Helping the client to develop “positive addictions” (Glaser 1976)—that is, activities (e.g., meditation, exercise, or yoga) that have long-term positive effects on mood, health, and coping— is another way to enhance lifestyle balance. Self-efficacy often increases as a result of developing positive addictions, largely caused by the experience of successfully acquiring new skills by performing the activity. In one clinical intervention based on this approach, the client is taught to visualize the urge or craving as a wave, watching it rise and fall as an observer and not to be “wiped out” by it. This imagery technique is known as “urge surfing” and refers to conceptualizing the urge or craving as a wave that crests and then washes onto a beach. In so doing, the client learns that rather than building interminably until they become overwhelming, urges and cravings peak and subside rather quickly if they are not acted on.

Other behavioral characteristics that have been identified in patients with bulimia nervosa include impulsivity and mood lability, and it is possible that these traits may contribute to the onset or perpetuation of symptoms in this disorder. Several psychological models of binge-eating behavior have been proposed. In one model, for example, an individual attempting to follow a reduced calorie diet may experience an abstinence violation effect following ingestion of modest amounts of snack foods, leading to a transient inclination to abandon dietary restraint altogether.

Relapse Prevention

The camaraderie and cohesion of an RP group are extremely valuable to the treatment process. However, clients should be cautioned against treatment program romances and outside involvement with other group members (e.g., entering into a business relationship). When they start treatment, clients must sign an agreement to avoid intense relationships outside group.

Going to the front of the room to grab a new one-day chip after months or years of sobriety makes us feel like complete failures. We feel ashamed of ourselves, and fear that everybody else must be ashamed of us as well. First characterized as an important ingredient in the relapse process in the mid-1980s, the AVE has profound relevance for addiction professionals today. In our era of heightened overdose risk, the AVE is more likely than ever to have tragic effects. His issue with drinking led to a number of personal problems, including the loss of his job, tension in his relationship with his wife (and they have separated), and legal problems stemming from a number of drinking and driving violations. He lost his license due to drinking and driving, and as a condition of his probation, he was required to attend Alcoholics Anonymous meetings.

Moving Forward in Recovery After AVE

Teasdale and colleagues (1995) have proposed a model of depressive relapse which attempts to explain the process of relapse in depression and also the mechanisms by which cognitive therapy achieves its prophylactic effects in the treatment of depression. This model involves an information-processing analysis of depressive relapse. It hypothesizes that following recovery, mild states of depression can reactivate depressogenic cycles of cognitive processing similar to those found during a major depressive episode. Teasdale et al. suggest that preventive interventions such as cognitive therapy operate by changing the patterns of cognitive processing that become active in states of mild negative affect preceding a full relapse into major depression. They suggest that the redeployment of attention utilized in stress-reduction procedures based on the techniques of mindfulness meditation (Kabat-Zinn, 1990) can be integrated with cognitive therapy procedures into a system of attentional control training.

For people in recovery, a relapse can mean the return to a cycle of active addiction. While relapse doesn’t mean you can’t achieve lasting sobriety, it can be a disheartening abstinence violation effect setback in your recovery. The neurotransmitter serotonin has been the focus of considerable research in patients with anorexia nervosa and bulimia nervosa.

How Does The Abstinence Violation Effect Occur?

The abstinence violation effect (AVE) refers to the negative cognitive and affective responses that an individual experiences after the return to substance abuse after a period of abstinence. These responses, both physical and psychological, can be very difficult to deal with. Prolonged use of a substance causes a level or physical tolerance but after a period of abstinence that tolerance declines substantially.

Is abstinence 100% failure rate?

Even with that potentially generous estimate of 42.5 – 50%, abstinence has the lowest effectiveness rate in typical use of all methods.

A study published by Hunt and colleagues demonstrated that nicotine, heroin, and alcohol produced highly similar rates of relapse over a one-year period, in the range of 80-95%2. A significant proportion (40–80%) of patients receiving treatment for alcohol use disorders have at least one drink, a “lapse,” within the first year of after treatment, whereas around 20% of patients return to pre-treatment levels of alcohol use3. Relapse prevention (RP) is a strategy for reducing the likelihood and severity of relapse following the cessation or reduction of problematic behaviours4. Be that as it may, a perennial threat to recovering, especially if abstinence is perceived as the prerequisite of changing one’s substance using behavior, is to use, even once. In formal treatment circles, this sense of failure is referred to as the abstinence violation effect or AVE and is perhaps the single greatest contributor to a return to active involvement in one’s SUD.

What Is Abstinence Violation Effect?

The expected drug effects do not necessarily correspond with the actual effects experienced after consumption. Based on operant conditioning, the motivation to use in a particular situation is based on the expected positive or negative reinforcement value of a specific outcome in that situation5. Both negative and positive expectancies are related to relapse, with negative expectancies being protective against relapse and positive expectancies being a risk factor for relapse4. Those who drink the most tend to have higher expectations regarding the positive effects of alcohol9.