The Abstinence Myth in Treatment

In a similar fashion, the nature of these attributions determines whether the violation will lead to full-blown relapse. People can relapse when things are going well if they become overconfident in their ability to manage every kind of situation that can trigger even a momentary desire to use. Or they may be caught by surprise in a situation where others around them are using and not have immediate recourse to recovery support. Or they may believe that they can partake in a controlled way or somehow avoid the negative consequences.

The obsessive-compulsive model for describing compulsive sexual behavior

• Whether a high-risk situation culminates in a lapse depends largely on the individual’s capacity to enact an effective coping response–defined as any cognitive or behavioral compensatory strategy that reduces the likelihood of lapsing.
• Specifically, RP was most effective when applied to alcohol or polysubstance use disorders, combined with the adjunctive use of medication, and when evaluated immediately following treatment.
• That view contrasts with the evidence that addiction itself changes the brain—and stopping use changes it back.
• So, if you want to stop off at the gym after work several days a week, leave some spare workout clothes in the car so you don’t have to remember to bring them on the right day.
• Many formal weight-loss programs require people to limit their eating to one place, using only certain dishes, to facilitate portion control.

The Abstinence Violation Effect (AVE) is a psychological phenomenon that refers to a person’s reaction to breaking a self-imposed rule of abstinence or self-control. It occurs when individuals who have set strict rules for themselves regarding certain behaviors or habits (e.g., alcohol consumption, smoking, or eating certain foods) engage in the prohibited behavior, leading to feelings of guilt, shame, and loss of control. Many factors play a role in a person’s decision to misuse legal or illegal psychoactive substances, and different schools of thinking assign different weight to the role each factor plays. Recovery benefits from a detailed relapse prevention plan kept in a handy place—next to your phone charger, taped to the refrigerator door or the inside of a medicine cabinet—for immediate access when cravings hit.

Addictive Behaviors

Whether a high-risk situation culminates in a lapse depends largely on the individual’s capacity to enact an effective coping response–defined as any cognitive or behavioral compensatory strategy that reduces the likelihood of lapsing. In the last several years increasing emphasis has been placed on „dual process” models of addiction, which hypothesize that distinct (but related) cognitive networks, each reflective of specific neural pathways, act to influence substance use behavior. According to these models, the relative balance between controlled (explicit) and automatic (implicit) cognitive networks is influential in guiding drug-related decision making [54,55]. Dual process accounts of addictive behaviors [56,57] are likely to be useful for generating hypotheses about dynamic relapse processes and explaining variance in relapse, including episodes of sudden divergence from abstinence to relapse. Implicit cognitive processes are also being examined as an intervention target, with some potentially promising results [62]. Strengthening coping skills is a goal of virtually all cognitive-behavioral interventions for substance use [75].

Integrating implicit cognition and neurocognition in relapse models

For example, overeaters may have an AVE when they express to themselves, “one slice of cheesecake is a lapse, so I may as well go all-out, and have the rest of the cheesecake.” That is, since they have violated the rule of abstinence, they “may as well” get the most out of the lapse. Treatment in this component involves describing the AVE, and working with the client to learn alternative coping skills for when a lapse occurs, such that a relapse is prevented. The AVE occurs when a client is in a high-risk situation and views the potential lapse as so severe, that he or she may as well relapse. The treatment is not lapse prevention; lapses are to be expected, planned for, and taken as opportunities for the client to demonstrate learning. Most often, relapse tends to be construed as a return to pretreatment levels of occurrence of the targeted behavior.

Lapses may also evoke physiological (e.g., alleviation of withdrawal) and/or cognitive (e.g., the AVE) responses that in turn determine whether use escalates or desists. The dynamic model further emphasizes the importance of nonlinear relationships and timing/sequencing of events. For instance, in a high-risk context, a slight and momentary drop in self-efficacy could have a disproportionate impact on other relapse antecedents (negative affect, expectancies) [8]. Furthermore, the strength of proximal influences on relapse may vary based on distal risk factors, abstinence violation effect with these relationships becoming increasingly nonlinear as distal risk increases [31]. For example, one could imagine a situation whereby a client who is relatively committed to abstinence from alcohol encounters a neighbor who invites the client into his home for a drink. Feeling somewhat uncomfortable with the offer the client might experience a slight decrease in self-efficacy, which cascades into positive outcome expectancies about the potential effects of having a drink as well as feelings of shame or guilt about saying no to his neighbor’s offer.

Restricting mobile phone access during homework increases attainment of study goals

The focus is on identifying and accepting the urge, not acting on the urge or attempting to fight it4. Interpersonal relationships and support systems are highly influenced by intrapersonal processes such as emotion, coping, and expectancies18. Following the initial introduction of the RP model in the 1980s, its widespread application largely outpaced efforts to systematically validate the model and test its underlying assumptions. Given this limitation, the National Institutes on Alcohol Abuse and Alcoholism (NIAAA) sponsored the Relapse Replication and Extension Project (RREP), a multi-site study aiming to test the reliability and validity of Marlatt’s original relapse taxonomy. Efforts to evaluate the validity [119] and predictive validity [120] of the taxonomy failed to generate supportive data. It was noted that in focusing on Marlatt’s relapse taxonomy the RREP did not comprehensive evaluation of the full RP model [121].

• Working with Dr Lindgren, she has investigated implicit alcohol cognitions, along with the impact of the environment on self-reported measures of alcohol consumption.
• Support for this research has been provided by the National Institute on Alcohol Abuse and Alcoholism, the National Institute on Drug Abuse, the National Institute on Mental Health, and the Department of Defense.
• The AVE process typically involves a triggering event or cue, such as encountering a tempting situation, feeling stressed, or experiencing a moment of weakness.
• The abstinence violation effect (AVE) occurs when an individual, having made a personal commitment to abstain from using a substance or to cease engaging in some other unwanted behavior, has an initial lapse whereby the substance or behavior is engaged in at least once.
• Additionally, we review the nascent but rapidly growing literature on genetic predictors of relapse following substance use interventions.

Exercise addiction

• As noted by the authors, the CBT studies evaluated in their review were based primarily on the RP model [29].
• The first refers to the first 4 weeks of a non-temporary, indefinite abstinence period (i.e., a genuine cessation attempt).
• Many who embark on addiction recovery see it in black-and-white, all-or-nothing terms.
• Another factor that may occur is the Problem of Immediate Gratification where the client settles for shorter positive outcomes and does not consider larger long term adverse consequences when they lapse.
• Also, many studies that have examined potential mediators of outcomes have not provided a rigorous test [129] of mechanisms of change.
• 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].