Abstinence Violation Effect AVE

Findings of the review showed that there is a paucity of prospective studies investigating abstinence effects in relation to potential behavioral addictions, except for exercise. Across all behaviors, exercise demonstrated the clearest pattern of withdrawal-related symptoms mainly related to mood disturbances. While withdrawal and craving were investigated to a fair extent across the studies, the study of relapse using abstinence protocols is underutilized within behavioral addiction research. Short-term abstinence shows promise as an intervention for some problematic behaviors, especially gaming, pornography use, mobile phone use, and social media use. However, potential counterproductive consequences of abstinence (e.g., rebound effects and compensatory behaviors) were not adequately assessed by the studies, which limits current evaluation of the utility of abstinence as an intervention. Additionally, the revised model has generated enthusiasm among researchers and clinicians who have observed these processes in their data and their clients [122,123].

The effects of exercise withdrawal on mood states in runners

• AA was established in 1935 as a nonprofessional mutual aid group for people who desire abstinence from alcohol, and its 12 Steps became integrated in SUD treatment programs in the 1940s and 1950s with the emergence of the Minnesota Model of treatment (White & Kurtz, 2008).
• Findings concerning possible genetic moderators of response to acamprosate have been reported [99], but are preliminary.
• In one clinical intervention based on this approach, the client is taught to visualize the urge or craving as a wave, watching it rise and fall as an observer and not to be “wiped out” by it.

Naturally occurring periods of abstinence (e.g., intrinsically motivated cessation attempts) are useful for researchers to systematically observe where they do occur but may be rare depending on the behavior of interest. Prospective studies examining cognitive, affective, physical, and behavioral reactions to abstinence can be a useful methodological tool in systematically investigating addiction-related symptomatology, especially withdrawal, craving, and relapse (i.e., do these symptoms manifest, and if so, for whom, how, and why?). Cognitive restructuring, or reframing, is used throughout the RP treatment process to assist clients in modifying their attributions for and perceptions of the relapse process. In particular, cognitive restructuring is a critical component of interventions to lessen the abstinence violation effect. Thus, clients are taught to reframe their perception of lapses—to view them not as failures or indicators of a lack of willpower but as mistakes or errors in learning that signal the need for increased planning to cope more effectively in similar situations in the future.

Global Lifestyle Self-Control Strategies

Additionally, in the United Kingdom, where there is greater access to nonabstinence treatment (Rosenberg & Melville, 2005; Rosenberg & Phillips, 2003), the proportion of individuals with opioid use disorder engaged in treatment is more than twice that of the U.S. (60% vs. 28%; Burkinshaw et al., 2017). Although specific intervention strategies can address the immediate determinants of relapse, it is also important to modify individual lifestyle factors and covert antecedents that can increase exposure or reduce resistance to high-risk situations. Global self-control strategies are designed to modify the client’s lifestyle to increase balance as well as to identify and cope with covert antecedents of relapse (i.e., early warning signals, cognitive distortions, and relapse set-ups). Another approach to preventing relapse and promoting behavioral change is the use of efficacy-enhancement procedures—that is, strategies designed to increase a client’s sense of mastery and of being able to handle difficult situations without lapsing. One of the most important efficacy-enhancing strategies employed in RP is the emphasis on collaboration between the client and therapist instead of a more typical “top down” doctor-patient relationship. In the RP model, the client is encouraged to adopt the role of colleague and to become an objective observer of his or her own behavior.

Masturbation prohibition in sex offenders: A crossover study

• Asking clients questions designed to assess expectancies for both immediate and delayed consequences of drinking versus not drinking (i.e., using a decision matrix) (see table, p. 157) often can be useful in both eliciting and modifying expectancies.
• It has also been used to advocate for managed alcohol and housing first programs, which represent a harm reduction approach to high-risk drinking among people with severe AUD (Collins et al., 2012; Ivsins et al., 2019).
• This reframing of lapse episodes can help decrease the clients’ tendency to view lapses as the result of a personal failing or moral weakness and remove the self-fulfilling prophecy that a lapse will inevitably lead to relapse.
• 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.

