Relapse Prevention: An Overview of Marlatts Cognitive-Behavioral Model

Nevertheless, the study provides relatively good support for other aspects of the RP model. For example, Miller and colleagues (1996) found that although mere exposure to specific high-risk situations did not predict relapse, the manner in which people coped with those situations strongly predicted subsequent relapse or continued abstinence. Furthermore, in that study the majority of relapse episodes after treatment occurred during situations involving negative emotional states, a finding that has been replicated in other studies (Cooney et al. 1997; McKay 1999; Shiffman 1992). Finally, the results of Miller and colleagues (1996) support the role of the abstinence violation effect in predicting which participants would experience a full-blown relapse following an initial lapse. Specifically, those participants who had a greater belief in the disease model of alcoholism and a higher commitment to absolute abstinence (who were most likely to experience feelings of guilt over their lapse) were most likely to experience relapse in that study. In a recent review of the literature on relapse precipitants, Dimeff and Marlatt (1998) also concluded that considerable support exists for the notion that an abstinence violation effect can precipitate a relapse.

Contents

Relapse Prevention Therapy at White Oak Recovery Center

However, we review these findings in order to illustrate the scope of initial efforts to include genetic predictors in treatment studies that examine relapse as a clinical outcome. These findings may be informative for researchers who wish to incorporate genetic variables in future studies of relapse and relapse prevention. Based on the cognitive-behavioral model of relapse, RP was initially conceived as an outgrowth and augmentation of traditional behavioral approaches to studying and treating addictions. The evolution of cognitive-behavioral theories of substance use brought notable changes in the conceptualization of relapse, many of which departed from traditional (e.g., disease-based) models of addiction. Cognitive-behavioral theories also diverged from disease models in rejecting the notion of relapse as a dichotomous outcome. Rather than being viewed as a state or endpoint signaling treatment failure, relapse is considered a fluctuating process that begins prior to and extends beyond the return to the target behavior 8,24.

Coping

They must also overcome the guilt and negative self-labeling that evolved during addiction. what is the relapse prevention model Clients sometimes think that they have been so damaged by their addiction that they cannot experience joy, feel confident, or have healthy relationships 9. When individuals continue to refer to their using days as “fun,” they continue to downplay the negative consequences of addiction. Expectancy theory has shown that when people expect to have fun, they usually do, and when they expect that something will not be fun, it usually isn’t 15. In the early stages of substance abuse, using is mostly a positive experience for those who are emotionally and genetically predisposed.

Causes of Relapse in Late Stage Recovery

One of the primary distinctions is that the cognitive-behavioral model describes intervention treatment, whereas the relapse prevention model focuses on aftercare treatment. An important part of RP is the notion of Abstinence violation effect (AVE), which refers to an individual’s response to a relapse where often the client blames himself/herself, with a subsequent loss of perceived control4. It occurs when the client perceives no intermediary step between a lapse and relapse i.e. since they have violated the rule of abstinence, “they may get most out” of the lapse5. People who attribute the lapse to their own personal failure are likely to experience guilt and negative emotions that can, in turn, lead to increased drinking as a further attempt to avoid or escape the feelings of guilt or failure7.

Set Clear Goals

The RP curriculum can be administered in both residential treatment (RTC) and outpatient programs (including IOP and PHP). RP has also been used in eating disorders in combination with other interventions such as CBT and problem-solving skills4. Let us help you find your path to recovery and teach you the skills to maintain a life-long, fulfilling recovery. Our compassionate and licensed professionals at NATC collaborate with you after medically supervised detox to create a comprehensive and individualized rehabilitation plan. 3) Clients feel they are not learning anything new at self-help meetings and begin to go less frequently. Clients need to understand that one of the benefits of going to meetings is to be reminded of what the “voice of addiction” sounds like, because it is easy to forget.

Identifying Triggers

If addiction were so easy, people wouldn’t want to quit and wouldn’t have to quit. A basic fear of recovery is that the individual is not capable of recovery. The belief is that recovery requires some special strength or willpower that the individual does not possess.

