Coping with a lapse: the abstinence/rule violation effect

Slips and lapses are common in the recovery process. While they are disappointing, they do not mean failure or indicate an inability to change. The client's challenge is to find ways to overcome slips and maintain goals as best as possible. Treat a slip as a learning experience.

It is important to talk about how to deal with a lapse with the client in this session to start them thinking about how to prevent a relapse to regular use of speed. This is particularly important if this is to be your final session (i.e., you have decided to deliver the two-session rather than the four-session intervention).

Often people will feel very bad about themselves if they have a lapse, and will see it as the end of the world and an end to their attempts at abstinence (or other goals). The abstinence violation effect is said to be your client's reaction if he/she had made a decision to stop using, and then did. Alternatively, a rule violation effect is said to be your client's reaction if he/she had decided to change his/her pattern of speed use (e.g. to cut down or to stop) and he/she then had a 'slip' and used. If the client returns to using on one or two occasions as they previously were, then this is called a lapse. However, if following this 'lapse' the client completely returns to their previous levels of speed use, this is called a relapse. If your client has a lapse, it is more likely to turn into a relapse if he/she engages in particular distorted styles of thinking and feelings about him/herself (called the abstinence/rule violation effect or 'breaking the rule effect'). Explain to your client:

"The 'breaking the rule effect' could happen if you have a slip and 'break your rules'. By this I mean your goal or rule about staying off speed completely (or cutting down to a lesser level if reduction is your client's goal). The 'breaking the rule effect' happens when you have a slip and break your rules, and then think something like "oh stuff it, I've had a hit – broken my rule, I might as well keep going...".

But, there are other ways of looking at the situation. Slips will happen – everybody makes mistakes, and it doesn't mean that you have failed completely. You can stop at one hit, and go again from there – you can start with a clean slate. A slip doesn't mean you are getting worse, or headed for a relapse, rather that you are experiencing what everybody does – a simple slip. But, if you have a slip, it is more likely to turn into a relapse if you give into the 'breaking the rule effect'."

The main strategy to help your client cope with the abstinence/rule violation effect is to re-evaluate and modify the thinking errors that contribute to the effect. The aim is for your client to firstly identify the distortions in his/her thinking that occur in relation to his/her speed use (e.g. minimisation, all or nothing, overgeneralisation); and secondly to generate a more helpful, less catastrophic and more realistic way of viewing the situation (e.g. a slip/mistake rather than a complete failure). For example: Top of page

Unhelpful thought: "I've blown it".
Helpful thought: "I've just had a slip and I can get back on track".

Unhelpful thought: "I knew I wouldn't be able to stop".
Helpful thought: "I have been able to make a change...this is only a slip and I will keep on trying".

Unhelpful thought: "I've messed up already so I might as well keep going".
Helpful thought: "I've just made a mistake and I can learn from it and get back on course".

Discuss these alternative thoughts with your client during the session.