After the two stimuli have been paired repeatedly, the neutral stimulus becomes a conditioned stimulus that elicits the same physiological response. Although many developments over the last decade encourage confidence in the RP model, additional research is needed to test its predictions, limitations and applicability. In particular, given recent theoretical revisions to the RP model, as well as the tendency for diffuse application of RP principles across different treatment modalities, there is an ongoing need to evaluate and characterize specific theoretical mechanisms of treatment effects. The last decade has seen numerous developments in the RP literature, including the publication of Relapse Prevention, Second Edition  and its companion text, Assessment of Addictive Behaviors, Second Edition . The following sections provide an overview of major theoretical, empirical and applied advances related to RP over the last decade.
In the multifaceted journey of overcoming addiction and living a healthier life, individuals often encounter a psychological phenomenon known as the abstinence violation effect (AVE). It sheds light on the challenges individuals face when attempting to maintain abstinence and how a single lapse can trigger a surge of negative emotions, potentially leading to a full relapse or a return to unhealthy living (Collins & Witkiewitz, 2013; Larimer, Palmer, & Marlatt, 1999). Mark’s key responsibilities include handling day-to-day maintenance matters and oversees our Environment of Care management plan in conjunction with Joint Commission and DCF regulations. Mark’s goal is to provide a safe environment where distractions are minimized, and treatment is the primary focus for clients and staff alike. Mark received a bachelor’s degree in Business Administration, with a minor in Economics from the University of Rhode Island.
4. Consequences of abstinence-only treatment
Additionally, the intervention had no effect on subjective measures of craving, suggesting the possibility that intervention effects may have been specific to implicit cognitive processes . Overall, research on implicit cognitions stands to enhance understanding of dynamic relapse processes and could ultimately aid in predicting lapses during high-risk situations. Teasdale and colleagues (1995) have proposed a model of depressive relapse which attempts to explain the process of relapse in depression and also the mechanisms by which cognitive therapy achieves its prophylactic effects in the treatment of depression.
For instance, in a high-risk context, a slight and momentary drop in self-efficacy could have a disproportionate impact on other relapse antecedents (negative affect, expectancies) . Furthermore, the strength of proximal influences on relapse may vary based on distal risk factors, with these relationships becoming increasingly nonlinear as distal risk increases . For example, one could imagine a situation whereby a client who is relatively committed to abstinence from alcohol encounters a neighbor who invites the client into his home for a drink. Feeling somewhat uncomfortable with the offer the client might experience a slight decrease in self-efficacy, which cascades into positive outcome expectancies about the potential effects of having a drink as well as feelings of shame or guilt about saying no to his neighbor’s offer.
Laurel, as the Director of Corporate Compliance for USR, is responsible for ensuring that the facility follows all federal and state regulatory requirements, accreditation standards and industry best practices. Laurel has over twenty years’ experience in legal and regulatory affairs in both the public and private sectors. She attended the University of Kansas where she studied political science, and she is designated by the Council on Licensure, Enforcement and Regulation (CLEAR) as a Certified National Investigator and Inspector (CNII). Prior to joining Amethyst, she served as the Director of Enforcement for a state regulatory body.
As was the case for Marlatt’s original RP model, efforts are needed to systematically evaluate specific theoretical components of the reformulated model . The empirical literature on relapse in addictions has grown substantially over the past decade. Because the volume and scope of this work precludes an exhaustive review, the following section summarizes a select body of findings reflective of the literature and relevant to RP theory. The studies reviewed focus primarily on alcohol and tobacco cessation, however, it should be noted that RP principles have been applied to an increasing range of addictive behaviors [10,11]. In conclusion, the abstinence violation effect is a psychological effect that impacts those in recovery, as well as those who are focused on making more positive behavioral choices in their lives.
Mechanisms of treatment effects
Proximal risks actualize, or complete, the distal predispositions and include transient lapse precipitants (e.g. stressful situations) and dynamic individual characteristics (e.g. negative affect, self-efficacy). Combinations of precipitating and predisposing risk factors are innumerable for any particular individual and may create a complex system in which the probability of relapse is greatly increased. The psychologist Alan Marlatt popularized the idea of the abstinence violation effect. His model of relapse prevention from the 1980s still influences how we treat addictive behaviors today. In Marlatt’s model, you go through a period of abstinence before experiencing a high-risk situation, which can be any stressors in your life.
Implicit measures of alcohol-related cognitions can discriminate among light and heavy drinkers  and predict drinking above and beyond explicit measures . One study found that smokers’ attentional bias to tobacco cues predicted early lapses during a quit attempt, but this relationship was not evident among people receiving nicotine replacement therapy, who showed reduced attention to cues . The onset of bulimia nervosa is often preceded by extended periods of recurrent dieting occurring in the context of other psychosocial stressors. Other behavioral characteristics that have been identified in patients with bulimia nervosa include impulsivity and mood lability, and it is possible that these traits may contribute to the onset or perpetuation of symptoms in this disorder.
The reformulated cognitive-behavioral model of relapse
Most scientists who studied SUD treatment believed that abstinence was the only acceptable treatment goal until at least the 1980s (Des Jarlais, 2017). Abstinence rates became the primary outcome for determining SUD treatment effectiveness (Finney, Moyer, & Swearingen, 2003; Kiluk, Fitzmaurice, Strain, & Weiss, 2019; Miller, 1994; Volkow, 2020), a standard which persisted well into the 1990s (Finney et al., 2003). Little attention was given to whether people in abstinence-focused treatments endorsed abstinence goals themselves, or whether treatment could abstinence violation effect help reduce substance use and related problems for those who did not desire (or were not ready for) abstinence. Rather, when people with SUD are surveyed about reasons they are not in treatment, not being ready to stop using substances is consistently the top reason cited, even among individuals who perceive a need for treatment (SAMHSA, 2018, 2019a). Indeed, about 95% of people with SUD say they do not need SUD treatment (SAMHSA, 2019a). Even among those who do perceive a need for treatment, less than half (40%) make any effort to get it (SAMHSA, 2019a).