A good clinician can recognize the signs of an impending AVE and help you to avoid it. Ecological momentary assessment, either via electronic device or interactive voice response methodology, could provide the data necessary to fully test the dynamic model of relapse19. In a study by McCrady evaluating the effectiveness of psychological interventions for alcohol use disorder such as Brief Interventions and Relapse Prevention was classified as efficacious23. Cognitive restructuring can be used to tackle cognitive errors such as the abstinence violation effect. Clients are taught to reframe their perception of lapses, to view them not as failures but as key learning opportunities resulting from an interaction between various relapse determinants, both of which can be modified in the future. Lapse management includes drawing a contract with the client to limit use, to contact the therapist as soon as possible, and to evaluate the situation for factors that triggered the lapse6.

• Treatment in this component involves describing the AVE, and working with the client to learn alternative coping skills for when a lapse occurs, such that a relapse is prevented.
• This does not mean that 12-step is an ineffective or counterproductive source of recovery support, but that clinicians should be aware that 12-step participation may make a client’s AVE more pronounced.
• Stages imply a readiness to change and therefore the abstinence violation effect TTM has been particularly relevant in the timing of interventions.
• In pretreatment DBT-SUD, the therapist also weaves in orientation to a number of other elements including treatment of SUDs and behavioral patterns that typically arise as a part of substance use (e.g., lying behaviors) and how those behaviors are targeted in DBT.
• Problem orientation must also be addressed in addition to these steps, and the efficacy of PST increases when problem orientation is addressed in addition to the other steps25,26.
• While relapse does not mean you can’t achieve lasting sobriety, it can be a disheartening setback in your recovery.

Cognitive therapy seeks to identify and challenge maladaptive thoughts and ideas such as I can never be 100% sober, the stress of my job makes me drink, if I only felt better and less stressed I would be able to stop drinking. The AVE was introduced into the substance abstinence violation effect definition abuse literature within the context of the “relapse process” (Marlatt & Gordon, 1985, p. 37). Relapse has been variously defined, depending on theoretical orientation, treatment goals, cultural context, and target substance (Miller, 1996; White, 2007).

Health practitioners

Role play, behavioural rehearsal and modeling are used to train patients in assertiveness. Patient is instructed not to provide explanations for abstinence so as to avoid counter arguments. Specific training steps to suit patients in the Indian setting have been described16,17.

Helping clients develop positive addictions or substitute indulgences (e.g. jogging, meditation, relaxation, exercise, hobbies, or creative tasks) also help to balance their lifestyle6. Global self-management strategy involves encouraging clients to pursue again those previously satisfying, nondrinking recreational activities. Early learning theories and later social cognitive and cognitive theories have had a significant influence on the formulation CBT for addictive behaviours. Theoretical constructs such as self-efficacy, appraisal, outcome expectancies related to addictions arising out these models have impacted treatment models considerably. Oxford English Dictionary defines motivation as “the conscious or unconscious stimulus for action towards a desired goal provided by psychological or social factors; that which gives purpose or direction to behaviour.

What Can Clinicians Do To Counteract the AVE?

Each experience of successful or unsuccessful coping with a high-risk situation builds up a greater or lesser sense of self-efficacy, which determines the future risk of relapse in similar circumstances. 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. The transition from slip or lapse to relapse involves the “abstinence violation effect,” which results from a state of cognitive dissonance regarding the nonabstinent behavior and the individual’s image of being abstinent. This dissonance can be reduced by either changing the behavior or changing the image, and characteristically in this population is resolved by the latter. Internal and stable attributes for the slip also lead to further lapse behavior. This model has received a good deal of empirical support and has the merit of dismantling the process of relapse and exploring subjective and cognitive variables in a manner that has important treatment implications.