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Abstinence Violation Effect

  • January 2013
DOI:10.1007/978-1-4419-1005-9_623
Authors:
Susan E Collins at Washington State University
Susan E Collins
Katie Witkiewitz at University of New Mexico
Katie Witkiewitz
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Abstinence Violation Effect
Susan E. Collins
1
and Katie Witkiewitz
2
1
Department of Psychiatry and Behavioral
Sciences, University of Washington, Harborview
Medical Center, Seattle, WA, USA
2
University of New Mexico, Albuquerque,
New Mexico, USA
Synonyms
AVE
Definition
The abstinence violation effect (AVE) refers to
the negative cognitive (i.e., internal, stable,
uncontrollable attributions; cognitive disso-
nance) and affective responses (i.e., guilt,
shame) experienced by an individual after a
return to substance use following a period of
self-imposed abstinence from substances
(Curry, Marlatt, & Gordon, 1987).
Description
AVE in the Context of the Relapse Process
The AVE was introduced into the substance
abuse literature within the context of the “relapse
process” (Marlatt & Gordon, 1985, p. 37).
Relapse has been variously defined, depending
on theoretical orientation, treatment goals, cul-
tural context, and target substance (Miller, 1996;
White, 2007). It is, however, most commonly
used to refer to a resumption of substance-use
behavior after a period of abstinence from sub-
stances (Miller, 1996). The term relapse may be
used to describe a prolonged return to substance
use, whereas lapse may be used to describe dis-
crete, circumscribed “slips” during sustained
abstinence (Marlatt & Gordon, 1985, p. 32).
As originally described by Marlatt and Gordon
(1985), the relapse process typically begins when
a person who has achieved abstinence encounters a
situation that puts them at high risk for relapse (i.e.,
a high-risk situation). If the person is able to cope
effectively with the high-risk situation, they may
experience increased self-efficacy (i.e., confidence
to avoid a lapse). If, on the other hand, they are
unable to cope with the high-risk situation, they
may experience decreased self-efficacy. If this
decreased self-efficacy is paired with positive out-
come expectancies for substance use, a person
may have a heightened risk for a lapse. If a lapse
occurs, it may be experienced as a “violation” of
self-imposed abstinence, which gave rise to the
term, AVE. The AVE may, in turn, precipitate
a relapse if the person turns to substances repeat-
edly to cope with the resulting negative cognitive
and affective reactions of the AVE.
AVE: Cognitive and Affective Responses to
a Lapse
The AVE is characterized by a lapse paired with
a specific constellation of negative cognitive and
affective reactions. The role of cognitions stems
from attributional theory (Weiner, 1974):
a person might attribute their lapse to factors
that are internal, global, and uncontrollable. For
example, people may believe the lapse occurred
due to their own, irreparable character defects or
chronic disease determinants. The associated
affective component stems from dissonance
between the lapse and one’s perceived self-
image as an abstainer, which together with the
attributions, can lead to feelings of guilt, shame,
and hopelessness (Marlatt & Gordon, 1985).
People who experience the AVE are more likely
to progress from a lapse to a relapse (Miller,
Westerberg, Harris, & Tonigan, 1996), and
several studies have demonstrated the role of
the AVE in predicting relapse among drinkers
(Collins & Lapp, 1991), smokers (Curry et al.,
1987), dieters (Mooney, Burling, Hartman, &
Brenner-Liss, 1992), and marijuana users
(Stephens, Curtin, Simpson, & Roffman, 1994).
In contrast, if people attribute the lapse to
external, unstable (i.e., changeable), and control-
lable causes, they may not interpret the lapse as
a threat to their self-image and may instead view
it as a unique occurrence that can be avoided in
the future. This attributional style may diffuse the
A8 Abstinence Violation Effect
person’s affective response to the lapse and
reduces the likelihood of a progression from
lapse to relapse (Laws, 1995; Marlatt & Gordon,
1985; Walton, Castro, & Barrington, 1994).
Averting the AVE may have lasting effects: as
the situation is less affectively charged, the indi-
vidual might be open to exploring the determi-
nants of the lapse and to experimenting with
alternative coping strategies in the future. This
may, in turn, lead to increased self-efficacy and
more effective coping across various high-risk
situations (Marlatt & Gordon, 1985).
