Abstract
To the Editor
Relapse is a major clinical problem in treating addictive behaviours. The impact of the individual’s perception of their initial lapse can be damaging to their psychological well-being and it plays a significant role in progression towards relapse. This phenomenon is known as abstinence violation effect (AVE; Marlatt and Donovan, 1985). Abstinence violation effect has been widely researched in substance use populations. There is a dearth of work to explore the presence of AVE among individuals with behavioural addictions. The individual in this case approached the Service for Healthy Use of Technology (SHUT) Clinic, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, Karnataka, India because his pornography use started to progressively interfere in his occupational functioning and in his interpersonal relationships.
Mr X was a 31-year-old, unmarried male who worked as a salaried professional. Mr X started accessing pornography from the age of 18 years. He watched pornography four to five times per day with each session lasting 20–30 minutes. These sessions were followed by masturbation. The total duration of use on each day was 2–3 hours. This pattern of excessive pornography use continued till 26 years of age and was considered to be a behavioural addiction. However, with the emergence of psychosocial obligations, Mr X started contemplating a reduction in his pornography use. He was not able to abstain from pornography use beyond 90 days. The lapse or violation of abstinence led to helpless cognitions, including ‘I am not strong willed to delay the urges’; hopeless cognitions such as ‘I will never overcome my habit’; catastrophic thoughts that ‘I will start performing poorly at work, home’; cognitions of worthlessness, regret and guilt such as ‘I am such a failure, loser in life’ and criticality, shame and disgust cognitions including ‘nothing is going right for me’ and ‘I cannot stand myself’.
The attribution of lapse to personal failure/internal factors beyond individual control led to relapse. Thus, AVE (negative perceptions of self) led the individual to use pornography regularly and a lapse triggered a complete relapse in a few days. The individual was provided with psychoeducation about the AVE and its role in relapse.
This has implications for the need to study the concept of AVE among behavioural addictions and to sensitize professionals for its management.
Footnotes
Acknowledgements
The authors have conceptualized the idea of writing the communication. The co-author helped in the preparation of the manuscript. Both the authors have given their consent for manuscript submission.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.
Ethical Approval
This research work has been approved by the institute ethics committee of NIMHANS, Bangalore, Karnataka, India.
Funding
This research work was funded by a Research Grant from the Department of Health Research, Indian council of Medical Research, New Delhi, India to Dr M.K.S. The funding agency has no role other than funding.
Research Involving Human Participants and/or Animals
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Statement of Human Rights
This research work has been approved by the institute ethics committee of NIMHANS, Bangalore, Karnataka, India.