To date, however, there has been little empirical research directly testing this hypothesis. Advocates of nonabstinence approaches often point to indirect evidence, including research examining reasons people with SUD do and do not enter treatment. This literature – most of which has been conducted in the U.S. – suggests a strong link between abstinence goals and treatment entry.

Outcome Studies for Relapse Prevention

His father and maternal uncle were heavy drinkers (predispositions to drinking, social learning). Rajiv was anxious since childhood (early learning and temperamental contributions) and avoided social situations (poor coping). He started using alcohol in his college, with friends and found that drinking helped him cope with his anxiety.

Addictive Behaviors

If a behavior is causing problems, abstaining from the behavior appears (at face value) to be a logical solution. For instance, 12-step groups based on the original Alcoholics Anonymous (AA) model advocate an abstinence approach to compulsive behaviors, although abstinence goals across these groups may not always be absolute and may be more nuanced, depending on the behavior involved (Browne, 1991; Efrati & Gola, 2018). Some clinicians treating problematic sexual behavior have even suggested temporary (e.g., 90 days) ‘celibacy contracts’ of complete abstinence from any sexual behavior in early phases of treatment (Carnes, 1989). Historically, abstinence has also been the dominant long-term treatment goal within treatment settings for gambling disorder (Ladouceur, Lachance, & Fournier, 2009).

Relapse to smoking

These individuals also experience negative emotions similar to those experienced by the abstinence violators and may also drink more to cope with these negative emotions. In a similar fashion, the nature of these attributions determines whether the violation will lead to full-blown relapse. AVE occurs when someone who is striving for abstinence from a particular behavior or substance experiences a setback, such as a lapse or relapse. Instead of viewing the incident as a temporary setback, the individual perceives it as evidence of personal failure, leading to increased feelings of guilt, shame, and hopelessness (Collins & Witkiewitz, 2013; Larimer, Palmer, & Marlatt, 1999). It can impact someone who is trying to be abstinent from alcohol and drug use in addition to someone trying to make positive changes to their diet, exercise, and other aspects of their lives.

Relapse Prevention

• We first describe treatment models with an explicit harm reduction or nonabstinence focus.
• For example, all studies with SUD populations could include brief questionnaires assessing short-and long-term substance use goals, and treatment researchers could report the extent to which nonabstinence goals are honored or permitted in their study interventions and contexts, regardless of treatment type.
• As a result, the AVE can trigger a cycle of further relapse and continued substance use, since people may turn to substances as a way to cope with the emotional distress.
• The study was especially notable because most other treatment readiness measures have been validated on treatment-seeking samples (see Freyer et al., 2004).
• MET adopts several social cognitive as well as Rogerian principles in its approach and in keeping with the social cognitive theory, personal agency is emphasized.

An additional concern is that the lack of research supporting the efficacy of established interventions for achieving nonabstinence goals presents a barrier to implementation. Cognitive behaviour therapy is a structured, time limited, psychological intervention that has is empirically supported across a wide variety of psychological disorders. CBT for addictive behaviours can be traced back to the application of learning theories in understanding addiction and subsequently to social cognitive theories.

• Modifying social and environmental antecedents and consequences another approach to working with addictive behaviours18.
• Relapse prevention includes understanding what triggers substance abuse, which varies from person to person.
• If an individual does not try to abstain from the behavior in the first place, relapse, by definition, cannot be observed.
• In addition, relaxation training, time management, and having a daily schedule can be used to help clients achieve greater lifestyle balance.
• This model both accelerated the spread of AA and NA and helped establish the abstinence-focused 12-Step program at the core of mainstream addiction treatment.
• For example, an individual who has successfully abstained from alcohol, after having one beer, may drink an entire case of beer, thinking that since he or she has “fallen off the wagon,” he or she might as well go the whole way.

This may be regarded as ‘short-term’ because while participants are intending to quit the behavior completely, the focus here is on the experience of early abstinence. A 4-week period was chosen on the basis that the time course of acute withdrawal symptoms for substance addictions generally does not last beyond this period (Hughes, Higgins, & Bickel, 1994). Consequently, it can be reasonably extrapolated that acute withdrawal symptoms for behavioral addictions (if any do manifest) would also not persist beyond a 4-week period.

The Abstinence Violation Effect (AVE) is a psychological phenomenon that refers to a person’s reaction to breaking a self-imposed rule of abstinence or self-control. It occurs when individuals who have set strict rules for themselves regarding certain behaviors or habits (e.g., alcohol consumption, smoking, or eating certain foods) engage in the prohibited behavior, leading to feelings of guilt, shame, and loss of control. With regard to addictive behaviours Cognitive Therapy emphasizes psychoeducation and relapse prevention.

4. Consequences of abstinence-only treatment

Despite these obstacles, SSPs and their advocates grew into a national and international harm reduction movement (Des Jarlais, 2017; Friedman, Southwell, Bueno, & Paone, 2001). In addition to shaping mainstream addiction treatment, the abstinence-only 12-Step model also had an indelible effect on the field of SUD treatment research. Most scientists who studied SUD treatment believed that abstinence was the only acceptable treatment goal until at least the 1980s (Des Jarlais, 2017). Abstinence rates became the primary outcome for determining SUD treatment effectiveness (Finney, Moyer, & Swearingen, 2003; Kiluk, Fitzmaurice, Strain, & Weiss, 2019; Miller, 1994; Volkow, 2020), a standard which persisted well into the 1990s (Finney et al., 2003).

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. In high-risk situations, the person expects alcohol to the abstinence violation effect refers to help him or her cope with negative emotions or conflict (i.e. when drinking serves as “self-medication”). Expectancies are the result of both direct and indirect (e.g. perception of the drug from peers and media) experiences3. Relapse prevention (RP) is a cognitive behavioural treatment program, based on the relapse prevention model27,28.