Understanding the AVE is crucial for individuals in recovery and those focused on healthier lifestyle choices. Instead of surrendering to the negative spiral, individuals can benefit from reframing the lapse as a learning opportunity and teachable moment. 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. Jim is a recovering alcoholic who successfully abstained from drinking for several months. One abstinence violation effect day, when he was faced with a stressful situation, he felt overwhelmed, gave in to the urge, and had a drink.
4. Current status of nonabstinence SUD treatment
If supported in future studies, these results could be used to inform treatment planning for patients with alcoholism. To that end, an important feature of this study is the accessibility and clinical appeal of the drinking goal measure, which can be readily applied to a wide variety of treatment settings. Tailoring treatment approaches to patients’ goals, whether complete or conditional abstinence or controlled drinking may have positive results on treatment outcome.
Katie Witkiewitz
I have lost all that time,” which can trigger a self-destructive mindset and potentially lead to further relapse. In the multifaceted journey of overcoming addiction and living a healthier life, individuals often encounter a psychological phenomenon known as the abstinence violation effect (AVE). It sheds light on the challenges individuals face when attempting to maintain abstinence and how a single lapse can trigger a surge of negative emotions, potentially leading to a full relapse or a return to unhealthy living (Collins & Witkiewitz, 2013; Larimer, Palmer, & Marlatt, 1999). I’ve heard of AA meetings where a member with over 10 years of sobriety ends up drinking (let’s say as an attempt to cope with the loss of a loved one or other tragic event).
- As part of providing recovery-oriented counseling, counselors need to understand the concept of recovery capital and incorporate it into their practice by working with clients seeking recovery to help them identify, access, and build their own recovery capital.
- CP conceptualized the manuscript, conducted literature searches, synthesized the literature, and wrote the first draft of the manuscript.
- Ivori Zvorsky is an undergraduate student obtaining her major in psychology at the University of Richmond, USA.
The Effects of Drinking Goal on Treatment Outcome for Alcoholism
The debate between abstinence and non-abstinence approaches, specifically controlled drinking (CD), has remained a controversial topic in the alcoholism field since the 1960s (Davies, 1962; Miller & Caddy, 1977). As far as treatment outcomes are considered, there is no universally accepted definition of what constitutes successful CD. It has been suggested that CD, and more specifically a reduction in heavy drinking, has a number of clinical benefits that should be taken into consideration when discussing drinking goals (Gastfriend, Garbutt, Pettinati, & Forman, 2007).
Relapse Prevention
In contrast, individuals with greater SUD severity, who are more likely to have abstinence goals, generally have the best outcomes when working toward abstinence (Witkiewitz, 2008). Together, this suggests a promising degree of alignment between goal selection and probability of success, and it highlights the potential utility of nonabstinence treatment as an “early intervention” approach to prevent SUD escalation. Multiple versions of harm reduction psychotherapy for alcohol and drug use have been described in detail but not yet studied empirically. Consistent with the philosophy of harm reduction as described by Marlatt et al. (2001), harm reduction psychotherapy is accepting of a wide range of client goals, including risk reduction, moderation, and abstinence (of note, abstinence is conceptualized as consistent with harm reduction when it is a goal chosen by the client).
- Counselors should then use this self-awareness to address their biases and provide inclusive care.
- Maintain communication with recovery resource partners (e.g., if a counselor links a client to peer support services, the counselor should be available to the peer provider for consultation and feedback on how the client is doing).
- Relapse Prevention (RP) is another well-studied model used in both AUD and DUD treatment (Marlatt & Gordon, 1985).
- There is less research examining the extent to which moderation/controlled use goals are feasible for individuals with DUDs.
Cognitive behavioral therapy (CBT) for alcoholism has received empirical support since the 1980s (Marlatt & Gordon, 1985). CBT for alcohol use disorders is grounded in social-cognitive theory (Bandura, 1986) and employs skills training in order to help patients cope more effectively with substance use triggers, including life stressors (Longabaugh & Morgenstern, 1999; Morgenstern & Longabaugh, 2000). The ultimate goal of CBT is to provide the skills that can prevent a relapse and maintain drinking goals, whether they be abstinence or controlled drinking (Marlatt & Gordon, 1985; Marlatt & Witkiewitz, 2005). A recent meta-analysis of CBT for substance use disorders found support for a modest benefit of CBT over treatment as usual (Magill & Ray, 2009). Furthermore, one report using a trajectory analysis of the COMBINE study data found the Combined Behavioral Intervention (CBI), which is principally grounded in CBT, to reduce the risk of being in an “increasing to nearly daily drinking” trajectory.
