Given its focus on long-term maintenance of treatment gains, RP is a behavioral intervention that is particularly well suited for implementation in continuing care contexts. However, it is imperative that insurance providers and funding entities support these efforts by providing financial support for aftercare services. It is also important that policy makers and funding entities support initiatives to evaluate RP and other established interventions in the context of continuing care models. In general, more research on the acquisition and long-term retention of specific RP skills is necessary to better understand which RP skills will be most useful in long-term and aftercare treatments for addictions. The recently introduced dynamic model of relapse [8] takes many of the RREP criticisms into account. Additionally, the revised model has generated enthusiasm among researchers and clinicians who have observed these processes in their data and their clients [122,123].

• Establishing lapse management plans can aid the client in self-correcting soon after a slip, and cognitive restructuring can help clients to re-frame the meaning of the event and minimize the AVE [24].
• However, many of the treatments ranked in the top 10 (including brief interventions, social skills training, community reinforcement, behavior contracting, behavioral marital therapy, and self-monitoring) incorporate RP components.
• One critical goal will be to integrate empirically supported substance use interventions in the context of continuing care models of treatment delivery, which in many cases requires adapting existing treatments to facilitate sustained delivery [140].

Journal of Studies on Alcohol

An additional concern is that the lack of research supporting the efficacy of established interventions for achieving nonabstinence goals presents a barrier to implementation. McCrady [37] conducted a comprehensive review of 62 alcohol treatment outcome studies comprising 13 psychosocial approaches. Two approaches–RP and brief intervention–qualified as empirically validated treatments based on established criteria. Interestingly, Miller and Wilbourne’s abstinence violation effect [21] review of clinical trials, which evaluated the efficacy of 46 different alcohol treatments, ranked „relapse prevention” as 35th out of 46 treatments based on methodological quality and treatment effect sizes. However, many of the treatments ranked in the top 10 (including brief interventions, social skills training, community reinforcement, behavior contracting, behavioral marital therapy, and self-monitoring) incorporate RP components.

• In CBT for addictive behaviours cognitive strategies are supported by several behavioural strategies such as coping skills.
• The lapse process consists of a series of internal and external events, identified and analyzed in the process of therapy.
• Although SE is proposed as a fluctuating and dynamic construct [26], most studies rely on static measures of SE, preventing evaluation of within-person changes over time or contexts [43].

Decoupling Goal Striving From Resource Depletion by Forming Implementation Intentions

AVE also involves cognitive dissonance, a distressing experience people go through when their internal thoughts, beliefs, actions, or identities are put in conflict with one another. Set realistic expectations for your recovery journey, understanding that progress may not always be linear. Rather than only focusing on the end goal, celebrate small victories and all positive steps you’ve taken thus far. Feelings of guilt, shame, and self-blame may lead people to question their ability to overcome addiction and exacerbate underlying issues of low self-esteem. Overall, the Abstinence Violation Effect is a complex phenomenon influenced by a combination of cognitive, emotional, and biological factors.

Clinical Psychology Review

Specific intervention strategies include helping the person identify and cope with high-risk situations, eliminating myths regarding a drug’s effects, managing lapses, and addressing misperceptions about the relapse process. Other more general strategies include helping the person develop positive addictions and employing stimulus-control and urge-management techniques. Ultimately, individuals who are struggling with behavior change often find that making the initial change is not as difficult as maintaining behavior changes over time. Many therapies (both behavioral and pharmacological) have been developed to help individuals cease or reduce addictive behaviors and it is critical to refine strategies for helping individuals maintain treatment goals. As noted by McLellan [138] and others [124], it is imperative that policy makers support adoption of treatments that incorporate a continuing care approach, such that addictions treatment is considered from a chronic (rather than acute) care perspective.

• Fortunately, professional treatment for addiction can improve outcomes for people experiencing the Abstinence Violation Effect.
• 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).

Ecological momentary assessment in the investigation of craving and substance use in daily life: A systematic review

This concurs not only with clinical observations, but also with contemporary learning models stipulating that recently modified behavior is inherently unstable and easily swayed by context [32]. While maintaining its footing in cognitive-behavioral theory, the revised model also draws from nonlinear dynamical systems theory (NDST) and catastrophe theory, both approaches for understanding the operation of complex systems [10,33]. Detailed discussions of relapse in relation to NDST and catastrophe theory are available elsewhere [10,31,34]. In other words, abstinence violation effects make a single lapse much more likely to turn into a full return to a full relapse into negative behavioral or mental health symptoms. In the context of addiction, a breach of sobriety with a single drink or use of a drug has a high likelihood of a full relapse.

