Sober living

Therapist’s Guide to Evidence-Based Relapse Prevention by Academic Press Ebook

But the truth is a part of the drug dependent can give up drugs on one’s own. They can get rid of the dependence only through proper and effective treatment. Comprehensive treatment services offer a structured treatment environment that begins with the withdrawal/detoxification process and extends through aftercare planning following residential treatment. ‘Relapse prevention’ as a treatment model was developed in work with substance abusers where it was recognised that ‘cure’ was unrealistic. The goal of treatment is instead teaching behavioural and cognitive skills which may (a) prevent relapse from occurring or (b) minimise the extent of a relapse (Marlatt and Gordon 1985).

MBRP practices are intended to foster increased awareness of triggers, destructive habitual patterns, and “automatic” reactions that seem to control many of our lives. The mindfulness practices in MBRP are designed to help us pause, observe present experience, and bring awareness to the range of choices before each of us in every moment. We learn to respond in ways that serves us, rather than react in ways that are detrimental to our health and happiness.

Substance Use & Misuse

1)    Explain the effect of the mass-media on changing health behaviors and getting the message out. (1)  Since relapse is a rule not expectation with addictive behaviors, this ate is conceptualized as a spiral. People take actions, attempt maintence, relapse, return to the precontemplation phase, cycle through subsequent statges to action then repeat cycle many tiems until behavior fully eliminated. I)      Genetic factors, withdrawl factors, conditioned associations beteween cues and physical responses may lead to urges or cravings to engage in habit. Ensures that both parties reamin commiteed to behavior change and they are aware of others commitment.

abstinence violation effect and life restructuring

(2) to create, distribute, or dispense, or possess with intent to distribute or dispense, a counterfeit substance. Clients learn to avoid feeling overwhelmed by the past and explore strategies for focusing on the present. Clients learn the importance of making amends and discuss how to address people who refuse to forgive them. Clients learn that becoming ill can be a trigger and discuss ways to keep their recovery on track when they are sick. Clients explore the difference between spirituality and religion and discuss ways that spiritual beliefs can support recovery. Clients learn that although truthfulness is not always easy, it is integral to successful recovery.

Relapse prevention: an Overview

The client may feel like giving up and may need a reminder of the long-range benefits to be gained from this change. Clients should be encouraged to reflect optimistically on their past successes in being able to quit the old habit, instead of focusing on current setbacks. RP has also been used in eating disorders in combination with other interventions such as CBT and problem-solving skills4. One of the most notable developments in the last decade has been the emergence and increasing application of Mindfulness-Based Relapse Prevention (MBRP) for addictive behaviours. (2)  Can build social support for reinforcing adherence to recommend changes.

  • Before releasing this information to you, or anyone else, the counselor would need a signed written release of information from the client which would state what information may be released and to whom it may be released.
  • Similarly, the abstinence-violation effect—self-blame after breaching the self-imposed rules—is a strong determinant of relapse (Witkiewitz & Marlatt, 2004).
  • Clients learn to avoid feeling overwhelmed by the past and explore strategies for focusing on the present.
  • This imagery technique is known as “urge surfing” and refers to conceptualizing the urge or craving as a wave that crests and then washes onto a beach.

Clear and accessible, Working with Sexually Abusive Adolescents informs a wide range of practitionersincluding psychologists, psychiatrists, counselors, and social workersof current trends in working with this special population. $8,000,000 if the defendant is an individual or $20,000,000 if the defendant is other than an individual, or both. Notwithstanding any other provision of law, the court shall not place on probation or suspend the sentence of any person sentenced under this subparagraph. No person sentenced under this subparagraph shall be eligible for parole during the term of imprisonment imposed therein. Clients learn to recognize their emotional responses, especially signs of depression.


Miller and Hester reviewed more than 500 alcoholism outcome studies and reported that more than 75% of subjects relapsed within 1 year of treatment1. A study published by Hunt and colleagues demonstrated that nicotine, heroin, and alcohol produced highly similar rates of relapse over a one-year period, in the range of 80-95%2. A significant proportion (40–80%) of patients receiving treatment for alcohol use disorders have at least one drink, a “lapse,” within the first year of after treatment, whereas around 20% of patients return to pre-treatment levels of alcohol use3. Relapse prevention (RP) is a strategy for reducing the likelihood and severity of relapse following the cessation or reduction of problematic behaviours4. Cocaine use disorder (CUD) is a debilitating condition characterised by maladaptive cocaine-related memories and impaired cognitive and behavioural control.

abstinence violation effect and life restructuring

It is part of a cognitive-behavioral therapy, called CBT, aimed at treating some addictive disorders, such as alcohol addiction. At times, the counselor may need to intervene assertively in response to specific types of client behavior in the group. This intervention may consist of quieting a client, limiting a client’s involvement in the group, or removing a client from the group. The camaraderie and cohesion of an RP group are extremely valuable to the treatment process. However, clients should be cautioned against treatment program romances and outside involvement with other group members (e.g., entering into a business relationship).