- Instead, the literature indicates that most people with SUD do not want or need – or are not ready for – what the current treatment system is offering.
- The second, Combined Behavioral Intervention (CBI), consisted of up to twenty, 50-minute sessions which integrated aspects of cognitive behavioral therapy, 12-step facilitation, motivational interviewing, and involvement of support systems.
- As a data check, all outcomes presented in the primary COMBINE manuscript were replicated prior to any model testing for this study.
- This disinhibition of dietary restraint has been replicated numerous times 20,28 and demonstrates that dieters often eat a great deal after they perceive their diets to be broken.
On the other hand, if the reason for the violation is attributed to external, unstable, and/or local factors, such as an extremely tempting situation, then the individual is more likely to recover from the violation and get back onto the path of abstinence. Individuals with greater SUD severity tend to be most receptive to therapist input about goal selection (Sobell, Sobell, Bogardis, Leo, & Skinner, 1992). This suggests that treatment experiences and therapist input can influence participant goals over time, and there is value in engaging patients with non-abstinence goals in treatment. In the 1980s and 1990s, the HIV/AIDS epidemic prompted recognition of the role of drug use in disease transmission, generating new urgency around the adoption of a public health-focused approach to researching and treating drug use problems (Sobell & Sobell, 1995). The realization that HIV had been spreading widely among people who injected drugs in the mid-1980s led to the first syringe services programs (SSPs) in the U.S. (Des Jarlais, 2017). Early attempts to establish pilot SSPs were met with public outcry and were blocked by politicians (Anderson, 1991).
Summary of the COMBINE Study
The Abstinence Violation Effect is a concept originally introduced by psychologist Alan Marlatt in the context of treating substance abuse. It stems from the belief that individuals who establish strict rules of abstinence may be more vulnerable to relapse when faced with a violation of those rules. AVE can be observed in various areas, including addictions, dietary restrictions, and impulse control. As part of providing recovery-oriented counseling, counselors need to understand the concept of recovery capital and incorporate it into their practice by working with clients seeking recovery to help them identify, access, and build their own recovery capital.
- Taylor uses an app to watch her intake of calorie limit and does see positive outcomes to her new lifestyle.
- It is, however, most commonly used to refer to a resumption of substance use behavior after a period of abstinence from substances (Miller 1996).
- A recent qualitative study found that concern about missing substances was significantly correlated with not completing treatment (Zemore, Ware, Gilbert, & Pinedo, 2021).
- The debate between abstinence and non-abstinence approaches, specifically controlled drinking (CD), has remained a controversial topic in the alcoholism field since the 1960s (Davies, 1962; Miller & Caddy, 1977).
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Counselors and administrators can look for ways that this legislation can support enhanced program services. Some insurance providers and health plans require patients to obtain approval for certain types of care or medications prior to receiving them. Services and medications for the treatment of SUD have been subject to this requirement more frequently than other kinds of services, although some states are passing laws to change this.673 If a client’s insurance plan requires prior authorization, it may delay their ability to begin taking medication needed to treat OUD or AUD. Certain fee schedules make it difficult or impossible to be reimbursed for needed services. For instance, if an individual sees a primary care provider and an addiction specialist on the same day, both providers may not be able to obtain reimbursement.672 This may discourage, or even disincentivize, the use of integrated and multisystem care, which is fundamental to effective recovery-oriented services.
Stopping a Slip From Becoming a Relapse
Listing the outcome expectancies for the substance use and resolved behavior (e.g., reduced use of substances). Telephone check-ins and recovery management checkups (RMCs) are effective, proactive strategies for counselors to stay apprised of clients’ recovery status and intervene early in actual recurrence of use. Don’t just feel good about clients, but express positive feelings toward them (within clinical boundaries) to support their sense of worth. Limited research has looked at the effects of intersecting identities on SUD treatment.513 More is known about the associations between intersecting identities and substance use, information that is useful for counselors. Lack of specialized programs for people with co-occurring conditions, including individualized treatment plans that account for diverse literacy or cognitive capabilities. Be familiar with problematic behavioral issues other than substance use, such as problematic gambling and sexual behaviors.