Marlatt and Gordon’s relapse prevention program is aimed at treating alcohol addiction. It talks about the Rape Effect of Abstinence , which implies the fact of relapsing into addictive behaviour within a treatment of detoxification.

Relapses have an important influence on the evolution of a person in recovery. In this article we will see what the Effect of Abstinence Violation consists of; we will know how it appears and the repercussions that it entails for 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 often used for patients with alcohol addiction.

The program, as its name suggests, is aimed at preventing relapses that are specific to each addictive disorder. Marlatt and Gordon argue that three cognitive factors interact in relapse :

  • Self-efficacy: perceived ability to cope with situations.
  • Expectations of the results of the consumption behavior.
  • Causality attributions.

The Relapse Prevention Program speaks of the Effect of Abstinence Violation (EVA) as the appearance of a new addictive behavior on the part of the patient (i.e., that he or she drinks again, relapses); it is therefore about an emotional and cognitive consequence that arises in the addicted patient after a period of abstinence and commitment to treatment.

Effect of Abstinence Violation: Characteristics

Now that we have seen a little of what the Rape Effect of Abstinence is, let’s learn more about its characteristics.

The Effect of Abstinence Violation implies a loss of control in the drinker, which leads the subject to a new relapse . This effect produces in the person a negative emotional state of guilt and internal conflict between the incompatibility of the addictive behaviour carried out and his/her desire for abstinence.

The Rape Effect of Abstinence is about a pattern of thinking that appears after the use of the drug . It is usually used for cases of alcoholism.

There are authors who maintain that this effect appears as a result of the intense desire to drink, which appears after taking the first glass; this desire leads to a series of physiological manifestations in the organism.

For their part, Marlatt and Gordon believe that this is due more to a belief or the existence of expectations of the “self-fulfilling prophecy” type, rather than to underlying physiological mechanisms.

EVA components

The Rape Effect of Abstinence is composed of two cognitive-affective elements , and appears as a function of these two. Furthermore, these components are the ones that will trigger the aforementioned unpleasant emotional state associated with EVA. These components are:

1. A cognitive dissonance effect

Cognitive dissonance occurs because the addictive behavior of “drinking again” does not fit with the person’s desired self-image of abstinence .

There is then that dissonance or “incompatibility” for the patient between what they want (drinking) and what they know is “right” or what they want in the long run (not drinking and continuing to be abstinent).

2. A personal attribution effect

On the other hand, once the drinking behaviour has been carried out, the patient carries out an internal, stable and global attribution of the addictive behaviour (for example: thinking that one has consumed because one is a mess and that one will not be able to recover from one’s addiction).

In other words, the subject attributes the occurrence of his relapse behavior to stable, global and internal factors, and that makes the resistance to future temptations decrease (and therefore it is more likely that he will relapse in the future, thus creating a kind of “vicious circle”).

What factors influence relapses?

But what factors influence a person to use again and therefore to relapse?

On the one hand, the fact that the person is exposed to a situation considered high risk without having previously detected it, added to the fact that he/she does not have enough coping skills to know how to expose him/herself to such a risk situation and/or high levels of emotionality (pleasant or unpleasant).

All of these factors will make the person’s reasoning difficult and will lead to a loss of control (or self-control) in the person; eventually, the person will develop the Abstinence Rape Effect, regressing to drinking and therefore relapse.

In other words, one could say that the fact of relapsing makes it more likely that one will relapse in the future. In other words, the Rape Effect of Abstinence translates into a high-risk situation for relapse (no fall or one-time use).

The role of relapse

The fact that consumption occurs again, punctually and concretely, would imply a relapse. Throughout the detoxification treatment, it is preferable that relapses do not occur. However, the fact that they do occur does not have to prevent the continuation of the treatment and the eventual achievement of abstinence and recovery.

As we have seen in the Effect of Abstinence Violation, when relapses occur during treatment, a series of emotional and cognitive changes also occur in the person, which will affect his or her state and evolution within the treatment.

Treatment of EVA

Within a wider psychological and behavioural treatment, one of the possible techniques to be used to reduce the probability of the Effect of Abstinence Rape, consists of training in different cognitive strategies .

Such strategies include cognitive restructuring, aimed at modifying errors associated with the effect of violating abstinence or apparently irrelevant decisions.

Bibliographic references:

  • Echeburúa, E. (1999). Addictions without drugs?: the new addictions: gambling, sex, food, shopping, work, Internet. Desclée de Brouwer.
  • Pereiro, C. (2007). Relapse prevention and other psychotherapeutic or psychosocial approaches in the management of alcoholism. Evidence-based Alcohol Clinical Guidelines.
  • Pérez, M.; Fernández, J.R.; Fernández, C. and Amigo, I. (2010). Guide to effective psychological treatments I: Adults. Madrid: Pirámide.