An abstinence violation increases the likelihood that a single lapse will lead to a full relapse into negative behavioral or mental health symptoms if abstinence violation effects are present. Those who break sobriety with a single drink or use of a drug are at a high risk of a full relapse into addiction. When one returns to substance use after a period of abstinence, they experience a negative cognitive and affective reaction known as an abstinence violation effect in psychotherapy. An individual may experience uncontrollable, stable attributions and feelings of shame and guilt after relapsing as a result of AVE. The initial transgression of problem behaviour after a quit attempt is defined as a “lapse,” which could eventually lead to continued transgressions to a level that is similar to before quitting and is defined as a “relapse”. Another possible outcome of a lapse is that the client may manage to abstain and thus continue to go forward in the path of positive change, “prolapse”4.
Self-control and coping responses
Seemingly irrelevant decisions (SIDs) are those behaviours that are early in the path of decisions that place the client in a high-risk situation. For example, if the client understands that using alcohol in the day time triggers a binge, agreeing abstinence violation effect for a meeting in the afternoon in a restaurant that serves alcohol would be a SID5. Miller and Hester reviewed more than 500 alcoholism outcome studies and reported that more than 75% of subjects relapsed within 1 year of treatment1.
2. Controlled drinking
Rather, remember that relapse is a natural part of the journey and an opportunity for growth. When people don’t have the proper tools to navigate the challenges of recovery, the AVE is more likely to occur, which can make it difficult to achieve long-term sobriety. There are several factors that can contribute to the development of the AVE in people recovering from addiction.
Genetic influences on treatment response and relapse
- At this stage, a person might not even think about using substances, but there is a lack of attention to self-care, the person is isolating from others, and they may be attending therapy sessions or group meetings only intermittently.
- High-risk situations are related to both the client’s general and specific coping abilities.
- The myths related to substance use can be elicited by exploring the outcome expectancies as well as the cultural background of the client.
Next, we review other established SUD treatment models that are compatible with non-abstinence goals. We focus our review on two well-studied approaches that were initially conceptualized – and have been frequently discussed in the empirical literature – as client-centered alternatives to abstinence-based treatment. 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.
Cognitive Behavioural model of relapse
- Traditional alcoholism treatment approaches often conceptualize relapse as an end-state, a negative outcome equivalent to treatment failure.
- The risk of relapse is greatest in the first 90 days of recovery, a period when, as a result of adjustments the body is making, sensitivity to stress is particularly acute while sensitivity to reward is low.
- Marlatt’s work inspired the development of multiple nonabstinence treatment models, including harm reduction psychotherapy (Blume, 2012; Denning, 2000; Tatarsky, 2002).
- However, this approach is consistent with the goal of increasing treatment utilization by reaching those who may not otherwise present to treatment.
- Specifically, those participants who had a greater belief in the disease model of alcoholism and a higher commitment to absolute abstinence (who were most likely to experience feelings of guilt over their lapse) were most likely to experience relapse in that study.
- The myth that we need to erase all past mistakes and start with a “blank slate” if we want to live a healthful life is dangerous because it keeps us striving for fad fitness trends rather than consistency.
- It is in accord with the evidence that the longer a person goes without using, the weaker the desire to use becomes.
‘This Time Will Be Different’
- As an example, when out with friends at their favorite hangout, someone with alcohol use disorder may feel like having a drink.
- 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).
- For instance, twelve-month relapse rates following alcohol or tobacco cessation attempts generally range from 80-95% [1,4] and evidence suggests comparable relapse trajectories across various classes of substance use [1,5,6].
- In Europe, about half (44–46%) of individuals seeking treatment for AUD have non-abstinence goals (Haug & Schaub, 2016; Heather, Adamson, Raistrick, & Slegg, 2010).
- But sometimes people don’t even realize they took fentanyl in counterfeit Adderall or Xanax pills or while smoking meth.
- The RP model developed by Marlatt [7,16] provides both a conceptual framework for understanding relapse and a set of treatment strategies designed to limit relapse likelihood and severity.