In addition to shaping mainstream addiction treatment, the abstinence-only 12-Step model also had an indelible effect on the field of SUD treatment research. Most scientists who studied SUD treatment believed that abstinence was the only acceptable treatment goal until at least the 1980s (Des Jarlais, 2017). Abstinence rates became the primary outcome for determining SUD treatment effectiveness (Finney, Moyer, & Swearingen, 2003; Kiluk, Fitzmaurice, Strain, & Weiss, 2019; Miller, 1994; Volkow, 2020), a standard which persisted well into the 1990s (Finney et al., 2003). Little attention was given to whether people in abstinence-focused treatments endorsed abstinence goals themselves, or whether treatment could help reduce substance use and related problems for those who did not desire (or were not ready for) abstinence. It is essential to understand what individuals with SUD are rejecting when they say they do not need treatment. In this model, treatment success is defined as achieving and sustaining total abstinence from alcohol and drugs, and readiness for treatment is conflated with commitment to abstinence (e.g., Harrell, Trenz, Scherer, Martins, & Latimer, 2013).
- Possible substitutes can be designated in advance, made readily available, listed in a relapse prevention plan, and swiftly summoned when the need arises.
- Support for her work has been provided by the National Institute on Alcohol Abuse and Alcoholism and the University of Washington’s Alcohol and Drug Abuse Institute.
- Furthermore, abstinence remains a gold standard treatment outcome in pharmacotherapy research for drug use disorders, even after numerous calls for alternative metrics of success (Volkow, 2020).
- Some evidence suggests that the risk for relapse is heightened just as people are leaving the full-time support of an inpatient treatment program—before they’ve had a chance to practice newly acquired skills and insights, set up their own social support system, or gained insight into their emotional vulnerabilities.
- Recovery benefits from a detailed relapse prevention plan kept in a handy place—next to your phone charger, taped to the refrigerator door or the inside of a medicine cabinet—for immediate access when cravings hit.
1. Review aims
Continuous abstinence from all forms of tobacco at 6-months post-discharge was reported by 20.0% pre-implementation compared to 41.6% post-implementation. The abstinence violation effect (AVE) occurs when an individual, having made a personal commitment to abstain from using a substance or to cease engaging in some other unwanted behavior, has an initial lapse whereby the substance or behavior is engaged in at least once. The AVE occurs when the person attributes the cause of the initial lapse (the first violation of abstinence) to internal, stable, and global factors within (e.g., lack of willpower or the underlying addiction or disease). Recovery benefits from a detailed relapse prevention plan kept in a handy place—next to your phone charger, taped to the refrigerator door or the inside of a medicine cabinet—for immediate access when cravings hit. A good relapse prevention plan specifies a person’s triggers for drug use, lists some coping skills to summon up and distractions to engage in, and lists people to call on for immediate support, along with their contact information.
- A key point in Miller’s theory is that motivation for change is “action-specific”; he argues that no one is “unmotivated,” but that people are motivated to specific actions or goals (Miller, 2006).
- When euphoric recall and fading effect bias combine, they create a powerful distortion in how we predict outcomes, which is called outcome expectancies.
- This study, conducted within routine care workflows in an LMIC clinical setting, provides information about tobacco behaviors after the implementation of LifeFirst, a hospital-initiated cessation counseling program.
- Treatment components stemming from the RPM have been incorporated into behavioral interventions for relapse prevention (Brandon, Vidrine, & Litvin, 2007), not only for smoking cessation (Abrams et al., 2003), but also for other addictions and health-related behavior change targets (Marlatt & Donovan, 2005).
Treatment
For example, despite being widely cited as a primary rationale for nonabstinence treatment, the extent to which offering nonabstinence options increases treatment utilization (or retention) is unknown. In addition to evaluating nonabstinence treatments specifically, researchers could help move the field forward by increased attention to nonabstinence goals more broadly. For example, all studies with SUD populations could include brief questionnaires assessing short-and long-term substance use goals, and treatment researchers could report the extent to which nonabstinence goals are honored or permitted in their study interventions and contexts, regardless of treatment type. 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.
S1 Data. Deidentified dataset.