• Rather than being viewed as a state or endpoint signaling treatment failure, relapse is considered a fluctuating process that begins prior to and extends beyond the return to the target behavior [8,24].
• A careful functional analysis and identification of dysfunctional beliefs are important first steps in CBT.

Ark Behavioral Health

As a result of AVE, a person may experience uncontrollable, stable attributions, and feelings of shame and guilt after a relapse. Problem solving therapy (PST) is a cognitive behavioural program that addresses interpersonal problems and other problem situations that may trigger stress and thereby increase probability of the addictive behaviour. The four key elements of PST are problem identification, generating alternatives, decision making, implementing solutions, reviewing outcomes and revising steps where needed. Problem orientation must also be addressed in addition to these steps, and the efficacy of PST increases when problem orientation is addressed in addition to the other steps25,26. Lindsey Rodriguez is a third-year doctoral student in the Social Psychology Program at the University of Houston, USA.

Self-control and coping responses

The second refers to any temporary abstinence period, irrespective of time frame, which may also be regarded as ‘short-term’ because participants are only trying to quit a behavior temporarily. This includes studies that experimentally manipulate abstinence, since participants are only instructed to abstain from the behavior for a predetermined amount of time. Studies that have examined abstinence as a temporary goal, even if the time frame exceeds the initial 4-week acute withdrawal stage (e.g., a 90-day celibacy contract), are also of interest because they would be especially useful for evaluating temporary abstinence as a potential clinical intervention.

Effects and symptoms of deprivation of physical exercise review

For example, in AUD treatment, individuals with both goal choices demonstrate significant improvements in drinking-related outcomes (e.g., lower percent drinking days, fewer heavy drinking days), alcohol-related problems, and psychosocial functioning (Dunn & Strain, 2013). Additionally, individuals are most likely to achieve the outcomes that are consistent with their goals (i.e., moderation vs. abstinence), based on studies of both controlled drinking and drug use (Adamson, Heather, Morton, & Raistrick, 2010; Booth, Dale, & Ansari, 1984; Lozano et al., 2006; Schippers & Nelissen, 2006). For example, successful navigation of high-risk situations may increase self-efficacy (one’s perceived capacity to cope with an impending situation or task; [26]), in turn decreasing relapse probability. Conversely, a return to the target behavior can undermine self-efficacy, increasing the risk of future lapses.

It includes thoughts and feelings like shame, guilt, anger, failure, depression, and recklessness as well as a return to addictive behaviors and drug use. This can include abstinence from substance abuse, overeating, gambling, smoking, or other behaviors a person has been working to avoid. Additionally, individuals may engage in cognitive distortions or negative self-talk, such as believing that the relapse is evidence of personal weakness. Relapse is a process in which a newly abstinent patient experiences a sense of perceived control over his/her behaviour up to a point at which there is a high risk situation and for which the person may not have adequate skills or a sense of self-efficacy. Self- efficacy increases and the probability of relapsing decreases when one is able to cope with this situation31. When the minimal effective response (such as informing friends that “I do not drink”) is not sufficient to bring about change, the individual is instructed to escalate to a stronger response, such as warning, threat, involving others’ support.

Implicit measures of alcohol-related cognitions can discriminate among light and heavy drinkers [58] and predict drinking above and beyond explicit measures [59]. One study found that smokers’ attentional bias to tobacco cues predicted early lapses during a quit attempt, but this relationship was not evident among people receiving nicotine replacement therapy, who showed reduced attention to cues [60]. Two publications, Cognitive Behavioral Coping Skills Training for Alcohol Dependence (Kadden et al., 1994; Monti, Kadden, Rohsenow, Cooney, & Abrams, 2002) and Cognitive Behavioral Therapy for Cocaine Addiction (Carroll, 1998), are based on the RP model and techniques. Although specific CBT interventions may focus more or less on particular techniques or skills, the primary goal of CBT for addictions is to assist clients in mastering skills that will allow them to become and remain abstinent from alcohol and/or drugs (Kadden et al., 1994). CBT treatments are usually guided by a manual, are relatively short term (12 to 16 weeks) in duration, and focus on the present and future. Clients are expected to monitor substance use (see Table 8.1) and complete homework exercises between sessions.