The Abstinence Violation Approach Non 12 Step Drug Rehab and Alcohol Treatment

As seen in Rajiv’s case illustration, internal (social anxiety, craving) and external cues (drinking partner, a favourite brand of drink) were identified as triggers for his craving. Subsequently inadequate coping and lack of assertiveness and low self-efficacy maintained his drinking. The following section presents a brief overview of some of the major approaches to managing addictive behaviours.

Our hopelessness and our instinctive desire to give up were spot-on, or else we would be happy all the time. Giving up on sobriety should never feel like a justified response to vulnerability. Looking back does have its benefits in that it helps us identify weaknesses in our program. The problem is that abstinence violation effect magnifies these weaknesses and prevents us from seeking solutions. Our first instinct should be to figure out a relapse prevention plan that addresses the faults we have identified.

Understand The Relapse Process

Vertava Health offers 100% confidential substance abuse assessment and treatment placement tailored to your individual needs. Marlatt’s relapse prevention model also identifies certain factors called covert antecedents which don’t stand out as clearly. Examples include denial, rationalization of why it’s okay to use (i.e. to reduce stress), and/or urges and cravings. My gratitude to those that helped me at Gerstein as the years go by—I can look back and think about those times and actually be so thankful and grateful for the opportunities that I’ve had because of it. Those are things that helped me appreciate what other people are going through.

Despite significant empirical support for nonabstinence alcohol interventions, there is a clear gap in research examining nonabstinence psychosocial treatment for drug use disorders. Future research must test the effectiveness of nonabstinence treatments for drug use and address barriers to implementation. Marlatt and Gordon’s (1985) model of the relapse process in addictive disorders has had a major impact in the field of relapse prevention since the late 1980s.

What Is the Abstinence Violation Effect, and How Do I Get Over It?

In sum, the current body of literature reflects multiple well-studied nonabstinence approaches for treating AUD and exceedingly little research testing nonabstinence treatments for drug use problems, representing a notable gap in the literature. Multiple versions of harm reduction psychotherapy for alcohol and drug use have been described in detail but not yet studied empirically. However, to date there have been no published empirical trials testing the effectiveness of the approach. Mental health support should be available through a low-barrier health support system rather than law enforcement. In particular, the goal of such a low-barrier system is to provide easy, timely, and equitable access to quality health services and support for everyone within the community—with minimal requirements for connection and entry. Marginalized communities, such as 2SLGBTQ+, Black, Indigenous, and racialized people have specific generational and lifelong experiences of discrimination and exclusion in health and social systems that too often resulted in over-policing and over-incarceration.

Relapse Prevention (RP) is another well-studied model used in both AUD and DUD treatment (Marlatt & Gordon, 1985). 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). More recent versions of RP have included mindfulness-based techniques (Bowen, Chawla, & Marlatt, 2010; Witkiewitz et al., 2014). The RP model has been studied among individuals with both AUD and DUD (especially Cocaine Use Disorder, e.g., Carroll, Rounsaville, & Gawin, 1991); with the largest effect sizes identified in the treatment of AUD (Irvin, Bowers, Dunn, & Wang, 1999). As a newer iteration of RP, Mindfulness-Based Relapse Prevention (MBRP) has a less extensive research base, though it has been tested in samples with a range of SUDs (e.g., Bowen et al., 2009; Bowen et al., 2014; Witkiewitz et al., 2014). 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.

ABSTINENCE VIOLATION EFFECT (AVE)

For more than 30 years, this community-based service provider has offered communities in Toronto safe, humane, equity-based crisis services. Gerstein Crisis Centre provides free and confidential 24/7 tailored support services to individuals experiencing a mental health and/or substance use crisis, including thoughts of suicide, all of which may be exacerbated by or emanate from trauma, housing insecurity, and poverty, abstinence violation effect definition among other things. Quite frankly, studies that have attempted to look at lapse and relapse rates across different substances have discrepant findings because the terms are often defined differently. In addition, many individuals in recovery consider a single slip as a full-blown relapse. In CBT for addictive behaviours cognitive strategies are supported by several behavioural strategies such as coping skills.

These properties of the abstinence violation effect also apply to individuals who do not have a goal to abstain, but instead have a goal to restrict their use within certain self-determined limits. The limit violation effect describes what happens when these individuals fail to restrict their use within their predetermined limits and the subsequent effects of this failure. These individuals also experience negative emotions similar to those experienced by the abstinence violators and may also drink more to cope with these negative emotions. Cognitive dissonance also arises, and attributions are then made for the violation.

Client is taught that overcoming the problem behaviour is not about will power rather it has to do with skills acquisition. Another technique is that the road to abstinence is broken down to smaller achievable targets so that client can easily master the task enhancing self-efficacy. Also, therapists can provide positive feedback of achievements that the client has been able to make in other facets of life6.

• Marlatt and Gordon (1985) contend that individuals’ reactions to the initial slip and their attributions regarding the cause of the slip are the determining factors in the escalation of a lapse or setback into a full-blown relapse.
• Approach coping may involve attempts to accept, confront, or reframe as a means of coping, whereas avoidance coping may include distraction from cues or engaging in other activities.
• These differing definitions make the notion of a relapse rather vague, but sticking to the above traditional notions of a slip or lapse versus a full-blown relapse is most likely the only concrete solution to defining these behaviors.
• When abstinence is violated, individuals typically also have an emotional response consisting of guilt, shame, hopelessness, loss of control, and/or a sense of failure; they may use drugs or alcohol in an attempt to cope with the negative feelings that resulted from their abstinence violation.