The AVE process typically involves a triggering event or cue, such as encountering a tempting situation, feeling stressed, or experiencing a moment of weakness. This cue leads to a cognitive conflict, as the individual struggles between their desire to maintain abstinence and the urge to engage in the prohibited behavior. If the person succumbs to the urge and violates their self-imposed rule, the Abstinence Violation Effect is activated. Regard Healthcare offers 100% confidential substance abuse assessment and treatment placement tailored to your individual needs. Creating, implementing, and adhering to a relapse prevention plan helps to protect your sobriety and prevent the AVE response.
How Does The Abstinence Violation Effect Occur?
- As was the case for Marlatt’s original RP model, efforts are needed to systematically evaluate specific theoretical components of the reformulated model 1.
- Considering the numerous developments related to RP over the last decade, empirical and clinical extensions of the RP model will undoubtedly continue to evolve.
- Rather than communicating pessimism about a client’s potential to recover, these overdose prevention measures acknowledge the existence of the AVE and communicate that safety is more important than maintaining perfect abstinence.
- On the one hand, it can serve as a valuable learning opportunity, highlighting the triggers and situations that lead to relapse or rule violation.
- Central to the RP model is the role of cognitive factors in determining relapse liability.
The dynamic model of relapse assumes that relapse can take the form of sudden and unexpected returns to the target behavior. This concurs not only with clinical observations, but also with contemporary learning models stipulating that recently modified behavior is inherently unstable and easily swayed by context 32. While maintaining its footing in cognitive-behavioral theory, the revised model also draws from nonlinear dynamical systems theory (NDST) and catastrophe theory, both approaches for understanding the operation of complex systems 10,33.
- For example, successful navigation of high-risk situations may increase self-efficacy (one’s perceived capacity to cope with an impending situation or task; 26), in turn decreasing relapse probability.
- First characterized as an important ingredient in the relapse process in the mid-1980s, the AVE has profound relevance for addiction professionals today.
- The following section reviews selected empirical findings that support or coincide with tenets of the RP model.
- Instead of viewing the incident as a temporary setback, the individual perceives it as evidence of personal failure, leading to increased feelings of guilt, shame, and hopelessness (Collins & Witkiewitz, 2013; Larimer, Palmer, & Marlatt, 1999).
- When you are feeling overwhelmed, your brain may unconsciously crave drugs as a way to help you feel better.
- Given its focus on long-term maintenance of treatment gains, RP is a behavioral intervention that is particularly well suited for implementation in continuing care contexts.
Empirical findings relevant to the RP model
Studies show many view excessive drinking – and accompanying anxiety and hangovers – as incompatible with their ambitions and desire to stay in control. Young people especially face increasing social and economic pressures, and may be more focused https://ecosoberhouse.com/ on professional and personal growth than previous generations. In part, popular wellness trends have promoted alcohol-free living as a positive and aspirational lifestyle. A UK study commissioned by a zero-alcohol beer brand found that 25% of pub goers alternate between alcoholic and non-alcoholic beer. While commercial research like this requires cautious interpretation, it does highlight a growing appetite for moderation. The term is new but the concept of alternating drinks has long been a cornerstone of harm-reduction strategies.
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One study 46 reported increases in daily SE during abstinent intervals, perhaps indicating mounting confidence as treatment goals were maintained 45. While a person may physically abstain from using drugs or alcohol, their thoughts and emotions may have already returned to substance abuse. This model asserts that full-blown relapse is a transitional process based on a combination of factors.
Mechanisms of treatment effects
This does not mean that 12-step is an ineffective or counterproductive source of recovery support, but that clinicians should be aware that 12-step participation may make a client’s AVE more pronounced. First characterized as an important ingredient in the relapse process in the mid-1980s, the AVE has profound relevance for addiction professionals today. In our era of heightened overdose risk, the AVE is more likely than ever to have tragic effects. 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.
In another recent study, researchers trained participants in attentional bias modification (ABM) during inpatient treatment for alcohol dependence and measured relapse over the course of three months post-treatment 62. Relative to a control condition, ABM resulted in significantly improved ability to disengage from alcohol-related stimuli during attentional bias tasks. While incidence of relapse did not differ between groups, the ABM group showed a significantly longer time to first heavy drinking day compared to the control group. Additionally, the intervention had no effect on subjective measures of craving, suggesting the possibility that intervention effects may have been specific to implicit cognitive processes 62. Overall, research on implicit cognitions stands to enhance understanding of dynamic relapse processes and could ultimately aid in predicting lapses during high-risk situations. In addition to these areas, which already have initial empirical data, we predict that we could learn significantly more about the relapse process using experimental manipulation to test specific aspects of the cognitive-behavioral model of relapse.
In terms of clinical applications of RP, the most notable development in the last decade has been the emergence and increasing application of Mindfulness-Based Relapse Prevention (MBRP) for addictive behaviors 112,113. 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. The merger of mindfulness and cognitive-behavioral approaches is appealing from both theoretical and practical standpoints 115 and MBRP is a potentially effective and cost-efficient adjunct to CBT-based treatments. In contrast to the cognitive restructuring strategies typical of traditional CBT, MBRP stresses nonjudgmental attention to thoughts or urges. From this standpoint, urges/cravings are labeled as transient events that need not be acted upon reflexively.
Abstinence Violation Effect
For example, it has been shown that abstinence violation effect self-efficacy for abstinence can be manipulated 137. Thus, one could test whether increasing self-efficacy in an experimental design is related to better treatment outcomes. Similarly, self-regulation ability, outcome expectancies, and the abstinence violation effect could all be experimentally manipulated, which could eventually lead to further refinements of RP strategies. Based on the cognitive-behavioral model of relapse, RP was initially conceived as an outgrowth and augmentation of traditional behavioral approaches to studying and treating addictions.
This approach is exemplified by the “urge surfing” technique 115, whereby clients are taught to view urges as analogous to an ocean wave that rises, crests, and diminishes. Rather than being overwhelmed by the wave, the goal is to “surf” its crest, attending to thoughts and sensations as the urge peaks and subsides. Most notably, we provide a recent update of the RP literature by focusing primarily on studies conducted within the last decade. Additionally, we review the nascent but rapidly growing literature on genetic predictors of relapse following substance use interventions.
Not surprisingly, molecular genetic approaches have increasingly been incorporated in treatment outcome studies, allowing novel opportunities to study biological influences on relapse. Given the rapid growth in this area, we allocate a portion of this review to discussing initial evidence for genetic associations with relapse. Specifically, we focus on recent, representative findings from studies evaluating candidate single nucleotide polymorphisms (SNPs) as moderators of response to substance use interventions. It is important Twelve-step program to note that these studies were not designed to evaluate specific components of the RP model, nor do these studies explicitly espouse the RP model. Also, many studies have focused solely on pharmacological interventions, and are therefore not directly related to the RP model. However, we review these findings in order to illustrate the scope of initial efforts to include genetic predictors in treatment studies that examine relapse as a clinical outcome.