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The Abstinence Violation Approach Non 12 Step Drug Rehab and Alcohol Treatment

As of 2020, the number of drug-involved overdose deaths reached an all-time high of 91,799, according to the National Institute on Drug Abuse. At least 74.8% of those deaths involved opioids, 14% involved heroin, 26% involved psychostimulants, primarily… Before sharing sensitive information, make sure you’re on a federal government site.

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. Gradually he began to drink before meetings or interactions (maladaptive coping and negative reinforcement). He reported difficulty sleeping if he did not drink, could not get past the day without drinking or thinking about his next drink (establishment of a dependence pattern). His wife brought him for treatment and he was not keen on taking help He did not believe it was a problem (stage of change).

Characteristics of Abstinence Violation Effect

Serotonin plays an important role in postingestive satiety, and appears to be important in regulation of mood and anxiety-related symptoms. Preliminary findings suggest that impaired function in central nervous system serotonergic pathways may contribute to binge eating and mood instability in bulimia nervosa. Therapeutic effects of antidepressant medications in bulimia nervosa are thought to be related to their capacity to restore more normal signaling patterns in serotonergic pathways. Family abstinence violation effect studies have shown that there is an increased rate of eating disorders in first-degree relatives of individuals with anorexia nervosa and bulimia nervosa. Similarly, twin studies have shown a higher concordance for the eating disorders in monozygotic twins in comparison to dizygotic twins. These studies suggest that heritable biological characteristics contribute to the onset of the eating disorders, although the potential role of familial environmental factors must also be considered.

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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”). Motivational Interviewing (MI) and motivational enhancement therapy (MET) are approaches that target motivation https://ecosoberhouse.com/ and decisional balance of the patient. Although MI incorporates the principles of the trans theoretical model, it has been distinguished from both trans theoretical model and CBT21. Motivation enhancement therapy (MET) is a brief, program of two to four sessions, usually held before other treatment approaches, so as to enhance treatment response24.

ABSTINENCE VIOLATION EFFECT (AVE)

From New Year’s resolutions to the start of a new school year in September, we seem to be obsessed with clean, fresh starts where we can completely transform ourselves and our habits. However, this mentality may be just the thing that keeps us from achieving our goals. He calls this “urge surfing.” Instead of denying our addictive nature or hating ourselves for it, we learn to keep living in spite of it. We remember that our urges do not control us, that we have power over our own decisions. This is easier when utilizing a technique which Marlatt refers to as SOBER—Stop, Observe (our thoughts and emotions), Breathe, Expand (our awareness and our comprehension of potential consequences if we use), and Respond mindfully (make the right choice not to use).

Following this a decisional matrix can be drawn where pros and cons of continuing or abstaining from substance are elicited and clients’ beliefs may be questioned6. Interpersonal relationships and support systems are highly influenced by intrapersonal processes such as emotion, coping, and expectancies18. Critical for craving and relapse is the process of associative learning, whereby environmental stimuli repeatedly paired with drug consumption acquire incentive-motivational value, evoking expectation of drug availability and memories of past drug euphoria15. Inaction has typically been interpreted as the acceptance of substance cues which can be described as “letting go” and not acting on an urge. Many organizations, such as 12-Step programs like Alcoholics Anonymous, will often point to the notion that even thinking about using alcohol again represents a potential sign of a relapse. These differing definitions make the notion of a relapse rather vague, but sticking to the above traditional notions of a slip or lapse versus a full-blown relapse is most likely the only concrete solution to defining these behaviors.

Behavioral Treatments for Smoking

Addiction and related disorders are chronic lapsing and relapsing disorders where the combination of long term pharmacological and psychosocial managements are the mainstay approaches of management. Among the psychosocial interventions, the Relapse Prevention (RP), cognitive-behavioural approach, is a strategy for reducing the likelihood and severity of relapse following the cessation or reduction of problematic behaviours. Here the assessment and management of both the intrapersonal and interpersonal determinants of relapse are undertaken. This article discusses the concepts of relapse prevention, relapse determinants and the specific interventional strategies.

Therapy focuses on providing the individual the necessary skills to prevent a lapse from escalating into a relapse31. His therapist identified strategies to enhance his motivation, to help him engage in therapy, deal with craving, reducing social anxiety, assertiveness and beliefs and positive expectancies about alcohol use, and confidence or sense of self-efficacy in remaining abstinent. The wife was involved in therapy, to support his abstinence and help him engage in alternate activities. Rajiv’s problem is an illustration of how various psychological, environmental and situational factors are involved in the acquisition and maintenance of substance use. The AVE was introduced into the substance abuse literature within the context of the “relapse process” (Marlatt and Gordon 1985, p. 37). Relapse has been variously defined, depending on theoretical orientation, treatment goals, cultural context, and target substance (Miller 1996; White 2007).

2. Established treatment models compatible with nonabstinence goals

Overcoming the abstinence violation effect starts with being mindful of it and follows with being kinder to ourselves. If we accept the obvious fact that we are human beings and sometimes make mistakes, it is much easier to recover from setbacks. Rather than questioning our self-worth after a mistake is made, we will be able to simply acknowledge it and move on from there. The myth that we need to erase all past mistakes and start with a “blank slate” if we want to live a healthful life is dangerous because it keeps us striving for fad fitness trends rather than consistency. Amanda Marinelli is a Board Certified psychiatric mental health nurse practitioner (PMHNP-BC) with over 10 years of experience in the field of mental health and substance abuse. Amanda completed her Doctor of Nursing Practice and Post Masters Certification in Psychiatry at Florida Atlantic University.

Further, the more non-drinking friends a person with an AUD has, the better outcomes tend to be. Negative social support in the form of interpersonal conflict and social pressure to use substances has been related to an increased risk for relapse. Social pressure may be experienced directly, such as peers trying to convince a person to use, or indirectly through modelling (e.g. a friend ordering a drink at dinner) and/or cue exposure. For example, offering nonabstinence treatment may provide a clearer path forward for those who are ambivalent about or unable to achieve abstinence, while such individuals would be more likely to drop out of abstinence-focused treatment.

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