Relapse and the Hidden Dangers Behind One Drink Won’t Hurt

Detailed discussions of relapse in relation to NDST and catastrophe theory are available elsewhere 10,31,34. AVE occurs when someone who is striving for abstinence from a particular behavior or substance experiences a setback, such as a lapse or relapse. 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). It can impact someone who is trying to be abstinent from alcohol and drug use in addition to someone trying to make positive changes to their diet, exercise, and other aspects of their lives. Rather, when people with SUD are surveyed about reasons they are not in treatment, not being ready to stop using substances is consistently the top reason cited, even among individuals who perceive a need for treatment (SAMHSA, 2018, 2019a).

2. Established treatment models compatible with nonabstinence goals

A basic assumption is that relapse events are immediately preceded by a high-risk situation, broadly defined as any context that confers vulnerability for engaging in the target behavior. Examples of high-risk contexts include emotional or cognitive states (e.g., negative affect, diminished self-efficacy), environmental contingencies (e.g., conditioned drug cues), or physiological states (e.g., acute withdrawal). Although some high-risk situations appear nearly universal across addictive behaviors (e.g., negative affect; 25), high-risk situations are likely to vary across behaviors, across individuals, and within the same individual over time 10. 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 1970s, the pioneering work of a small number of alcohol researchers began to challenge the existing abstinence-based paradigm in AUD treatment research. They found that their controlled drinking intervention produced significantly better outcomes compared to usual treatment, and that about a quarter of the individuals in this condition maintained controlled drinking for one year post treatment (Sobell & Sobell, 1973).

How The Abstinence Violation Effect Impacts Long-Term Recovery

By reducing the emotional weight of negative experiences more quickly than positive ones, this bias helps us move on from past adversities and fosters psychological resilience. These rose-colored abstinence violation effect glasses are known as the fading effect bias, a psychological phenomenon in which the emotional impact of negative memories diminishes faster than that of positive ones. Over time, we tend to remember positive experiences more vividly and in greater detail than negative ones.

• The data demonstrate the reality of AVE reactions, but do not support hypotheses about their structure or determinants.
• Multiple theories of motivation for behavior change support the importance of self-selection of goals in SUD treatment (Sobell et al., 1992).
• 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.
• These patterns can be actively identified and corrected, helping participants avoid lapses before they occur and continue their recovery from substance use disorder.
• For example, offering nonabstinence treatment may provide a clearer path forward for those who are ambivalent about or unable to achieve abstinence, while such individuals would be more likely to drop out of abstinence-focused treatment.
• It is, however, most commonly used to refer to a resumption of substance use behavior after a period of abstinence from substances (Miller 1996).

Seek Support

With the right help, preparation, and support, you and your loved ones can still continue to build a long-lasting recovery from substance abuse. These patterns can be actively identified and corrected, helping participants avoid lapses before they occur and continue their recovery from substance use disorder. In other words, AVE describes the thoughts, feelings, and actions a person goes through after they make a mistake and have a drink or abuse a substance, despite trying to quit.

ABSTINENCE VIOLATION EFFECT (AVE)

The merger of mindfulness and cognitive-behavioral approaches is appealing from both theoretical and practical standpoints 115 and MBRP is alcohol rehab 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.

Theoretical and empirical rationale for nonabstinence treatment

• Identify triggers that may have contributed to the relapse and develop strategies to address them proactively in the future.
• SD assisted with conceptualization of the review, and SD and KW both identified relevant literature for the review and provided critical review, commentary and revision.
• Instead of surrendering to the negative spiral, individuals can benefit from reframing the lapse as a learning opportunity and teachable moment.
• Similar to the reward thought, you may have another common thought after a period of sobriety.
• Like the Sobells, Marlatt showed that reductions in drinking and harm were achievable in nonabstinence treatments (Marlatt & Witkiewitz, 2002).
• AVE can be observed in various areas, including addictions, dietary restrictions, and impulse control.

Thus, while it is vital to empirically test nonabstinence treatments, implementation research examining strategies to obtain buy-in from agency leadership may be just as impactful. Harm reduction therapy has also been applied in group format, mirroring the approach and components of individual harm reduction psychotherapy but with added focus on building social support and receiving feedback and advice from peers (Little, 2006; Little & Franskoviak, 2010). These groups tend to include individuals who use a range of substances and who endorse a range of goals, including reducing substance use and/or substance-related harms, controlled/moderate use, and abstinence (Little, 2006). Additionally, some groups target individuals with co-occurring psychiatric disorders (Little, Hodari, Lavender, & Berg, 2008). Important features common to these groups include low program barriers (e.g., drop-in groups, few rules) and inclusiveness of clients with difficult presentations (Little & Franskoviak, 2010). Expectancy research has recently started examining the influences of implicit cognitive processes, generally defined as those operating automatically or outside conscious awareness 54,55.

• Finally, an intriguing direction is to evaluate whether providing clients with personalized genetic information can facilitate reductions in substance use or improve treatment adherence 110,111.
• In Europe, about half (44–46%) of individuals seeking treatment for AUD have non-abstinence goals (Haug & Schaub, 2016; Heather, Adamson, Raistrick, & Slegg, 2010).
• Lack of consensus around target outcomes also presents a challenge to evaluating the effectiveness of nonabstinence treatment.