What Is The Abstinence Violation Effect?

Medically reviewed by

Joseph Sitarik, DO

February 4, 2019

What Is The Difference Between A Lapse And Relapse?

In order to understand AVE, it is important to realize the difference between a lapse and relapse. Again, many experts agree that a one-time lapse into using drugs or alcohol does not equally relapse. Relapse occurs when this behavior accelerates back into prolonged and compulsive patterns of drug abuse. Despite this, lapsing is still a risk factor and makes a person more prone to relapse.

How Does Relapse Occur?

While some assert that relapse occurs after the first sip of alcohol or use of another drug, certain scientists believe it is a process which more closely resembles a domino effect. Social-cognitive and behavioral theories believe relapse begins before the person actually returns to substance abuse.

While a person may physically abstain from using drugs or alcohol, their thoughts and emotions may have already returned to substance abuse. This school of thought is heavily based on Marlatt’s cognitive-behavioral model. This model asserts that full-blown relapse is a transitional process based on a combination of factors.

The following states are considered immediate triggers of relapse:

• Exposure to high-risk situations: These include: negative emotional states, interpersonal conflicts (arguments, etc.), social/peer pressure, witnessing drugs and/or alcohol used in a positive light (social functions), and exposure to substance cues or stimuli.
• Inability to cope: What actually leads a person to lapse or slip into using again is how they respond to these circumstances (i.e. if they effectively cope).
• Outcome expectancies: Some people begin to focus on how they believe alcohol or drugs could positively effect their life (i.e. pleasure or a means of escape). In doing so, they often ignore the negative outcomes.

The abstinence violation effect is also considered an immediate factor of relapse.

Marlatt’s relapse prevention model also identifies certain factors called covert antecedents which don’t stand out as clearly. Examples include denial, rationalization of why it’s okay to use (i.e. to reduce stress), and/or urges and cravings.

How Does The Abstinence Violation Effect Occur?

How does a lapse transition into relapse? As we’ve previously noted, it stems from the individual’s reaction to the lapse. “Relapse Prevention: An Overview of Marlatt’s Cognitive-Behavioral Model” suggests that there are three ways a person might respond in this situation. These include by:

• Blaming the lapse on personal failures, which then creates a sense of guilt and negative emotions.
• Believing the lapse is due to unchangeable factors like a lack of willpower or an inability to stop using.
• Realizing the lapse occurs because they cannot adequately cope with the high-risk situation at hand.

This model notes that those who have the latter mindset are proactive and strive to learn from their mistakes. To do so, they adapt their coping strategies to better deal with future triggers should they arise. This protects their sobriety and enhances their ability to protect themselves from future threats of relapse.

Contrasting this, the aforementioned negative mindsets can lead to a cycle of blame and shame. Instead of looking at the slip as an opportunity to grow and learn, a person lets it color the way they think about themselves. An individual who believes they’ve failed and violated their sobriety goals may begin to think that they’re not good enough to be considered a true abstainer.

These negative thoughts fuel a dangerous cycle fed on hopelessness and more guilt. In order to cope or avoid these damaging thoughts, these individuals turn back to drugs or alcohol to numb the pain. Others may continue using because they believe they’ve already lost the battle. This doesn’t have to be true.

How Do You Prevent The Abstinence Violation Effect?

Creating, implementing, and adhering to a relapse prevention plan helps to protect your sobriety and prevent the AVE response. While you can do this on your own, we strongly suggest you seek professional help. A good clinician can recognize the signs of an impending AVE and help you to avoid it.

On the other hand, if you’ve already lapsed, the article asserts that the clinician should help you to recover from it by:

• Re-framing the lapse. This helps you to understand how and why certain situations influenced you and remind you that you have the power to control lapsing.
• Taking you through the lapse step-by-step to understand how you could prevent it in the future.
• Pointing out positive coping skills that you already have. This helps to increase a person’s self-efficacy (the belief in your ability to succeed and overcome).
• Guiding a person in developing even more coping skills for future high-risk encounters.
• Assessing “whether clients are coping adequately with the negative affective component of the AVE, which may otherwise precipitate future lapses or relapses.”

Time magazine writes that Marlatt (the scientist behind the model) encourages people to cope by “urge surfing.” The magazine quotes his explanation of this: “The urge is like a wave,” he says. “It goes up and down. You don’t try to get rid of it, but accept it and let it pass.”

Having a solid support system of friends and family who are positive influences can help you to remain steady within your recovery. Access to aftercare support and programs can also help you to avoid and recover from the AVE.

A Good Treatment Program Can Help You To Avoid The Abstinence Violation Effect

Prevention of the abstinence violation effect can begin in treatment. Positive coping skills are critical to nipping the AVE in the bud. A good treatment program should explain the difference between a lapse and relapse. It should also teach a person how to stop the progression from a lapse into relapse. Self-awareness is crucial to this.

Being able to understand how your thoughts, emotions, and behaviors play off of each other can help you to better control and respond to them in a positive way. Acknowledging your triggers and developing the appropriate coping skills should be a part of a solid relapse prevention program. Lastly, treatment staff should help you to learn how to recognize the signs of an impending lapse or relapse so that you can ask for help before it happens.

We Can Help You Build And Maintain A Sober Life

If you’re worried you might be heading towards a lapse or full-blown relapse, don’t struggle with this alone. If you’re currently lost within the confusion of the abstinence violation effect, we can help. RehabCenter.net can help you or a loved one get back on solid ground. We can give you resources to help you create or tweak your relapse prevention plan. Additionally, we will guide you to outpatient and inpatient treatment options. Contact us today.