Countering The Abstinence Violation Effect: Supporting Recovery Through Relapse

"Well, I’ve already eaten two slices of cake—why not eat the whole thing?" or "I’m already in debt, I might as well go on another spending spree".These sentiments are not unusual or uncommon; people may sometimes feel that if they fail, they may as well make it a spectacular failure—worthy of the negative emotions associated with faltering. This is called the abstinence violation effect, which can be experienced by anyone but is particularly common in those recovering from substance use disorders. 

In clinical psychology and alcohol research, relapse prevention strategies, including coping skills and maintenance strategies, are designed to help individuals manage high risk situations and avoid a full blown relapse.During the recovery process for addictive behaviors such as alcohol abuse or smoking cessation, understanding the abstinence violation effect is a crucial component in preventing relapse and promoting long-term recovery.

What is the abstinence violation effect?

The AVE is a psychological response to relapse within the relapse process. It arises when a person starts to feel that when a lapse occurs, it is indicative of a moral failure, loss of hope for continued recovery, or proof that recovery is ultimately not possible. This is a common risk factor, but psychologists, rehabilitation professionals, and treatment centers work hard to combat it because it's generally not constructive for the individual's future success.

The abstinence violation effect is a theory that was developed based on Marlatt's cognitive behavioral model to help combat the incidence of individuals engaging in substance use or other unwanted behavior and falling into lapse and subsequent relapse by creating a more thorough understanding of the mechanisms involved in this process. Typically among those mechanisms are negative emotional states like shame, misunderstanding, and blame. People may sometimes feel that relapse is an indication of an inherent flaw or an entirely uncontrollable aspect of their disease, causing them to experience cognitive dissonance and feel ashamed, hopeless, or unable to combat relapse. It became the work of the individuals who identified the abstinence violation effect to mitigate the negative impacts of this flawed thought process through cognitive therapy and encourage healthier coping mechanisms in those who are in the process of recovery by adjusting outcome expectancies.

Who might experience the AVE?

Although the abstinence violation effects can also be seen in individuals who are not experiencing drug or alcohol use or other mental health conditions, this model can be particularly troublesome for those who have been treated or are being treated for any of these. This is largely due to the negative consequences associated with the AVE for individuals in these situations. Someone who relapses and then relapses more significantly may feel increased shame, embarrassment, and hopelessness. While this may not completely make or break a diet or exercise commitment, it can wreak havoc on an individual’s commitment to sobriety if effective management strategies are not in place.

So while the AVE is not a concept that relates only to addiction, strong symptoms of it can be present in substance use disorder situations. Addiction can so often be shrouded in layers of shame, blame, and misunderstanding. That’s why individuals experiencing these disorders may be more likely to feel as though their addiction is representative of personal defects and flaws rather than a culmination of a series of things, such as inadequate support, poor coping mechanisms taught or modeled in childhood and young adulthood, complex hereditary complications, and environmental factors. It’s an important part of any recovery program to address these preconceived notions of addiction and paint a more accurate portrait with the level of compassion, self-awareness, and support that is so essential to addiction recovery.

The AVE in addiction is systemic, and some experts believe that too few treatment modalities identify both the mechanisms that lead to addictive disorders and the ones that keep them in place, even years after a client seems to have recovered. Focusing on recovery as a continual path of growth, learning, and changing can be one of the most important ways that clinicians and individuals with substance use disorders can counter the inaccuracies present in the way we think about addiction. It can also support the development of healthier attitudes toward lapses and the possibility of relapse at some point in time.

What experiencing the AVE may feel like

Relapsing into a behavior associated with addiction can feel disappointing, or even frightening or devastating. The fear, uncertainty, and worry is then sometimes further compounded by frightened or angry family and friends, who may view an instance of relapse as an indication of failure or loss of sobriety. While this response from others may be understandable, it’s generally evidence of an unrealistic, unhealthy, and/or inaccurate view of addiction and relapse and it can do more harm than good.

