Combatting the Abstinence Violation Effect

Laboratory studies have shown that patients with eating disorders often experience abnormal patterns of hunger and satiety over the course of a meal. Serotonin plays an important role in postingestive satiety, and appears to be important in regulation of mood and anxiety-related symptoms. Preliminary findings suggest that impaired function in central nervous system serotonergic pathways abstinence violation effect may contribute to binge eating and mood instability in bulimia nervosa. Therapeutic effects of antidepressant medications in bulimia nervosa are thought to be related to their capacity to restore more normal signaling patterns in serotonergic pathways. Similarly, twin studies have shown a higher concordance for the eating disorders in monozygotic twins in comparison to dizygotic twins.

These factors can increase a person’s vulnerability to relapse both by increasing his or her exposure to high-risk situations and by decreasing motivation to resist drinking in high-risk situations. Cognitive restructuring, or reframing, is used throughout the RP treatment process to assist clients in modifying their attributions for and perceptions of the relapse process. In particular, cognitive restructuring is a critical component of interventions to lessen the abstinence violation effect.

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

In so doing, the client learns that rather than building interminably until they become overwhelming, urges and cravings peak and subside rather quickly if they are not acted on. The client is taught not to struggle against the wave or give in to it, thereby being “swept away” or “drowned” by the sensation, but to imagine “riding the wave” on a surf board. Like the conceptualization of urges and cravings as the result of an external stimulus, this imagery fosters detachment from the urges and cravings and reinforces the temporary and external nature of these phenomena.

This lapse, in turn, can result in feelings of guilt and failure (i.e., an abstinence violation effect). The abstinence violation effect, along with positive outcome expectancies, can increase the probability of a relapse. There are two major types of high-risk situations, those with intrapersonal determinants, in which the person’s response is physical or psychological in nature, and interpersonal determinants, those that are influenced by other individuals or social networks.

Cognitive behavioural interventions in addictive disorders

Bargaining with yourself and actively planning to use the substance again are common behaviors in the mental relapse phase. Emotional relapse – Thoughts and behaviors set you up for a relapse, even though you are not thinking about using the substance. Isolation, suppressing your emotions, feeling anxious, or angry can all make you feel like you need that substance to cope. It looks and sounds like a highly technical term for something that most people can relate to – feeling guilty when you use a substance, like alcohol or marijuana, after promising yourself you won’t use it ever again. Additionally, abstinence violation effect can affect people differently, based on different factors in their lives. The individual’s reactions to the lapse and their attributions (of a failure) regarding the cause of lapse determine the escalation of a lapse into a relapse.

The “dynamic model of relapse” builds on several previous studies of relapse risk factors by incorporating the characterization of distal and proximal risk factors. Distal risks, which are thought to increase the probability of relapse, include background variables (e.g. severity of alcohol dependence) and relatively stable pretreatment characteristics (e.g. expectancies). 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). Combinations of precipitating and predisposing risk factors are innumerable for any particular individual and may create a complex system in which the probability of relapse is greatly increased. Although the RP model considers the high-risk situation the immediate relapse trigger, it is actually the person’s response to the situation that determines whether he or she will experience a lapse (i.e., begin using alcohol). A person’s coping behavior in a high-risk situation is a particularly critical determinant of the likely outcome.

Cognitive neuroscience of self-regulation failure

The article also presents studies that have provided support for the validity of the RP model. Although this is a common enough response, it is an impulse that psychologists, rehabilitation professionals, and treatment centers work hard to combat. Family studies have shown that there is an increased rate of eating disorders in first-degree relatives of individuals with anorexia nervosa and bulimia nervosa. Similarly, what is abstinence violation effect twin studies have shown a higher concordance for the eating disorders in monozygotic twins in comparison to dizygotic twins. These studies suggest that heritable biological characteristics contribute to the onset of the eating disorders, although the potential role of familial environmental factors must also be considered. The AVE was introduced into the substance abuse literature within the context of the “relapse process” (Marlatt & Gordon, 1985, p. 37).

Combatting the Abstinence Violation Effect

For instance, someone with alcohol use disorder may feel like they want a drink when out with friends at a favorite hangout. A second important factor and strategy in encouraging recovery is the recognition that a lapse is not the end. Lapsing once does not necessitate a waterfall of relapses, and a period of relapse does not dictate a lifelong dedication to addiction. Having healthy and effective coping strategies in place to anticipate a lapse or relapse is pivotal, because the likelihood of never again lapsing into an addictive behavior is often quite low.

Results showed that more internal, stable, and global attributions for the cause of the lapse and perceived loss of control were related significantly to concurrently reported relapse. The term relapse may be used to describe a prolonged return to substance use, whereas lapsemay be used to describe discrete, circumscribed… Those with only a few weeks of sobriety will not feel as bad as those with years under their belt. Not out of the same warped practicality mentioned above, but because they simply feel as if they are hopeless. This isn’t the only way in which our thinking might become twisted when we Sober House experience a lapse in sobriety.

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