Abstinence Violation Effect AVE What It Is & Relapse Prevention Strategies
One helpful cognitive strategy in the initial phase of CBT includes using the Advantage/disadvantage technique with the patient29. The therapist and patient collaboratively review the advantages/disadvantages of engaging in substance use or addictive behaviour. Following the initial introduction of the RP model in the 1980s, its widespread application largely outpaced efforts to systematically validate the model and test its underlying assumptions. Given this limitation, the National Institutes on Alcohol Abuse and Alcoholism (NIAAA) sponsored the Relapse Replication and Extension Project (RREP), a multi-site study aiming to test the reliability and validity of Marlatt’s original relapse taxonomy.
What Can Clinicians Do To Counteract the AVE?
We first provide an overview of the development of abstinence and nonabstinence approaches within the historical context of SUD treatment in the U.S., followed by an evaluation of literature underlying the theoretical and empirical rationale for nonabstinence treatment approaches. Lastly, we review existing models of nonabstinence psychosocial treatment for SUD https://minnesotadigest.com/top-5-advantages-of-staying-in-a-sober-living-house/ among adults, with a special focus on interventions for drug use, to identify gaps in the literature and directions for future research. We identify a clear gap in research examining nonabstinence psychosocial treatment for drug use disorders and suggest that increased research attention on these interventions represents the logical next step for the field.
- However, it’s important to recognize that no one gets through life without emotional pain.
- There is also a need for updated research examining standards of practice in community SUD treatment, including acceptance of non-abstinence goals and facility policies such as administrative discharge.
- We first provide an overview of the development of abstinence and nonabstinence approaches within the historical context of SUD treatment in the U.S., followed by an evaluation of literature underlying the theoretical and empirical rationale for nonabstinence treatment approaches.
- One is to help clients identify warning signs such as on-going stress, seemingly irrelevant decisions and significant positive outcome expectancies with the substance so that they can avoid the high-risk situation.
- One helpful cognitive strategy in the initial phase of CBT includes using the Advantage/disadvantage technique with the patient29.
Empirical findings relevant to the RP model
However, despite findings that coping can prevent lapses there is scant evidence to show that skills-based interventions in fact lead to improved coping [75]. Central to the RP model is the role of cognitive factors in determining relapse liability. For example, successful navigation of high-risk situations may increase self-efficacy (one’s perceived capacity to cope with an impending situation or task; [26]), in turn decreasing relapse probability.
- 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.
- In particular, given recent theoretical revisions to the RP model, as well as the tendency for diffuse application of RP principles across different treatment modalities, there is an ongoing need to evaluate and characterize specific theoretical mechanisms of treatment effects.
- In addition, specific cognitive-behavioral skills training approaches, such as relaxation training, stress-management, and time management, can be used to help clients achieve greater lifestyle balance.
- Relapse prevention initially evolved as a calculated response to the longer-term treatment failures of other therapies.
- 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.
Integrating implicit cognition and neurocognition in relapse models
Others high risk situations include physical states such as hunger, thirst, fatigue, testing personal control, responsivity to substance cues (craving). The RP model highlights the significance of covert antecedents such as lifestyle patterns craving in relapse. Modifying social and environmental antecedents and consequences another approach to working with addictive behaviours18.
Emerging topics in relapse and relapse prevention
The RP model of relapse is centered around a detailed taxonomy of emotions, events, and situations that can precipitate both lapses and relapses to drinking. This taxonomy includes both immediate relapse determinants and covert antecedents, which indirectly increase a person’s vulnerability to relapse. Based on the classification of relapse determinants and high-risk situations proposed in the RP model, numerous treatment components have been developed that are aimed at helping the recovering alcoholic cope with high-risk situations. Top 5 Advantages of Staying in a Sober Living House The results of recent research, particularly the RREP study, likely will lead to modifications of the original RP model, particularly with regard to the assessment of high-risk situations as well as the conceptualization of covert and immediate antecedents of relapse. Overall, however, research findings support both the overall model of the relapse process and the effectiveness of treatment strategies based on the model. Counteracting the drinker’s misperceptions about alcohol’s effects is an important part of relapse prevention.
- 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.
- For instance, whereas traditional models often attribute relapse to endogenous factors like cravings or withdrawal–construed as symptoms of an underlying disease state–cognitive-behavioral theories emphasize contextual factors (e.g., environmental stimuli and cognitive processes) as proximal relapse antecedents.
- For example, in one study testing the predictive validity of a measure of treatment readiness among non-treatment-seeking people who use drugs, the authors found that the only item in their measure that significantly predicted future treatment entry was motivation to quit using (Neff & Zule, 2002).
- Substance use and its immediate consequences (e.g., impaired decision-making, the AVE) are additional phasic processes that are set into motion once a lapse occurs.
- Given low treatment engagement and high rates of health-related harms among individuals who use drugs, combined with evidence of nonabstinence goals among a substantial portion of treatment-seekers, testing nonabstinence treatment for drug use is a clear next step for the field.
- In the RP model, the client is encouraged to adopt the role of colleague and to become an objective observer of his or her own behavior.
- According to these models, the relative balance between controlled (explicit) and automatic (implicit) cognitive networks is influential in guiding drug-related decision making [54,55].
