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Abstinence Violation Effect

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It looks and sounds like a highly technical term for something that most people can relate to – feeling guilty when you use a substance, like alcohol or marijuana, after promising yourself you won’t use it ever again. Additionally, abstinence violation effect (AVE) can affect people differently, based on different factors in their lives.

AVE is not a personal failure nor a permanent failure to abstain from using a substance of abuse. It is an aspect of relapse prevention that can be helpful for someone in addiction treatment or contemplating going into treatment.

Keep reading to learn more about AVE.

What Is Abstinence Violation Effect?

Abstinence violation effect is defined as “ the negative cognitive and affective responses someone feels after a return to substance use following a period of self-imposed abstinence from substances. AVE affects the stable, uncontrollable attributions, and the person feels a strong sense of shame and guilt following the relapse.”

Someone who is experiencing abstinence violation effect may tend to consider their relapse as a concrete action with no end. Common thoughts may be, “As long as I used (substance) again, I should just keep on using it since there’s no way to stop.” Another thought that is common is,  “Addiction is a chronic disease, so there’s no harm in using again.”

Feelings of personal failure can lead to ongoing use of the substance. Someone who believes this strongly is more likely to relapse more than a few times. Self-guilt is one feeling that falls into the description of AVE. Guilt is a heavy emotion to bear, one that can constantly replay, causing someone to keep using the substance again to assuage the guilt they feel. 

Although, it is essential to keep in mind that the National Institute on Drug Abuse (NIDA) estimates that 40 to 60 percent of people who were once addicted to a substance will relapse at some point. 

One part of relapse prevention is knowing what triggers substance use, which varies by the person. For instance, someone with alcohol use disorder may feel like they want a drink when out with friends at a favorite hangout.

Another example is the urge to smoke at the times when smoking was enjoyed, such as with a coffee in the morning or when driving long distances.

Relapse

It is known that the longer someone abuses a substance, the higher tolerance they will have for the effects it produces. This is why, after a period of abstinence, that person’s tolerance declines substantially, and why someone can accidentally overdose if they start to use again at the same level as before abstaining.

Relapse doesn’t have to be all-consuming, though. It can be a single time someone decides to use the substance again. That one instance can lead the individual to experience AVE, which could then trigger a longer relapse. It is, therefore, paramount to know the different stages of relapse and how to circumvent it.

Relapse Prevention Education

There are three stages of relapse, as noted by Healthline:

At any point in time, any one of these can put someone at risk of relapsing.

  • Emotional relapse – Thoughts and behaviors set you up for a relapse, even though you are not thinking about using the substance. Isolation, suppressing your emotions, feeling anxious, or angry can all make you feel like you need that substance to cope.

Signs of an emotional relapse can be:

  • Anxiety
  • Guilt
  • Intolerance
  • Anger
  • Defensiveness
  • Mood swings
  • Isolation
  • Not asking for help
  • Not going to meetings
  • Mental relapse – The mental battle going in your head marks this phase. A part of you wants to use, and another part does not. You are only remembering the good aspects of using and not the bad parts. Bargaining with yourself and actively planning to use the substance again are common behaviors in the mental relapse phase.

Other mental relapse signs are:

  • Remembering the people, places, and things in which you used to use
  • Glorifying your past use of the substance
  • Lying about past use
  • Deliberately spending time with old friends who used
  • Imagining about using the substance
  • Thinking about how to relapse
  • Planning the relapse around other people’ schedules
  • Physical relapse – This is the phase where you actively start using again. Maybe it’s one drink, one pill, or one cigarette. That one lapse leads back into regular use. This is why most people who smoke or drink will say that all it takes it one cigarette or one drink to lead back into regular use. 

Someone in addiction treatment will learn relapse prevention skills and how to recognize their triggers and how to deal with them in therapy. Abstinence violation effect is a notable aspect of relapse education. Knowing what it is and how to handle it can help keep you on the right path to a lasting recovery.

Sources

SpringerLink. Encyclopedia of Behavioral Medicine. Abstinence Violation Effect 2013 Edition | Editors: Marc D. Gellman, J. Rick Turner. from https://link.springer.com/referenceworkentry/10.1007%2F978-1-4419-1005-9_623

Time. Why Falling Off the Wagon Isn't Fatal. Maia Szalavitz . Dec. 30, 2008 from http://content.time.com/time/health/article/0,8599,1868965,00.html

Substance Abuse Treatment, Prevention, and Policy. Marlatt's relapse prevention model: Historical foundations and overview. Relapse prevention for addictive behaviors. Christian S Hendershot, corresponding author, Katie Witkiewitz, William H George, and G Alan Marlatt from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3163190

Healthline. Relapse Prevention Plan: Techniques to Help You Stay on Track. Medically reviewed by Timothy J. Legg, PhD, CRNP. Written by Stephanie Watson. March 29, 2019 from https://www.healthline.com/health/opioid-withdrawal/relapse-prevention-plan

University of Santa Cruz, Counseling and Psychological Services. Relapse Prevention. (Retrived October 2019) from https://caps.ucsc.edu/counseling/aod/relapse-prevention.html

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