Relapse prevention for sexual offenders: considerations for the “abstinence violation effect”

It occurs when the client perceives no intermediary step between a lapse and relapse i.e. since they have violated the rule of abstinence, “they may get most out” of the lapse5. People who attribute the lapse to their own personal failure are likely to experience guilt and negative emotions that can, in turn, lead to increased drinking as a further attempt to avoid or escape the feelings of guilt or failure7. Because relapse is abstinence violation effect definition the most common outcome of treatment for addictions, it must be addressed, anticipated, and prepared for during treatment. The RP model views relapse not as a failure, but as part of the recovery process and an opportunity for learning. Marlatt (1985) describes an abstinence violation effect (AVE) that leads people to respond to any return to drug or alcohol use after a period of abstinence with despair and a sense of failure.

• Early learning theories and later social cognitive and cognitive theories have had a significant influence on the formulation CBT for addictive behaviours.
• Inaction has typically been interpreted as the acceptance of substance cues which can be described as “letting go” and not acting on an urge.
• If, however, individuals view lapses as temporary setbacks or errors in the process of learning a new skill, they can renew their efforts to remain abstinent.
• Our use of EMA methods avoided reliance of retrospective data, and allowed for detailed, lapse-by-lapse prospective analyses of how lapse responses affect smokers’ subsequent course.
• Individuals recovering from various forms of addiction frequently encounter relapses that have gained acceptance as an almost inevitable part of the recovery process.

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. Patient is instructed not to provide explanations for abstinence so as to avoid counter arguments. Although the term “recovery coach” was first used in 2006, the service has not gained wide adoption in addiction treatment.

Environmental manipulation and behavioural counseling

It is important to advance our understanding of the smoking relapse process, so that we might improve our ability to affect clinical outcomes. According to RPM, each lapse in the process represents a potential target for interventions designed to bolster coping resources and renew commitment to change. However, RPM interventions have generally failed to improve smoking cessation outcomes (Irvin et al., 1999; Lancaster et al., 2006). This may be because RPM interventions have focused on reducing what were seen as negative and counter-productive responses such as self-blame and guilt. Positive social support is highly predictive of long-term abstinence rates across several addictive behaviours.

Ongoing cravings, in turn, may erode the client’s commitment to maintaining abstinence as his or her desire for immediate gratification increases. This process may lead to a relapse setup or increase the client’s vulnerability to unanticipated high-risk situations. A critical difference exists between the first violation of the abstinence goal (i.e., an initial lapse) and a return to uncontrolled drinking or abandonment of the abstinence goal (i.e., a full-blown relapse). Although research with various addictive behaviors has indicated that a lapse greatly increases the risk of eventual relapse, the progression from lapse to relapse is not inevitable.

Eating Disorders and Stress*

In a study by McCrady evaluating the effectiveness of psychological interventions for alcohol use disorder such as Brief Interventions and Relapse Prevention was classified as efficacious23. Cognitive restructuring can be used to tackle cognitive errors such as the abstinence violation effect. Clients are taught to reframe their perception of lapses, to view them not as failures but as key learning opportunities resulting from an interaction between various relapse determinants, both of which can be modified in the future.

Negative emotional states, such as anxiety, depression, anger, boredom are often dealt with by using substances, interpersonal conflicts that the person cannot cope with effectively or resolve and the social -pressure to use a substance31. Others high risk situations include physical states such as hunger, thirst, fatigue, testing personal control, responsivity to substance cues (craving). The RP model highlights the significance of covert antecedents such as lifestyle patterns craving in relapse. His father and maternal uncle were heavy drinkers (predispositions to drinking, social learning).

Social Skills Training

It skills training such as behavioural rehearsal, assertiveness training, communication skills to cope with social pressures and interpersonal problem solving to reduce impact of conflicts, arousal reduction strategies such as relaxation training to manage pain or anxiety as risk for relapse. Cognitive reframing of lapses, coping imagery for craving and life style interventions, such as physical activity are used to help develop skills to deal with craving and broaden the patient’s behavioural repertoire. Cognitive restructuring techniques are employed to modifying beliefs related to perceived self-efficacy and substance related outcome expectancies (“such as drinking makes me more assertive”, “there is no point in trying to be abstinent I can’t do it”).

A focus of relapse-prevention treatment has been on helping those who lapse manage the AVE and maintain or reestablish abstinence from the undesired behavior. Marlatt and Gordon’s (1985) model of the relapse process in addictive disorders has had a major impact in the field of relapse prevention since the late 1980s. Marlatt and Gordon postulate that newly abstinent patients experience a sense of perceived control up to the point at which they encounter a high-risk situation, which most commonly entails a negative emotional state, an interpersonal conflict, or an experience of social pressure. If individuals cope effectively in the high-risk situation, perceived control and self-efficacy increase, which in turn makes the probability of relapse decrease.

The neurotransmitter serotonin has been the focus of considerable research in patients with anorexia nervosa and bulimia nervosa. Laboratory studies have shown that patients with eating disorders often experience abnormal patterns of hunger and satiety over the course of a meal. Serotonin plays an important role in postingestive satiety, and appears to be important in regulation of mood and anxiety-related symptoms.