The Abstinence Violation Approach Non 12 Step Drug Rehab and Alcohol Treatment

If stressors are not balanced by sufficient stress management strategies, the client is more likely to use alcohol in an attempt to gain some relief or escape from stress. This reaction typically leads to a desire for indulgence that often develops into cravings and urges. Two cognitive mechanisms that contribute to the covert planning of a relapse episode—rationalization and denial—as well as apparently irrelevant decisions (AIDs) can help precipitate high-risk situations, which are the central determinants of a relapse.

This perceived violation results in the person making an internal explanation to explain why they drank (or used drugs) and then becoming more likely to continue drinking (or using drugs) in order to cope with their own guilt. It is now believed that relapse prevention strategies must be taught to the individual during the course of therapy, and various strategies to enhance patient involvement and adherence such as increasing patient responsibility, promoting internal attributions to events are to be introduced in therapy. Working with a variety of targets helps in generalization of gains, patients are helped in anticipating high risk situations33. The Trans theoretical model (TTM), describes stages of behavioral change, processes of change and the decisional balance and self-efficacy which are believed to be intertwined to determine an individual’s behaviour11. Even when alcohol’s perceived positive effects are based on actual drug effects, often only the immediate effects are positive (e.g., euphoria), whereas the delayed effects are negative (e.g., sleepiness), particularly at higher alcohol doses. Asking clients questions designed to assess expectancies for both immediate and delayed consequences of drinking versus not drinking (i.e., using a decision matrix) (see table, p. 157) often can be useful in both eliciting and modifying expectancies.

III.D. Abstinence Violation Effect

In RP client and therapist are equal partners and the client is encouraged to actively contribute solutions for the problem. Client is taught that overcoming the problem behaviour is not about will power rather it has to do with skills acquisition. Another technique is that the road to abstinence is broken down to smaller achievable targets so that client can easily master the task enhancing self-efficacy. Also, therapists can provide positive feedback of achievements that the client has been able to make in other facets of life6.

abstinence violation effect

But in cases in which a person is prone to this cognitive distortion, abstinence may not be the healthiest approach to take. Abstinence from sex is the most reliable way to avoid sexually transmitted infections and pregnancy. Many high schools and religious programs in the United States teach abstinence-only sex education, advocating for abstaining from sex until marriage. While abstinence is the only guaranteed method for avoiding Tips for Treating and Living With Essential Tremor Cleveland Clinic disease and pregnancy, current discourse generally considers abstinence-only programs to be ineffective. Some educators advocate instead for emphasizing the benefits of abstinence and then teaching strategies for avoiding disease, promoting healthy sexuality, and ensuring emotional needs are met. 3The key relapse episode was defined as the most recent use of alcohol following at least 4 days of abstinence (Longabaugh et al. 1996).

Paulomi M. Sudhir

This is easier when utilizing a technique which Marlatt refers to as SOBER—Stop, Observe (our thoughts and emotions), Breathe, Expand (our awareness and our comprehension of potential consequences if we use), and Respond mindfully (make the right choice not to use). The result of this lackluster planning is that we recognize future disturbances, yet do nothing to truly resolve them. If we feel stress, anger or depression, we do not find healthy ways of confronting these feelings. We instead view these emotions as justifications of the negative cognition experienced under AVE. Our hopelessness and our instinctive desire to give up were spot-on, or else we would be happy all the time. As AVE is a form of all-or-nothing thinking, some may argue that it is a person’s outlook, not abstinence itself, that is harmful.

  • Many clients report that activities they once found pleasurable (e.g., hobbies and social interactions with family and friends) have gradually been replaced by drinking as a source of entertainment and gratification.
  • Although non-dieters ate less after consuming the milkshakes, presumably because they were full, dieters paradoxically ate more after having the milkshake (Figure 1a).
  • 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.
  • Modifying social and environmental antecedents and consequences another approach to working with addictive behaviours18.
  • When the commitment to remain abstinent is broken, it’s not uncommon for individuals to experience the abstinence violation effect, which often manifests as intense guilt and shame.