The Abstinence Violation Approach
By Dan Galant, PhD
“The Abstinence Violation Approach” – This ominous sounding term from the relapse prevention literature is perhaps one of the most useful concepts to understand in addiction treatment. I often have clients tell me years after our last therapy session that this was the singular most helpful idea to keep them on track! So what’s it all about – and how can it help you?
The Abstinence Violation Effect (AVE – think the abbreviation for avenue to help you remember it) is what happens when an individual deviates from his/her plan – and then continues to remain off that path due to frustration, shame, guilt, etc. Think of the problem drinker who has chosen to abstain from alcohol. When that person takes even one drink (”violating” their abstinence), the tendency is to think, “I really blew it…I’m a failure…might as well keep on drinking now!” I refer to this as a case of the “screw-it’s” (although harsher language is not uncommon!); a sense of giving up.
AVE and the 12-Step Approach
This effect is often unintentionally amplified by the 12-Step approach. I’ve heard of AA meetings where a member with over 10 years of sobriety ends up drinking (let’s say as an attempt to cope with the loss of a loved one or other tragic event). Instead of looking objectively and productively at the situation (e.g. this person only drank two days in the last 10 years – an impressive accomplishment! Let’s figure out some healthier ways they can cope with life’s bigger challenges…), this person must come back to the next meeting…as a “newcomer” starting over again from the beginning! Many would rather keep on drinking rather than come back to a primary source of support in shame. It seems akin to failing one exam during senior year in high school and being sent back to first grade as a result! Hopefully, one does not lose all the knowledge and experience gained along the journey.
As a Cognitive Behavioral therapist, I encourage people to challenge all-or-nothing thinking as well as self-labeling. I like the saying, “there is no failure…only feedback.” Instead of continuing to beat one’s self up continuously, I’d prefer he/she accept the negative consequences (costs) of their behavior, then move on to a better understanding of the context: What triggered this? What costs were re-experienced? What can I do next time to be better prepared?
Applying AVE More Broadly
Although AVE typically applies to substance use, it really has more broad application: deviation from any plan of healthier behaviors. This could be the committed athlete who misses one work out and decides the whole week (or longer) is ruined; the person who is eating healthily and has junk food for lunch, deciding to make poor choices for dinner because now “the diet is off,” etc. In each case, awareness of the AVE can lead to a choice to more quickly get right back on track! It can make the difference between a small slip…and a major relapse.
I often have this conversation at the very first session with a client. Sometimes they wonder if I’m being overly negative – after all, this is a discussion about the possibility of relapse. I offer the metaphor of a fire drill; even though I am not expecting (hopefully!) a fire in my building, I certainly want to prepare a plan in case I am faced with it. I relate that I have a “mixed” message for them: on the one hand, stay encouraged, keep up your motivation to really stay on track…yet, if for any reason you are not 100% able to do so, remember the AVE…and get right back on track!