Abstinence Violation Effect AVE
Other motivational enhancement components, such as the decisional balance, are highlighted to reinforce the continued abstinence. For example, reviewing the pros of quitting may be helpful to reinforce current abstinence, and reviewing the cons of quitting may raise clients’ awareness regarding potential risky situations so they may plan ways to avoid future lapses and relapses [55]. Self-help typically refers to the provision of structured materials that assist individuals in making a quit attempt and sustaining abstinence without significant assistance from a health care professional or other formalized support [43]. Self-help interventions may include written, video, audio-based, telephone-based, or computer-based materials but do not typically involve face-to-face social interventions. A recent meta-analysis examining the effects of self-help over 15 studies involving pregnant women showed that self-help interventions nearly doubled the odds of maintaining abstinence and preventing relapse over the longer-term compared with standard care [44•].
This standard persisted in SUD treatment even as strong evidence emerged that a minority of individuals who receive 12-Step treatment achieve and maintain long-term abstinence (e.g., Project MATCH Research Group, 1998). In a 2013 Cochrane review which also discussed regarding relapse prevention in smokers the authors concluded that there is insufficient evidence to support the use of any specific behavioural intervention to help smokers who have successfully quit for a short time to avoid relapse. The verdict is strongest for interventions focused on identifying and resolving tempting situations, as most studies were concerned with these24. The results of the Sobell’s studies challenged the prevailing understanding of abstinence as the only acceptable outcome for SUD treatment and raised a number of conceptual and methodological issues (e.g., the Sobell’s liberal definition of controlled drinking; see McCrady, 1985). A “controlled drinking controversy” followed, in which the Sobells as well as those who supported them were publicly criticized due to their claims about controlled drinking, and the validity of their research called into question (Blume, 2012; Pendery, Maltzman, & West, 1982).
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When you are feeling overwhelmed, your brain may unconsciously crave drugs as a way to help you feel better. But you may have the thought that you need the drug or alcohol to help get you through the tough situation. Unconscious cravings may turn into the conscious thought the abstinence violation effect refers to that it is the only way you can cope with your current situation. A physical relapse occurs when you take your first drug or drink after achieving sobriety. Marlatt differentiates between slipping into abstinence for the first time and totally abandoning the goal.
- It sheds light on the challenges individuals face when attempting to maintain abstinence and how a single lapse can trigger a surge of negative emotions, potentially leading to a full relapse or a return to unhealthy living (Collins & Witkiewitz, 2013; Larimer, Palmer, & Marlatt, 1999).
- In its original form, RP aims to reduce risk of relapse by teaching participants cognitive and behavioral skills for coping in high-risk situations (Marlatt & Gordon, 1985).
- Many researchers define relapse as a process rather than as a discrete event and thus attempt to characterize the factors contributing to relapse3.
- 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.
- In the smoking cessation literature, smoking reduction has been described as a harmreduction approach for smokers who are unwilling to quit [35], and also as a means of “cuttingdown toquit” for smokers who are interested in quitting but not prepared for an abrupt smoking stop [36•].
Relapse prevention programmes addressing not just the addictive behaviour, but also factors that contribute to it, thereby decreasing the probability of relapse. Addictive behaviours are characterized by a high degree of co-morbidity and these may interfere with treatment response. Relapse prevention (RP) is a cognitive behavioural treatment program, based on the relapse prevention model27,28. A psycho-educational self-management approach is adopted in this program and the client is trained in a variety of coping skills and responses. The model incorporates the stages of change proposed by Procahska, DiClement and Norcross (1992) and treatment principles are based on social-cognitive theories11,29,30.
Review of Interventions Preventing Relapse to Smoking
A careful functional analysis and identification of dysfunctional beliefs are important first steps in CBT. The hallmark of CBT is collaborative empiricism and describes the nature of therapeutic relationship. RP has also been used in eating disorders in combination with other interventions such as CBT and problem-solving skills4. Helping clients develop positive addictions or substitute indulgences (e.g. https://ecosoberhouse.com/ jogging, meditation, relaxation, exercise, hobbies, or creative tasks) also help to balance their lifestyle6. Disclosure In 2005, Dr. Marlatt served as a consultant on the development of smoking cessation materials for Philip Morris. These patterns can be actively identified and corrected, helping participants avoid lapses before they occur and continue their recovery from substance use disorder.
Future research must test the effectiveness of nonabstinence treatments for drug use and address barriers to implementation. Here we provide a brief review of existing models of nonabstinence psychosocial treatment, with the goal of summarizing the state of the literature and identifying notable gaps and directions for future research. Previous reviews have described nonabstinence pharmacological approaches (e.g., Connery, 2015; Palpacuer et al., 2018), which are outside the scope of the current review.
