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:
self-monitoring (What do I do in high-risk situations?)
relapse fantasies (What would it be like to relapse?)
relaxation training/stress management
skills training
contingency contracts
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)SMOKING AND ALCOHOL USE 127