Focus: Addiction: Relapse Prevention and the Five Rules of Recovery PMC

Cognitive therapy is one of the main tools for changing people’s negative thinking and developing healthy coping skills . The effectiveness of cognitive therapy in relapse prevention has been confirmed in numerous studies .

relapse prevention

The studies reviewed focus primarily on alcohol and tobacco cessation, however, it should be noted that RP principles have been applied to an increasing range of addictive behaviors . The dynamic model of relapse assumes that relapse can take the form of sudden and unexpected returns to the target behavior. This concurs not only with clinical observations, but also with contemporary learning models stipulating that recently modified behavior is inherently unstable and easily swayed by context .

The reformulated cognitive-behavioral model of relapse

Testing the model’s components will require that researchers avail themselves of innovative assessment techniques and pursue cross-disciplinary collaboration in order to integrate appropriate statistical methods. Irrespective of study design, greater integration of distal and proximal variables will aid in modeling the interplay of tonic and phasic influences on relapse outcomes. As was the case for Marlatt’s original RP model, efforts are needed to systematically evaluate specific theoretical components of the reformulated model . Findings concerning possible genetic moderators of response to acamprosate have been reported , but are preliminary.

Current theory and research indicate that physiological components of drug withdrawal may be motivationally inert, with the core motivational constituent of withdrawal being negative affect . Thus, examining withdrawal in relation to relapse may only prove useful to the extent that negative affect is assessed adequately . Relapse poses a fundamental barrier to the treatment of addictive behaviors by representing the modal outcome of behavior change efforts [1–3]. For instance, twelve-month relapse rates following alcohol or tobacco cessation attempts generally range from 80-95% and evidence suggests comparable relapse trajectories across various classes of substance use . Preventing relapse or minimizing its extent is therefore a prerequisite for any attempt to facilitate successful, long-term changes in addictive behaviors. As time passes, it may be important to revisit your relapse prevention plan. The components you acknowledged in your plan at the beginning of your recovery have the potential to change and develop over time, as do the people in your support system.

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Alcohol, drugs, or addictive behaviors used to provide temporary relief from those feelings, but you can’t rely on them anymore. Finding hobbies that keep you busy and occupy the mind can be a great relapse prevention tool as well. Take up a creative outlet like dance or painting, attend a yoga class, and find ways to help yourself relax.

It may even motivate you to achieve your best outcome through forming new relationships and engaging in new activities. Yet, there are steps you can take to avoid negative outcomes. I’m a lifelong compulsive overeater who has used every one of these excuses for not working my program. If I were to address these stepping-stones, I would say, “Oh, I’m exhausted from the service I do. I deserve a treat.” But am I exhausted or just feeling sorry for myself, i.e. self-pity and unappreciated? Is this what’s really going on, or am I being dishonest or impatient, not taking the time to pray and meditate?

Staying Sober

Relapse prevention strategies can be taught in individual or group therapy formats. The use of experiential learning techniques can make learning a more active process, enhance self-awareness, decrease defensiveness, and encourage behavior change. Meditation-based interventions can be well suited for experiential learning of self-awareness and positive coping skills. Research evidence indicates that mindfulness meditation training and practice can enhance outcomes in SUDs.[5-7] Mindfulness-based relapse prevention is a 8-week program specifically tailored for relapse prevention in SUDs. As outlined in this review, the last decade has seen notable developments in the RP literature, including significant expansion of empirical work with relevance to the RP model. Overall, many basic tenets of the RP model have received support and findings regarding its clinical effectiveness have generally been supportive. RP modules are standard to virtually all psychosocial interventions for substance use and an increasing number of self-help manuals are available to assist both therapists and clients.

  • It’s even a good idea for clients to share their relapse prevention strategies with their loved ones to get additional assistance.
  • In fact, research indicates that there is an increased “wanting” for the drug, alcohol, or addictive activity during stressful situations—especially if the substance or activity was the person’s primary coping mechanism.
  • Thus, the essence of effective relapse prevention involves addressing factors related to vulnerability to substance abuse, rather than substance use behavior itself.
  • Stay away from the old friends who used with you and look to people who can support you soberly in your recovery.

For example, one could imagine a situation whereby a client who is relatively committed to abstinence from alcohol encounters a neighbor who invites the client into his home for a drink. Importantly, this client might not have ever considered such an invitation as a high-risk situation, yet various contextual factors may interact to predict a lapse. Relapse is often thought of as a moment in time when an individual takes a drink or does drugs. In addition to this, a relapse prevention plan also helps you to overcome common misconceptions about the mental health effects of alcohol and drugs. It can also help you overcome some of the physical challenges that addiction creates by teaching you strategies to manage those complications.

Specific Relapse Prevention Techniques for the Holidays:

Some researchers divide physical relapse into a “lapse” and a “relapse” . Clinical experience has shown that when clients focus too strongly on how much they used during a lapse, they do not fully appreciate the consequences of one drink.

  • There are different models to try to prevent a future relapse.
  • It also may help to have a healthy activity that you can do instead like going for a run, seeing a movie, having dinner with a sponsor, or reading a good book.
  • Emotional relapseis typically the first sign or stage of a relapse.
  • Maintaining hope in an individual’s ability to achieve incremental change is the foundation of recovery-oriented relapse prevention training.
  • It forces people to reevaluate their lives and make changes that non-addicts don’t have to make.
  • The client’s appraisal of lapses also serves as a pivotal intervention point in that these reactions can determine whether a lapse escalates or desists.

In the later stages the pull of relapse gets stronger and the sequence of events moves faster. Individuals use drugs and alcohol to escape negative emotions; however, they also use as a reward and/or to enhance positive emotions . In these situations, poor self-care often relapse prevention precedes drug or alcohol use. For example, individuals work hard to achieve a goal, and when it is achieved, they want to celebrate. But as part of their all-or-nothing thinking, while they were working, they felt they didn’t deserve a reward until the job was done.

As noted by McLellan and others , 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 care perspective. The recently introduced dynamic model of relapse takes many of the RREP criticisms into account. Additionally, the revised model has generated enthusiasm among researchers and clinicians who have observed these processes in their data and their clients . Still, some have criticized the model for not emphasizing interpersonal factors as proximal or phasic influences . Rather than signaling weaknesses of the model, these issues could simply reflect methodological challenges that researchers must overcome in order to better understand dynamic aspects of behavior . Ecological momentary assessment , either via electronic device or interactive voice response methodology, could provide the data necessary to fully test the dynamic model of relapse.

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