of addictive behaviours and preventing relapse. Relapse prevention programmes are based on social cognitive and cognitive behavioural principles. More recent developments in the area of managing addictions include third wave behaviour therapies.

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. Teasdale and colleagues provide a description of this training which teaches generic psychological, self-control skills and can be used on a continuing basis to maintain skills after initial training.