Marlatt and Gordon’s Relapse Prevention Program aims to treat alcohol dependence. He talks about the violation effect of abstinence, Which involves a relapse into addictive behavior during drug rehab or drug rehab treatment.
Relapses greatly influence the course of a recovering person. In this article we will see what the violation effect of abstinence consists of; we will know how it appears and its impact on the person with an addictive disorder.
Relapse prevention program
Marlatt and Gordon’s Relapse Prevention Program (1985) is aimed at people with a substance-related addictive disorder. Specifically, it is commonly used in patients with alcohol dependence.
The program, as the name suggests, aims to prevent relapses of each addictive disorder. Marlatt and Gordon argue that in relapse, three cognitive factors interact:
- Self-efficacy: perceived ability to cope with situations.
- Expectations on the outcomes of consumer behavior.
- Causal attributions.
The relapse prevention program talks about the effect of abstinence violation (VAS) as the emergence of a new addictive behavior on the part of the patient (i.e., that the patient drinks from new, relapse); it is therefore about an emotional and cognitive consequence that occurs in the drug addict patient after a period of abstinence and commitment to treatment.
Effect of violation of abstinence: features
Now that we’ve seen a bit of what the abstinence violation effect is, let’s get to know its features in more detail.
The violation effect of abstinence involves a loss of control of the drinker, which leads the subject to a new relapse. This effect produces in the person a negative emotional state of guilt and an internal conflict between the incompatibility of the addictive behavior practiced and his desire for abstinence.
The violation effect of abstinence is a thought pattern that appears after drug use. It is generally used for cases of alcoholism.
There are authors who argue that this effect appears as the result of the intense desire to drink, which appears after drinking the first glass; this desire leads to a series of physiological manifestations in the organism.
For their part, Marlatt and Gordon believe that it is due more to a belief or the existence of expectations of the type “self-fulfilling prophecy” than to underlying physiological mechanisms.
The violation effect of abstinence it is made up of two cognitive-affective elements, And appears based on both of them. Additionally, these components are what will trigger the aforementioned unpleasant emotional state associated with EVA. These components are:
1. An effect of cognitive dissonance
Cognitive dissonance occurs due to addictive ‘drink again’ behavior it does not match the self-image of abstinence desired by the person.
There is then this dissonance or “incompatibility” for the patient between what he wants (to drink) and what he knows to be “right” or what he wants in the long term (not to drink and to continue with the abstinence).
2. An effect of personal attribution
On the other hand, once the drinking behavior has taken place, the patient performs an internal, stable and global attribution of the addictive behavior (For example: thinking that you have consumed because it is a disaster and will not be able to recover from your addiction).
In other words, the subject attributes the occurrence of his relapse behavior to stable, global and internal factors, which leads him to decrease his resistance to future temptations (and therefore to be more likely to relapse in the future, thus creating a kind of “vicious circle”).
What factors influence relapses?
But what factors encourage the person to use again and therefore to relapse?
On the one hand, the fact that the person is exposed to a situation considered to be high risk without having detected it beforehand, in addition to the fact that he does not have sufficient adaptive capacities to know how to expose himself to this risky situation and / or to high levels of emotionality (pleasant or unpleasant).
All these factors they will make it difficult for the person to reason and will result in loss of control (or self-control) in the person; finally, the person would develop the effect of violation of abstinence, re-consumption of alcohol and therefore relapse.
In other words, you could say that relapse makes her more likely to relapse in the future. In other words, the violation effect of abstinence results in a situation with a high risk of relapse (no fall or occasional use).
The role of relapses
The fact that there is consumption again, punctual and concrete, would imply a relapse. Throughout the detoxification treatment, it is best that relapses do not occur. However, the fact that they occur it should not prevent further processing and that abstinence and recovery are finally achieved.
As we have seen in the violation effect of abstinence, when relapses appear during treatment, there are also a number of emotional and cognitive changes in the person, which will affect their condition and course during processing.
Therefore, broader psychological and behavioral treatment, one of the possible techniques to use to reduce the likelihood of the abstinence violation effect, is to: training in different cognitive strategies.
These strategies include cognitive restructuring, focused on modifying errors associated with the effect of violation of abstinence or seemingly irrelevant decisions.
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- Pereiro, C. (2007). Prevention of relapses and other psychotherapeutic or psychosocial approaches in the management of alcoholism. Evidence-Based Alcohol Clinical Guide.
- Pérez, M .; Fernandez, JR; Fernández, C. and Amic, I. (2010). Guide to Effective Psychological Treatments I: Adults. Madrid: Pyramid.