Although many researchers and clinicians consider urges and cravings primarily physiological states, the RP model proposes that both urges and cravings are precipitated by psychological or environmental stimuli. Ongoing cravings, in turn, may erode the client’s commitment to maintaining abstinence as his or her desire for immediate gratification increases. This process may lead to a relapse setup or increase the client’s vulnerability to unanticipated high-risk situations. This article presents one influential model of the antecedents of relapse and the treatment measures that can be taken to prevent or limit relapse after treatment completion.

• Overall, research on implicit cognitions stands to enhance understanding of dynamic relapse processes and could ultimately aid in predicting lapses during high-risk situations.
• Abstinence effects across different addictive substances, while useful for comparison with behavioral addictions, are beyond the scope of the present review.
• 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.
• Although there is some debate about the best definitions of lapse and relapse from theoretical and conceptual levels, these definitions should suffice.
• It is essential to understand what individuals with SUD are rejecting when they say they do not need treatment.
• 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.

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. Although high-risk situations can be conceptualized as the immediate determinants of relapse episodes, a number of less obvious factors also influence the relapse process. These covert antecedents include lifestyle factors, such as overall stress level, as well as cognitive factors that may serve to “set up” a relapse, such as rationalization, denial, and a desire for immediate gratification (i.e., urges and cravings) (see figure 2). These factors can increase a person’s vulnerability to relapse both by increasing his or her exposure to high-risk situations and by decreasing motivation to resist drinking in high-risk situations. Such positive outcome expectancies may become particularly salient in high-risk situations, when the person expects alcohol use to help him or her cope with negative emotions or conflict (i.e., when drinking serves as “self-medication”).

Specific Intervention Strategies

Marlatt and Gordon (1980, 1985) have described a type of reaction by the drinker to a lapse called the abstinence violation effect, which may influence whether a lapse leads to relapse. This reaction focuses on the drinker’s emotional response to an initial lapse and on the causes to which he or she attributes the lapse. People who attribute the lapse to their own personal failure are likely to experience guilt and negative emotions that can, in turn, lead to increased drinking as a further attempt to avoid or escape the feelings of guilt or failure.

The relationships between withdrawal, craving and relapse in substance use are complex and have been reviewed and discussed extensively elsewhere (e.g., Patten & Martin, 1996; Piasecki, 2006; Serre, Fatseas, Swendsen, & Auriacombe, 2015; Wray, Gass, & Tiffany, 2013). However, it is important to bear in mind for this review that abstinence violation effect the term ‘withdrawal’ may have a somewhat different meaning for behavioral addictions when compared with substance addictions. Unlike substance addictions, behavioral addictions do not involve direct contact with brain synapses through the introduction of an exogenous ligand, but instead alter endogenous ligand functions.

Thus, this perspective considers only a dichotomous treatment outcome—that is, a person is either abstinent or relapsed. In contrast, several models of relapse that are based on social-cognitive or behavioral theories emphasize relapse as a transitional process, a series of events that unfold over time (Annis 1986; Litman et al. 1979; Marlatt and Gordon 1985). According to these models, the relapse process begins prior to the first posttreatment alcohol use and continues after the initial use. This conceptualization provides a broader conceptual framework for intervening in the relapse process to prevent or reduce relapse episodes and thereby improve treatment outcome. The current review highlights multiple important directions for future research related to nonabstinence SUD treatment.

Many clients may never need to use their lapse-management plan, but adequate preparation can greatly lessen the harm if a lapse does occur. Another efficacy-enhancing strategy involves breaking down the overall task of behavior change into smaller, more manageable subtasks that can be addressed one at a time (Bandura 1977). Thus, instead of focusing on a distant end goal (e.g., maintaining lifelong abstinence), the client is encouraged to set smaller, more manageable goals, such as coping with an upcoming high-risk situation or making it through the day without a lapse.