Evidence of the abstinence violation effect can be seen in any individual who attributes a lapse and subsequent relapse to entirely uncontrollable conditions, such as a perceived character flaw or adherence to the constraints of addiction. In realistic, healthy approaches to addiction recovery, relapse is seen as a very real possibility, and actions are taken to minimize the risks involved. An important part of this process involves developing self-awareness and creating a thorough understanding of what triggers the desire to engage in certain behaviors.

Combating the AVE

The abstinence violation effect is a complex phenomenon that usually needs to be approached from several different directions to be handled effectively. Read on for a few points of that approach.

Changing how recovery is viewed

Although many view recovery as a static state that must be achieved, practitioners and individuals working to combat the AVE recognize that recovery is a spectrum, and that lapse and relapse operate on that spectrum. A single lapse does not have to result in a downward spiral of additional lapses and prolonged relapse, and a significant period of relapse does not have to culminate in a lifelong powerlessness over addictive behavior. Having healthy and effective coping strategies in place to anticipate a lapse or relapse can be pivotal, because the likelihood of never again lapsing into an addictive behavior is often quite low.

It can also be particularly vital for mental health professionals to communicate the reality of addiction. It’s not a matter of increased willpower or “wanting it” enough. Substance use disorders are clinical mental health disorders, meaning addiction is a matter of neurological and biological predispositions and changes that take time to rectify. These rectifying steps usually include changing external elements rather than finding a magic button of willpower.

Adjusting external circumstances

Making changes to certain parts of your life that can trigger the increased need to cope is often another important part of avoiding instances of the AVE. For example, this can look like:

• Removing oneself from a situation involving the use of addictive substances
• Leaving a job that creates high stress
• Taking steps to create space in a relationship that fosters stress and addictive behavior

Life situations, relationships, and commitments all have to be parsed through carefully and continually evaluated for balance and harmony. That way, the individual may be better able to avoid the most likely causes of relapse and the potential resulting AVE.

Adopting a sense of compassion

One of the most important factors involved in countering the abstinence violation effect may be compassion. Viewing oneself or a loved one with compassion can ease some of the rigidity and negative emotions associated with the AVE. Shame is one of the first and most prominent feelings someone who has experienced a relapse may feel, which can then lead to additional instances of relapse, feelings of fear, and the impulse to hide, potentially culminating in a loop of relapsing—feeling shame, relapsing, feeling shame, and so on. Extending compassion to yourself or a loved one in this situation can potentially interrupt that cycle.

Seeking support after a relapse

When a lapse or relapse has occurs, seeking appropriate mental health support from a qualified professional can be a helpful first step toward resuming your journey on the road to recovery and decreasing the likelihood of repeated lapses. This is at least partly because relapses may signify gaps in the coping and recovering process that might have been there to begin with. Continuing to work with a mental health professional can help you learn to cover gaps that may have been missed by developing healthy coping mechanisms that can improve your response to future triggers and/or relapses.

Getting support for substance use disorders and/or relapses

If you were initially treated for an addiction disorder, that therapist can provide additional help. Or, another therapist can be consulted to help you at your current stage. Some people feel more comfortable or supported by meeting with this type of professional in person. In this case, you can search for a qualified provider in your area. If you prefer receiving this type of support from the comfort of your own home, you might consider working with a therapist virtually. With an online therapy platform like BetterHelp, for instance, you can get matched with a licensed provider who meets your needs and preferences, and you can speak with them via phone, video call, and/or online chat. They can help you reframe your recovery journey and develop healthier coping mechanisms for triggers and relapses. 

Research suggests that online therapy can be effective in treating things like gambling disorders and helping with smoking cessation. It has also been shown to promote a decrease in symptoms of anxiety, depression, and specific phobias, all which have a comorbid relationship with substance use disorders. If you’re interested in trying online therapy, you can reach out to get matched with a qualified virtual therapist today.