Relapse rates are known to exceed over 75% within the first 12 months following initial abstinence (Hunt, Barnett, & Branch, 1971). After high-risk situations are identified it is critical to examine each situation paying special attention to related triggers and potential strategies for coping with the situation. Craving is defined for clients as a longing or desire to use a substance and urges are defined as the intention to use substances. Clients often find they have a strong craving with no intention to use or may also experience strong craving and a strong intention to use. Experiencing both craving and an urge to use makes the client vulnerable to relapse unless the client uses a coping strategy to reduce or eliminate the urge. Many people find that being aware of situations that tend to elicit cravings and developing ways of coping with cravings in those situations can greatly reduce the risk of relapse.

These concepts introduced grey areas in the traditional model of addiction treatment that previously viewed the treatment outcome in rigid binary terms i.e as abstinence and relapse (Donovan, 1996, p.135). These terms are considered as possible outcomes of the attempt to change a problematic behaviour such as problematic drug use. The initial return to problematic drug use following abstinence attempt is known as lapse (Steckler et al., 2013)(G. A. Marlatt & Witkiewitz, 2005). The lapse progresses to relapse if the patient returns to the pre-abstinence level of problematic drug use (Steckler et al., 2013)(G. A. Marlatt & Witkiewitz, 2005). On the other hand, if the patient succeeds in maintaining a positive behaviour change, it would be characterised as prolapse (G. A. Marlatt & Witkiewitz, 2005). Relapse prevention is an important goal in the treatment of substance misuse disorders.

After outlining its basic assumptions, we describe the RP model in some detail. Following a critique of Marlatt’s theory, we examine the strengths and weaknesses of Pithers’ RP approach. At some point, you will likely encounter employees with problems related to alcohol in dealing with performance, conduct, and leave problems. In other cases, you may know, either because the employee admits to being an alcoholic, or the problem is self-evident.

  • This increased tolerance is marked by the alcoholic’s ability to consume greater quantities of alcohol while appearing to suffer few effects and continuing to function.
  • I)      Assess frequency of a target behavior and antecedents and concequences of behavior.
  • The majority of the treatments described by NIDA (1998) and Miller and Wilbourne (2002) incorporate at least some aspects of the cognitive-behavioral model of relapse and the RP strategies described by Marlatt and Gordon (1985).
  • That is, it can be a specific state, it does not always have to be a point of “no return” during the detox process; nor does it necessarily have to involve going back to the treatment start box.
  • 1)    Summarize the effectiveness of educational appeals and the use of fear appeals in changing attitudes and health behaviors.

This increased tolerance is marked by the alcoholic’s ability to consume greater quantities of alcohol while appearing to suffer few effects and continuing to function. This tolerance is not created simply because the alcoholic drinks too much but rather because the alcoholic is able to drink great quantities because of physical changes going on inside his or her body. Clients may need help to deal with the inevitable feelings of guilt and shame and the cognitive dissonance that usually accompany a lapse. Guilt and shame reactions are particularly dangerous because they are likely to motivate further substance use or other addictive behaviors as a means of coping with these unpleasant reactions to the slip. Cognitive restructuring can be used to tackle cognitive errors such as the abstinence violation effect.


In the treatment of drug dependence, rehabilitation is a process of reinstating the things the individual has lost as a result of drug dependence. It is a process for the drug dependent individual to overcome physical-psychological damages and family-social alienation and reintegrate abstinence violation effect into the drugs-free healthy mainstream life. The first step in this process is motivating the individual to take treatment. One of the most critical predictors of relapse is the individual’s ability to utilize effective coping strategies in dealing with high-risk situations.

The threat of the loss of a job is often the push the alcoholic needs to enter treatment. This threat is usually communicated to the employee through some type of an adverse or disciplinary action and is accompanied by a referral to the Employee Assistance Program (EAP) which will refer the employee to an appropriate treatment program. Employee relations staff will work with the EAP to the extent that confidentiality is not violated, will try to assist you in working with the EAP, and will work with you to try to make sure that any adverse or disciplinary actions are appropriate and defensible. In most agencies, it is the employee relations or human resources specialist who actually prepares or drafts adverse or disciplinary action letters, including those involving a firm choice. A firm choice is a clear warning to an employee who has raised alcohol or drug abuse in connection with a specific performance, conduct, or leave use incident or deficiency.

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