Relapse prevention PMC

Expectancies are the result of both direct and indirect (e.g. perception of the drug from peers and media) experiences3. One critical goal will be to integrate empirically supported substance use interventions in the context of continuing care models of treatment delivery, which in many cases requires adapting existing treatments to facilitate sustained delivery [140]. Given its focus on long-term maintenance of treatment gains, RP is a behavioral intervention that is particularly well suited for implementation in continuing care contexts. However, it is imperative that insurance providers and funding entities support these efforts by providing financial support for aftercare services. It is also important that policy makers and funding entities support initiatives to evaluate RP and other established interventions in the context of continuing care models.

• The past 20 years has seen growing acceptance of harm reduction, evidenced in U.S. public health policy as well as SUD treatment research.
• 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 [10,11].
• One night, she craves pizza and wings, orders out, and goes over her calories for the day.
• Maintain a balanced lifestyle by eating healthily, exercising regularly, getting enough sleep, and engaging in activities that bring you happiness and fulfillment.
• Thus, instead of focusing on a distant end goal (e.g., maintaining lifelong abstinence), the client is encouraged to set smaller, more manageable goals, such as coping with an upcoming high-risk situation or making it through the day without a lapse.

Systematic reviews and large-scale treatment outcome studies

Advocates of nonabstinence approaches often point to indirect evidence, including research examining reasons people with SUD do and do not enter treatment. This literature – most of which has been conducted in the U.S. – suggests a strong link between abstinence goals and treatment entry. For example, in one study testing the predictive validity of a measure of treatment readiness among non-treatment-seeking people who use drugs, the authors found that the only item in their measure that significantly predicted future treatment entry was motivation to quit using (Neff & Zule, 2002). The study was especially notable because most other treatment readiness measures have been validated on treatment-seeking samples (see Freyer et al., 2004). This finding supplements the numerous studies that identify lack of readiness for abstinence as the top reason for non-engagement in SUD treatment, even among those who recognize a need for treatment (e.g., Chen, Strain, Crum, & Mojtabai, 2013; SAMHSA, 2019a). In the last several years increasing emphasis has been placed on “dual process” models of addiction, which hypothesize that distinct (but related) cognitive networks, each reflective of specific neural pathways, act to influence substance use behavior.

For Immediate Treatment Help Call 800-526-5053

• Drawing from Intrinsic Motivation Theory (Deci, 1975) and the controlled drinking literature, Miller (1985) argued that clients benefit most when offered choices, both for drinking goals and intervention approaches.
• The focus is on identifying and accepting the urge, not acting on the urge or attempting to fight it4.
• Rather than only focusing on the end goal, celebrate small victories and all positive steps you’ve taken thus far.
• Sometimes people relapse because, in their eagerness to leave addiction behind, they cease engaging in measures that contribute to recovery.
• Relapse has been variously defined, depending on theoretical orientation, treatment goals, cultural context, and target substance (Miller 1996; White 2007).

The RP model of relapse is centered around a detailed taxonomy of emotions, events, and situations that can precipitate both lapses and relapses to drinking. This taxonomy includes both immediate relapse determinants and covert antecedents, which indirectly increase a person’s vulnerability to relapse. Based on the classification of relapse determinants and high-risk situations proposed in the RP model, numerous treatment components have been developed that are aimed at helping the recovering alcoholic cope with high-risk situations. The results of recent research, https://ecosoberhouse.com/ particularly the RREP study, likely will lead to modifications of the original RP model, particularly with regard to the assessment of high-risk situations as well as the conceptualization of covert and immediate antecedents of relapse. Overall, however, research findings support both the overall model of the relapse process and the effectiveness of treatment strategies based on the model. Although high-risk situations can be conceptualized as the immediate determinants of relapse episodes, a number of less obvious factors also influence the relapse process.

G Alan Marlatt

These patterns can be actively identified and corrected, helping participants avoid lapses before they occur and continue their recovery from substance use disorder. Otherwise, recovering individuals are likely to make the worst of a single mistake and accelerate back through the relapse process as a result. When an urge to use hits, it can be helpful abstinence violation effect 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, made readily available, listed in a relapse prevention plan, and swiftly summoned when the need arises.

Cognitive Dissonance

Examples of high-risk contexts include emotional or cognitive states (e.g., negative affect, diminished self-efficacy), environmental contingencies (e.g., conditioned drug cues), or physiological states (e.g., acute withdrawal). Although some high-risk situations appear nearly universal across addictive behaviors (e.g., negative affect; [25]), high-risk situations are likely to vary across behaviors, across individuals, and within the same individual over time [10]. Whether a high-risk situation culminates in a lapse depends largely on the individual’s capacity to enact an effective coping response–defined as any cognitive or behavioral compensatory strategy that reduces the likelihood of lapsing. Most notably, we provide a recent update of the RP literature by focusing primarily on studies conducted within the last decade.

Specific Intervention Strategies

Marlatt’s relapse prevention model: Historical foundations and overview