Many people can relate to this feeling of guilt when they use a substance, like alcohol or marijuana, after promising themselves they wouldn’t. For people in recovery, a relapse can mean the return to a cycle of active addiction. While relapse doesn’t mean you can’t achieve lasting sobriety, it can be a disheartening setback in your recovery.
Unfortunately, a single lapse can cause you to fall into a full relapse because of something called the abstinence violation effect (AVE). Various factors in people’s lives can affect AVE differently. It is not necessarily a failure of self-control nor a permanent failure to abstain from using a substance of abuse. Those in addiction treatment or contemplating treatment can benefit from this aspect of relapse prevention.
What is the abstinence violation effect, and what are the signs of a coming relapse? Learn more about AVE.
What Is Abstinence Violation Effect?
In psychotherapy, an abstinence violation effect refers to the negative cognitive and affective reactions one experiences after returning to substance use after a period of abstinence. As a result of AVE, a person may experience uncontrollable, stable attributions, and feelings of shame and guilt after a relapse.
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.
The abstinence violation effect may cause someone to perceive their relapse as an action without a conclusion. Some people may think, “As long as I use drugs or alcohol again, I should just keep on using it since there is no way to stop.” Another thought is, “Addiction is a chronic disease, so I should just keep on using.”
Ongoing use of the substance can be caused by feelings of personal failure. This strongly held belief increases the likelihood of relapse more than once. The feeling of self-guilt falls under the description of AVE. A person’s guilt is a difficult emotion to carry, one that can constantly replay in their minds, causing them to use substances again to ease their guilt.
Nevertheless, 40 to 60% of people who once were addicted to a substance and achieved sobriety relapse at some point, based on estimates from the National Institute on Drug Abuse (NIDA).
Relapse prevention includes understanding what triggers substance abuse, which varies from person to person. As an example, when out with friends at their favorite hangout, someone with alcohol use disorder may feel like having a drink.
Another example is when driving long distances, or with a cup of coffee, smokers may feel the urge to smoke when they normally enjoy smoking.
Is a Relapse Dangerous?
When someone abuses a substance for a long time, they will have a higher tolerance for its effects. It is for this reason that someone’s tolerance declines following a period of abstinence and that they may overdose if they start using again at the same level as before.
Despite the fact that relapse can be all-consuming, it does not have to be. It may be a single occurrence where someone decides to use the substance again. A single AVE instance can result in a long-term relapse for the individual. Knowing the different stages of relapse and how to avoid them is therefore crucial.
You might imagine a relapse as a single event that occurs during a moment of weakness. Relapses, however, don’t begin with action; they begin in the mind.
Relapse is viewed by psychologists as more of a process than a singular event. A relapse is the result of a series of events that occur over time, according to psychologist and researcher Alan Marlatt, Ph.D.
A mindset shift caused by triggers or stress may lead you to take that drink or start using drugs again. A relapse can be caused by a cascading effect that includes several issues that occur before you begin using again, according to Marlatt.
The road to relapse may look something like this:
- You experience stress caused by a lifestyle imbalance.
- Stress has made you crave indulgences to cope.
- You experience cravings.
- You rationalize using drugs again.
- You experience a high-risk situation.
- You don’t have an effective coping response.
- Your self-efficacy decreases.
- You lapse and take the drug, causing you to experience shame.
- You continue using the drug.
It can take time for this process to occur, or it can occur quickly. There are, however, dozens of coping strategies that can be used at each of those nine steps to prevent relapse, according to Marlatt. Despite the fact that a wide variety of events can trigger a relapse, the recurrence of symptoms occurs in three stages: an emotional relapse, a mental relapse, and a physical relapse.
There are several types of relapse, which can include:
Relapse begins with emotional stages. The idea of using it again isn’t even on your mind at this point. As a result of stress, high-risk situations, or inborn anxieties, you are experiencing negative emotional responses. Emotional relapses can be incredibly difficult to recognize because they occur so deeply below the surface in your mind.
Anxiety, depression, loneliness, and irritability are all symptoms of this stage. It is inevitable that everyone will experience negative emotions at one point or another. It is not necessarily these natural emotions that cause emotional relapse, but how you cope with them, that does.
Relapsing mentally involves thinking about using drugs or alcohol again. There may be an internal conflict between resisting thoughts about drugs and compulsions to use them. There is a possibility that you might rationalize why you might not experience the same consequences if you continue to use.
A physical relapse occurs when you take your first drug or drink after achieving sobriety. Marlatt differentiates between slipping into abstinence for the first time and totally abandoning the goal. Seeking help in time can prevent you from slipping into uncontrolled active addiction. However, because of AVE, it’s very difficult to stop a relapse at this point.
Everyone is different, and your experience with relapse may be unique. However, there are some common early psychological signs that a relapse may be on the way. If you are worried that you might be headed for a relapse, you don’t have to wait until it happens to reach out for help.
Recovery is a tough road. On top of that, life can get difficult at times. People in addiction recovery often experience drug cravings when they go through stress. Addiction rewires the brain to consider drug use an important source of reward. When you are feeling overwhelmed, your brain may unconsciously crave drugs as a way to help you feel better. But you may have the thought that you need the drug or alcohol to help get you through the tough situation. Unconscious cravings may turn into the conscious thought that it is the only way you can cope with your current situation.
‘I Deserve This’
A period of successful recovery and abstinence is something to be celebrated. However, it can sometimes lead to the thought that you have earned a drink or a night of using drugs. It sounds counterintuitive, and it is, but it is a common thought that many people have to recognize to avoid relapse. Celebrating victories is a good thing, but it’s important to find constructive ways to appreciate your sobriety.
‘This Time Will Be Different’
Similar to the reward thought, you may have another common thought after a period of sobriety. When you’ve experienced some success in your recovery, you may think that you can return to drug or alcohol use and control it. You may think that this time will be different, but if your drinking and drug use has gotten out of control in the past, it’s unlikely to be different this time.
‘Relapse Is Inevitable’
Relapse is a common part of recovery for many people. More than half of people who achieve sobriety eventually relapse. Knowing that can be disheartening, but it can also cause you to relapse out of the belief that relapse is inevitable. It’s important to note that a relapse doesn’t mean your recovery has failed. Many people who achieve long-term sobriety do so after a relapse. Still, you should also realize that relapse isn’t guaranteed, especially if you stay vigilant in managing your continued recovery.