Coping is defined as the thoughts and behaviours used to manage the internal and external demands of situations that are appraised as stressful. A person who can execute effective coping strategies (e.g. a behavioural strategy, such as leaving the situation, or a cognitive strategy, such as positive self-talk) is less likely to relapse compared with a person lacking those skills. Moreover, people who have coped successfully with high-risk situations are assumed to experience a heightened sense of self-efficacy4. Self-efficacy is defined as the degree to which an individual feels confident and capable of performing certain behaviour in a specific situational context5. The RP model proposes that at the cessation of a habit, a client feels self-efficacious with regard to the unwanted behaviour and that this perception of self-efficacy stems from learned and practiced skills3. In a prospective study among both men and women being treated for alcohol dependence using the Situational Confidence Questionnaire, higher self-efficacy scores were correlated to a longer interval for relapse to alcohol use8.

Covert antecedents and immediate determinants of relapse and intervention strategies for identifying and preventing or avoiding those determinants. If stressors are not balanced by sufficient stress management strategies, the client is more likely to use alcohol in an attempt to gain some relief or escape from stress. This reaction typically leads to a desire for indulgence that often develops into cravings and urges. Two cognitive mechanisms that contribute to the covert planning of a relapse episode—rationalization and denial—as well as apparently irrelevant decisions (AIDs) can help precipitate high-risk situations, which are the central determinants of a relapse. People who lack adequate coping skills for handling these situations experience reduced confidence in their ability to cope (i.e., decreased self-efficacy).

In a study by McCrady evaluating the effectiveness of psychological interventions for alcohol use disorder such as Brief Interventions and Relapse Prevention was classified as efficacious23. Helping clients develop positive addictions or substitute indulgences (e.g. jogging, meditation, relaxation, exercise, hobbies, or creative tasks) also help to balance their lifestyle6. Cognitive restructuring can be used to tackle cognitive errors such as the abstinence violation effect. Clients are taught to reframe their perception of lapses, to view them not as failures but as key learning opportunities resulting from an interaction between various relapse determinants, both of which can be modified in the future. Lapse management includes drawing a contract with the client to limit use, to contact the therapist as soon as possible, and to evaluate the situation for factors that triggered the lapse6. Critical for craving and relapse is the process of associative learning, whereby environmental stimuli repeatedly paired with drug consumption acquire incentive-motivational value, evoking expectation of drug availability and memories of past drug euphoria15.

Ultimately, individuals who are struggling with behavior change often find that making the initial change is not as difficult as maintaining behavior changes over time. Many therapies (both behavioral and pharmacological) have been developed to help individuals cease or reduce addictive behaviors and it is critical to refine strategies for helping individuals maintain treatment goals. As noted by McLellan 138 and others 124, it is imperative that policy makers support adoption of treatments that incorporate a continuing care approach, such that addictions treatment is considered from a chronic (rather than acute) care perspective.

A critical difference exists between the first violation of the abstinence goal (i.e., an initial lapse) and a return to uncontrolled drinking or abandonment of the abstinence goal (i.e., a full-blown relapse). Although research with various addictive behaviors has indicated that a lapse greatly increases the risk of eventual relapse, the progression from lapse to relapse is not inevitable. Second, mind-body relaxation helps individuals let go of negative thinking such as dwelling on the past or worrying about the future, which are triggers for relapse.

what is the relapse prevention model

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In one study of treatment-seeking methamphetamine users 132, researchers examined fMRI activation during a decision-making task and obtained information on relapse over one year later. Based on activation patterns in several cortical regions they were able to correctly identify 17 of 18 participants who relapsed and 20 of 22 who did not. Functional imaging is increasingly being incorporated in treatment outcome studies (e.g., 133) and there are increasing efforts to use imaging approaches to predict relapse 134. In this context, a critical question will concern the predictive and clinical utility of brain-based measures with respect to predicting treatment outcome. Broadly speaking, there are at least three primary contexts in which genetic variation could influence liability for relapse during or following treatment.

These results suggest that researchers should strive to consider alternative mechanisms, improve assessment methods and/or revise theories about how CBT-based interventions work 77,130. 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.

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