Abstinence Violation Effect AVE

From this standpoint, urges/cravings are labeled as transient events that need not be acted upon reflexively. This approach is exemplified by the “urge surfing” technique 115, whereby clients are taught to view urges as analogous to an ocean wave that rises, crests, and diminishes. Rather than being overwhelmed by the wave, the goal is to “surf” its crest, attending to thoughts and sensations as the urge peaks and subsides. In addition to these areas, which already have initial empirical data, we predict that we could learn significantly more about the relapse process using experimental manipulation to test specific aspects of the cognitive-behavioral model of relapse. Thus, one could test whether increasing self-efficacy in an experimental design is related to better treatment outcomes.

Urge management techniques

Broadly speaking, there are at least three primary contexts in which genetic variation could influence liability for relapse during or following treatment. First, in the context of pharmacotherapy interventions, relevant genetic variations can impact drug pharmacokinetics or pharmacodynamics, thereby moderating treatment response (pharmacogenetics). Second, the likelihood of abstinence following a behavioral or pharmacological intervention can be moderated by genetic influences on metabolic processes, receptor activity/expression, and/or incentive value specific to the addictive substance in question. Most notably, we provide a recent update of the RP literature by focusing primarily on studies conducted within the last decade.

Day Trippin’

• These instructions reiterate the importance of stopping alcohol consumption and (safely) leaving the lapse-inducing situation.
• They are the result of a series of events occurring over the course of time, explains psychologist Alan Marlatt, Ph.D.
• Proximal risks actualize, or complete, the distal predispositions and include transient lapse precipitants (e.g. stressful situations) and dynamic individual characteristics (e.g. negative affect, self-efficacy).

Preventing relapse or minimizing its extent is therefore a prerequisite for any attempt to facilitate successful, long-term changes in addictive behaviors. Despite precautions and preparations, many clients committed to abstinence will experience a lapse after initiating abstinence. Lapse-management strategies focus on halting the lapse and combating the abstinence violation effect to prevent an uncontrolled relapse episode. Lapse management includes contracting with the client to limit the extent of use, to contact the therapist as soon as possible after the lapse, and to evaluate the situation for clues to the factors that triggered the lapse.

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Recognizing the factors that contributed to the lapse, such as stressors or triggers, helps individuals to develop strategies and techniques to navigate similar challenges in the future. Several studies over the past two decades have evaluated the reliability and predictive validity2 of the RP model as well as the efficacy of treatment techniques based on this model. One recent large-scale research effort assessing the RP model was the Relapse Replication and Extension Project (RREP), which was funded by the National Institute on Alcohol Abuse and Alcoholism (Lowman et al. 1996). This collaborative research project evaluated the reliability of raters’ categorizations of high-risk situations using Marlatt’s taxonomy and assessed whether a prior situation could predict future lapse episodes. In one clinical intervention based on https://ecosoberhouse.com/ 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. This imagery technique is known as “urge surfing” and refers to conceptualizing the urge or craving as a wave that crests and then washes onto a beach.

Directions for Future Research

Marlatt and Gordon (1985) have proposed that the covert antecedent most strongly related to relapse risk involves the degree of balance in the person’s life between perceived external demands (i.e., “shoulds”) and internally fulfilling or enjoyable activities (i.e., “wants”). In the absence of other non-drinking pleasurable activities, the person may view drinking as the only means of obtaining pleasure or escaping pain. In many cases, initial lapses occur in high-risk situations that are completely unexpected and for which the drinker is often unprepared. In relapse “set ups,” however, it may be possible to identify a series of covert decisions or choices, each of them seemingly inconsequential, which in combination set the person up for situations with overwhelmingly high risk.

Integrating implicit cognition and neurocognition in relapse models

• Additionally, lab-based studies will be needed to capture dynamic processes involving cognitive/neurocognitive influences on lapse-related phenomena.
• Although withdrawal is usually viewed as a physiological process, recent theory emphasizes the importance of behavioral withdrawal processes 66.
• For instance, genetic factors could influence relapse in part via drug-specific cognitive processes.
• Thus, whereas tonic processes can determine who is vulnerable for relapse, phasic processes determine when relapse occurs 8,31.

One of the key features of the AVE is its potential to trigger a downward spiral of further relapse and continued substance use. Taylor may think, “All that good work down the drain, I am never going to be able to keep this up for my life.” Like Jim, this may also trigger a negative mindset and a return to unhealthy eating and a lack of physical exercise. This is an open-access report distributed under the terms of the Creative Commons Public Domain License.

Specific intervention strategies include helping the abstinence violation effect refers to the person identify and cope with high-risk situations, eliminating myths regarding a drug’s effects, managing lapses, and addressing misperceptions about the relapse process. Other more general strategies include helping the person develop positive addictions and employing stimulus-control and urge-management techniques. The most promising pharmacogenetic evidence in alcohol interventions concerns the OPRM1 A118G polymorphism as a moderator of clinical response to naltrexone (NTX).

Learn From Relapse

The RP model also incorporates numerous specific and global intervention strategies that allow therapist and client to address each step of the relapse process. Global strategies comprise balancing the client’s lifestyle and helping him or her develop positive Sober living house addictions, employing stimulus control techniques and urge-management techniques, and developing relapse road maps. Covert antecedents and immediate determinants of relapse and intervention strategies for identifying and preventing or avoiding those determinants. If stressors are not balanced by sufficient stress management strategies, the client is more likely to use alcohol in an attempt to gain some relief or escape from stress. This reaction typically leads to a desire for indulgence that often develops into cravings and urges. Two cognitive mechanisms that contribute to the covert planning of a relapse episode—rationalization and denial—as well as apparently irrelevant decisions (AIDs) can help precipitate high-risk situations, which are the central determinants of a relapse.

Moreover, people who have coped successfully with high-risk situations are assumed to experience a heightened sense of self-efficacy (i.e., a personal perception of mastery over the specific risky situation) (Bandura 1977; Marlatt et al. 1995, 1999; Marlatt and Gordon 1985). Conversely, people with low self-efficacy perceive themselves as lacking the motivation or ability to resist drinking in high-risk situations. 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 CBT for addictive behaviours cognitive strategies are supported by several behavioural strategies such as coping skills. 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.

Normalize Relapse

Consistent with the broader literature, it can be anticipated that most genetic associations with relapse outcomes will be small in magnitude and potentially difficult to replicate. It is inevitable that the next decade will see exponential growth in this area, including greater use of genome-wide analyses of treatment response 109 and efforts to evaluate the clinical utility and cost effectiveness of tailoring treatments based on pharmacogenetics. 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.