RP has also been used in eating disorders in combination with other interventions such as CBT and problem-solving skills4. 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.
Despite the intense controversy, the Sobell’s high-profile research paved the way for additional studies of nonabstinence treatment for AUD in the 1980s and later (Blume, 2012; Sobell & Sobell, 1995). Marlatt, in particular, became well known for developing nonabstinence treatments, such as BASICS for college drinking (Marlatt et al., 1998) and Relapse Prevention (Marlatt & Gordon, 1985). Like the Sobells, Marlatt showed that reductions in drinking and harm were achievable in nonabstinence treatments (Marlatt & Witkiewitz, 2002). In the 1970s, the pioneering work of a small number of alcohol researchers began to challenge the existing abstinence-based paradigm in AUD treatment research. They found that their controlled drinking intervention produced significantly better outcomes compared to usual treatment, and that about a quarter of the individuals in this condition maintained controlled drinking for one year post treatment (Sobell & Sobell, 1973). Negative emotional states, such as anxiety, depression, anger, boredom are often dealt with by using substances, interpersonal conflicts that the person cannot cope with effectively or resolve and the social -pressure to use a substance31.
When an urge to use hits, it can be helpful to engage the brain’s reward pathway in an alternative direction by quickly substituting a thought or activity that’s more beneficial or fun— taking a walk, listening to a favorite piece of music. Possible substitutes can be designated in advance, abstinence violation effect definition made readily available, listed in a relapse prevention plan, and swiftly summoned when the need arises. Distraction is a time-honored way of interrupting unpleasant thoughts of any kind, and particularly valuable for derailing thoughts of using before they reach maximum intensity.
- In its original form, RP aims to reduce risk of relapse by teaching participants cognitive and behavioral skills for coping in high-risk situations (Marlatt & Gordon, 1985).
- We can’t keep our urges from occurring, nor can we change past events in which we have acted on them.
- More recent versions of RP have included mindfulness-based techniques (Bowen, Chawla, & Marlatt, 2010; Witkiewitz et al., 2014).
- However, there are some common early psychological signs that a relapse may be on the way.
- One study found that among those who did not complete an abstinence-based (12-Step) SUD treatment program, ongoing/relapse to substance use was the most frequently-endorsed reason for leaving treatment early (Laudet, Stanick, & Sands, 2009).
However, these interventions also typically lack an abstinence focus and sometimes result in reductions in drug use. Marlatt and Gordon’s (1985) model of the relapse process in addictive disorders has had a major impact in the field of relapse prevention since the late 1980s. Marlatt and Gordon postulate that newly abstinent patients experience a sense of perceived control up to the point at which they encounter a high-risk situation, which most commonly entails a negative emotional state, an interpersonal conflict, or an experience of social pressure. If individuals cope effectively in the high-risk situation, perceived control and self-efficacy increase, which in turn makes the probability of relapse decrease.
2. Established treatment models compatible with nonabstinence goals
With regard to addictive behaviours Cognitive Therapy emphasizes psychoeducation and relapse prevention. Therefore, many of the techniques discussed under relapse prevention that aim at modification of dysfunctional beliefs related to outcomes of substance use, coping or self-efficacy are relevant and overlapping. Other models of relapse prevention also draw upon the construct of self-efficacy34. It is now believed that relapse prevention strategies must be taught to the individual during the course of therapy, and various strategies to enhance patient involvement and adherence such as increasing patient responsibility, promoting internal attributions to events are to be introduced in therapy. Working with a variety of targets helps in generalization of gains, patients are helped in anticipating high risk situations33.
- 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.
- The realization that HIV had been spreading widely among people who injected drugs in the mid-1980s led to the first syringe services programs (SSPs) in the U.S. (Des Jarlais, 2017).
- At start of therapy, Rajiv was not confident of being able to help himself (self-efficacy and lapse- relapse pattern).
- However, telling your non-dieting partner to make sure you don’t snack after dinner is a set-up for a fight the first time you have a bad day and decide you need a treat.
- Family and significant others are an integral part of the treatment program.
It’s important to note that a relapse doesn’t mean your recovery has failed. Still, you should also realize that relapse isn’t guaranteed, especially if you stay vigilant in managing your continued recovery. However, there are some common early psychological signs that a relapse may be on the way. If you are worried that you might be headed for a relapse, you don’t have to wait until it happens to reach out for help. Nevertheless, 40 to 60% of people who once were addicted to a substance and achieved sobriety relapse at some point, based on estimates from the National Institute on Drug Abuse (NIDA).