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The abstinence violation effect
Page 127 Black blue SMOKING AND ALCOHOL USE 127 or will become a full-blown relapse. Marlatt and Gordon describe this transition as the abstinence violation effect (AVE). The abstinence violation effect The transition from initial lapse to full blown relapse is determined by dissonance conflict and self-attribution. Dissonance is created by a conflict between a self-image as someone who no longer smokes/drinks and the current behaviour (e.g. smoking/drinking). This conflict is exacerbated by a disease model of addictions, which emphasizes ‘all or nothing’, and minimized by a social learning model, which acknowledges the likelihood of lapses. Having lapsed, the individual is motivated to understand the cause of the lapse. If this lapse is attributed to the self (e.g. ‘I am useless, it’s my fault’), this may create guilt and self-blame. This internal attribution may lower self-efficacy, thereby increasing the chances of a full-blown relapse. However, if the lapse is attributed to the external world (e.g. the situation, the presence of others), guilt and self-blame will be reduced and the chances of the lapse remaining a lapse will be increased. Marlatt and Gordon developed a relapse prevention programme based on cognitive behavioural techniques to help prevent lapses turning into full-blown relapses. This programme involved the following procedures: I self-monitoring (What do I do in high-risk situations?) I relapse fantasies (What would it be like to relapse?) I relaxation training/stress management I skills training I contingency contracts I cognitive restructuring (learning not to make internal attributions for lapses). How these procedures relate to the different stages of relapse is illustrated in Figure 5.7. Fig. 5-7 Relapse prevention intervention strategies (after Marlatt and Gordon 1985) Page 127 Black blue