Preventing the AVE Response
Clinicians may help clients interrupt the relapse
process at various points and ultimately avoid the
AVE. First, clinicians can help clients identify
and apply effective behavioral and cognitive
strategies in high-risk situations to avoid the ini-
tial lapse altogether. If a lapse occurs, clinicians
should be empathetic and nonjudgmental in their
approach (Miller & Rollnick, 2002) and should
help clients reframe the lapse as the product of
multiple factors (versus only internal factors),
as being controllable (versus uncontrollable),
and as situation-specific (versus global; Larimer,
Palmer, & Marlatt, 1999). A step-by-step explo-
ration may help clients learn how to interrupt
the relapse process at various points to avoid
future lapses, the AVE and/or relapses (Larimer
et al., 1999). Further, the clinician may elicit
and positively reinforce clients’ existing coping
skills to support the clients’ self-efficacy and
may teach clients additional behavioral and cog-
nitive coping strategies for application in future
high-risk situations, as necessary (Witkiewitz &
Marlatt, 2007). Finally, clinicians should assess
whether clients are coping adequately with
the negative affective component of the AVE,
which may otherwise precipitate future lapses or
relapses.
Cross-References
▶Addictive Behaviors
▶Alcohol Abuse and Dependence
▶Binge Drinking
▶Health Risk (Behavior)
▶National Institute on Alcohol Abuse and
Alcoholism
▶Relapse, Relapse Prevention
References and Readings
Collins, R. L., & Lapp, W. M. (1991). Restraint and
attributions: Evidence of the abstinence violation
effect in alcohol consumption. Cognitive Therapy
and Research, 15, 69–84.
Curry, S., Marlatt, G. A., & Gordon, J. R. (1987). Absti-
nence violation effect: Validation of an attributional
construct with smoking cessation. Journal of Consult-
ing and Clinical Psychology, 55, 145–149.
Larimer, M. E., Palmer, R. S., & Marlatt, G. A. (1999).
Relapse prevention: An overview of Marlatt’s
cognitive-behavioral model. Alcohol Research &
Health, 23, 151–160.
Laws, D. R. (1995). Central elements in relapse preven-
tion procedures with sex offenders. Psychology, Crime
and Law, 2, 41–53.
Marlatt, G. A., & Gordon, J. R. (1985). Relapse preven-
tion: Maintenance strategies in the treatment of addic-
tive behaviors. New York: The Guilford Press.
Miller, W. R. (1996). What is relapse? Fifty ways to leave
the wagon. Addiction, 91(Suppl.), S15–S27.
Miller, W. R., & Rollnick, S. (2002). Motivational
interviewing: Preparing people for change (2nd ed.).
New York: US Guilford Press.
Miller, W. R., Westerberg, V. S., Harris, R. J., & Tonigan,
J. S. (1996). What predicts relapse? Prospective testing
of antecedent models. Addiction, 91(Suppl.), 155–171.
Mooney, J. P., Burling, T. A., Hartman, W. M., & Bren-
ner-Liss, D. (1992). The abstinence violation effect
and very low calorie diet success. Addictive Behaviors,
19, 23–32.
Stephens, R. S., Curtin, L., Simpson, E. E., & Roffman,
R. A. (1994). Testing the abstinence violation effect
construct with marijuana cessation. Addictive Behav-
iors, 19, 23–32.
Walton, M. A., Castro, F. G., & Barrington, E. H. (1994).
The role of attributions in abstinence, lapse and relapse
following substance abuse treatment. Addictive Behav-
iors, 19, 319–331.
Weiner, B. (1974). Achievement motivation and attribu-
tion theory. Morristown, NJ: General Learning Press.
White, W. L. (2007). Addiction recovery: Its definition
and conceptual boundaries. Journal of Substance
Abuse Treatment, 33, 229–241.
Witkiewitz, K., & Marlatt, G. A. (2007). Relapse
prevention for alcohol and drug problems. In
G. A. Marlatt & D. M. Donovan (Eds.), Relapse
prevention: Maintenance strategies in the treatment
of addictive behaviors (2nd ed.). New York: The
Guilford Press.
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Restraint and attributions: Evidence of the abstinence violation effect in alcohol consumption
Article
  • Feb 1991
In this cross-sectional test of the occurrence of the abstinence violation effect (AVE), a community sample of 323 social drinkers completed measures of drinking restraint (perceived efficacy for controlling alcohol consumption and behavioral attempts to limit drinking) and causal attributions for drinking-related events. These measures were included as predictors in a multivariate multiple-regression equation in which three aspects of self-reported drinking served as dependent variables: minimum number of drinks per occasion, maximum number of drinks per occasion, and drinking-related problems. The results indicated differential sets of predictors for each of the dependent variables. Both aspects of restraint predicted minimum consumption, and both aspects of restraint and attributions for positive drinking situations predicted maximum consumption. Perceived efficacy for controlling alcohol consumption and attributions for negative drinking situations predicted alcohol-related problems. The consistency between this pattern of results and Marlatt's (1985a) reformulation of the AVE is discussed.
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