They may not recognize that stopping use of a substance is only the first step in recovery—what must come after that is building or rebuilding a life, one that is not focused around use. They may falsely believe that their recovery is complete, or that cravings are a sign of failure, when in fact it takes time to rebuild a life and time for the brain to rewire itself and learn to respond to everyday pleasures. In general, the longer a person has not used a substance, the lower their desire to use. No matter how much abstinence is the desired goal, viewing any substance use at all as a relapse can actually increase the likelihood of future substance use. It encourages people to see themselves as failures, attributing the cause abstinence violation effect of the lapse to enduring and uncontrollable internal factors, and feeling guilt and shame.
Sometimes people relapse because, in their eagerness to leave addiction behind, they cease engaging in measures that contribute to recovery. Research has found that getting help in the form of supportive therapy from qualified professionals, and social support from peers, can prevent or minimize relapse. In particular, cognitive behavioral therapy (CBT) can help people overcome the fears and negative thinking that can trigger relapse. The AVE occurs when an individual views his relapse as a deviation from his commitment to absolute abstinence. For example, an individual who has successfully abstained from alcohol, after having one beer, may engage in binge drinking, thinking that since he has “fallen off the wagon” he might as well drink an entire case of beer. The relapse often creates a feeling of self-blame and loss of perceived self-control.
In Europe, about half (44–46%) of individuals seeking treatment for AUD have non-abstinence goals (Haug & Schaub, 2016; Heather, Adamson, Raistrick, & Slegg, 2010). In the U.S., about 25% of patients seeking treatment for AUD endorsed nonabstinence goals in the early 2010s (Dunn & Strain, 2013), while more recent clinical trials have found between 82 and 91% of those seeking treatment for AUD prefer nonabstinence goals (Falk et al., 2019; Witkiewitz et al., 2019). 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).
Effects of short-term abstinence from alcohol on subsequent drinking patterns of social drinkers
- Additionally, the system is punitive to those who do not achieve abstinence, as exemplified by the widespread practice of involuntary treatment discharge for those who return to use (White, Scott, Dennis, & Boyle, 2005).
- The Abstinence Violation Effect (AVE) is a psychological phenomenon that refers to a person’s reaction to breaking a self-imposed rule of abstinence or self-control.
- Notably, these individuals are also most likely to endorse nonabstinence goals (Berglund et al., 2019; Dunn & Strain, 2013; Lozano et al., 2006; Lozano et al., 2015; Mowbray et al., 2013).
- 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.
The RP model has been studied among individuals with both AUD and DUD (especially Cocaine Use Disorder, e.g., Carroll, Rounsaville, & Gawin, 1991); with the largest effect sizes identified in the treatment of AUD (Irvin, Bowers, Dunn, & Wang, 1999). As a newer iteration of RP, Mindfulness-Based Relapse Prevention (MBRP) has a less extensive research base, though it has been tested in samples with a range of SUDs (e.g., Bowen et al., 2009; Bowen et al., 2014; Witkiewitz et al., 2014). It is important to highlight that most of the studies cited above did not provide goal-matched treatment; thus, these outcomes generally reflect differences between individuals with abstinence vs. non-abstinence goals who participated in abstinence-based AUD treatment. In conclusion, the abstinence violation effect is a psychological effect that impacts those in recovery, as well as those who are focused on making more positive behavioral choices in their lives. By reframing lapses as learning opportunities and teachable moments, cultivating self-compassion, and seeking support, individuals can navigate these challenges more effectively, increasing their chances of leading a healthier lifestyle. Upon breaking the self-imposed rule, individuals often experience negative emotions such as guilt, shame, disappointment, and a sense of failure.
Her research interests include addictions, posttraumatic stress disorder, sexuality, and relationships. Her work focuses on implicit (i.e. nonconscious or automatic) cognitive processes that contribute to the development and maintenance of maladaptive behavior and psychopathology. Support for her work has been provided by the National Institute on Alcohol Abuse and Alcoholism and the University of Washington’s Alcohol and Drug Abuse Institute. Rather than labeling oneself as a failure, weak, or a loser, recognizing the effort and progress made before the lapse can provide a more balanced perspective.
Additionally, the system is punitive to those who do not achieve abstinence, as exemplified by the widespread practice of involuntary treatment discharge for those who return to use (White, Scott, Dennis, & Boyle, 2005). Self- or proxy-reported cessation in the pre- and post-implementation samples from all forms of tobacco and stratified by tobacco product type are displayed in Fig 2. While abstinence was similar in both groups at 1-week post-discharge, the proportion reporting continuous abstinence began to decline more quickly in the pre-implementation group starting at 1-month.