Abstinence Violation Effect

The abstinence violation effect (AVE) includes the cognitive and emotional responses a substance abuser may experience after breaking a rule for abstinence. In 1985, Alan Marlatt and Judith Gordon proposed the AVE as an important ingredient of relapse and a variable needing to be addressed as part of their relapse prevention model. In 2001, George Parks, Britt Anderson, and Alan Marlatt suggested that the AVE included the attributions and cognitive dissonance that develop following a lapse in alcohol or other drug use by a substance user who had previously made an active decision to maintain abstinence. It has been hypothesized that a slip or lapse, the first violation of the abstinence goal, has the potential to turn into a full-blown relapse depending upon the attributions an individual applies to the lapse and the level of cognitive dissonance experienced in relation to the lapse.

Cognitive dissonance is a psychological phenomenon that develops when there is a disagreement between goals or values and behavior. In the case of the AVE, cognitive dissonance occurs when an individual identifies her- or himself as an abstainer, while at the same time experiencing thoughts and urges to use alcohol and other drugs. The abstinence "rule" creates the value that, in order to be successful in recovery, a substance abuser must not act on these urges. If the individual encounters high-risk situations (i.e., any situation that increases the risk of a potential relapse), succumbs to urges, and breaks the abstinence rule, a lapse has occurred.

This cognitive dissonance is further complicated by the attributions ascribed to the lapse. The most extreme of these attributions often seen in AVE are internal, stable, and global. In other words, in extreme cases of negative attributions, individuals will view the lapse as an internal flaw ("I should have controlled this") that is stable across time ("I will never get clean") and is attributed to global causes that disregard the context of the situation ("No matter what, I am a failure"). This can result in feelings of being a failure, of being a bad person, or of disappointing those who are closest. These attributions also cause the individual to have a decreased level of self-efficacy (i.e., confidence in the ability to make a behavior change) because of a perception that urges cannot be controlled. Negative attributions, coupled with these decreased feelings of self-efficacy, may lead to increased amounts of cognitive dissonance. As a result of the increased cognitive dissonance, decreased self-efficacy, and negative attributes, substance abusers may feel out of control and as if it is "too late" to seek help. Further, the person may come to believe that "all is lost" in relation to abstinence and that she or he may as well return to previous substance use behaviors. This is an example of dichotomous thinking associated with substance use and the AVE. Thus, the individual may continue to use alcohol and other drugs because of their dichotomous thinking, fail to seek help, and relapse.

AVE may also be seen in substance abusers who endorse controlled substance use. In this case, AVE is called the rule violation effect. The psychological phenomenon associated with AVE is similar to that of the rule violation effect. Instead of the abstinence rule being violated, it is the self-imposed rule for controlling the substance of choice that is violated.

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