Relapse Prevention: An Overview of Marlatts Cognitive-Behavioral Model

Interpersonal relationships and support systems are highly influenced by intrapersonal processes such as emotion, coping, and expectancies18. There may be an internal conflict between resisting thoughts about drugs and compulsions to use them. There is a possibility that you might rationalize why you might not experience the same consequences if you continue to use. A mindset shift caused by triggers or stress may lead you to take that drink or start using drugs again.

Strengths-Based Counseling

As the client gains new skills and feels successful in implementing them, he or she can view the process of change as similar to other situations that require the acquisition of a new skill. Such positive outcome expectancies may become particularly salient in high-risk situations, when the person expects alcohol use to help him or her cope with negative emotions or conflict (i.e., when drinking serves as “self-medication”). In these situations, the drinker focuses primarily on the anticipation of immediate gratification, such as stress reduction, neglecting possible delayed negative consequences.

Unconditional Positive Regard

• A “controlled drinking controversy” followed, in which the Sobells as well as those who supported them were publicly criticized due to their claims about controlled drinking, and the validity of their research called into question (Blume, 2012; Pendery, Maltzman, & West, 1982).
• Connections to other services and supports for clients in recovery, such as housing resources and child care.
• One is to help clients identify warning signs such as on-going stress, seemingly irrelevant decisions and significant positive outcome expectancies with the substance so that they can avoid the high-risk situation.
• 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.
• Counselor participation in recovery-oriented systems of care can benefit clients by promoting holistic, coordinated, and nonepisodic services.

Listing the outcome expectancies for the substance use and resolved behavior (e.g., reduced use of substances). Some tools may be more appropriate for use in certain settings or with specific populations. Below is a description of several of these tools, including information about how to access them and limitations. The chapter also looks at ways that payment systems can affect the delivery of care for counselors in healthcare and behavioral health service systems. Introducing an approach to promoting a healthy life for clients who are beyond early recovery.

Dynamic model

• The initial transgression of problem behaviour after a quit attempt is defined as a “lapse,” which could eventually lead to continued transgressions to a level that is similar to before quitting and is defined as a “relapse”.
• The term “predictive validity” refers to the ability of a test or method to predict a certain outcome (e.g., relapse risk) accurately.
• By providing comprehensive care, our treatment programs create a supportive environment in which our clients can build a solid foundation for lasting sobriety.
• Indeed, there is anecdotal evidence that this may be the case; for example, a qualitative study of nonabstinence drug treatment in Denmark described a client saying that he would not have presented to abstinence-only treatment due to his goal of moderate use (Järvinen, 2017).

Addiction and related disorders are chronic lapsing and relapsing disorders where the combination of long term pharmacological and psychosocial managements are the mainstay approaches of management. Among the psychosocial interventions, the Relapse Prevention (RP), cognitive-behavioural approach, is a strategy for reducing the likelihood and severity of relapse following the cessation or reduction of problematic behaviours. Here the assessment and management of both the intrapersonal and interpersonal determinants of relapse are undertaken.

4. Current status of nonabstinence SUD treatment

• Based on operant conditioning, the motivation to use in a particular situation is based on the expected positive or negative reinforcement value of a specific outcome in that situation5.
• Consider that affirming clients can have many useful impacts, such as strengthening clients’ engagement in therapy and sense of agency.
• Several studies over the past two decades have evaluated the reliability and predictive validity2 of the RP model as well as the efficacy of treatment techniques based on this model.
• Indeed, this argument has been central to advocacy around harm reduction interventions for people who inject drugs, such as SSPs and safe injection facilities (Barry et al., 2019; Kulikowski & Linder, 2018).

Although the RP model considers the high-risk situation the immediate relapse trigger, it is actually the person’s response to the situation that determines whether he or she will experience a lapse (i.e., begin using alcohol). A person’s coping behavior in a high-risk situation is a particularly critical determinant of the likely outcome. Thus, a person who can execute effective coping strategies (e.g., a behavioral strategy, such as leaving the Twelve-step program 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-efficacy (i.e., a personal perception of mastery over the specific risky situation) (Bandura 1977; Marlatt et al. 1995, 1999; Marlatt and Gordon 1985).

Is a Relapse Dangerous?

A number of studies have examined psychosocial risk reduction interventions for individuals with high-risk drug use, especially people who inject drugs. In contrast to the holistic approach of harm reduction psychotherapy, risk reduction interventions are generally designed to target specific HIV risk behaviors (e.g., injection or sexual risk behaviors) without directly addressing mechanisms of SUD, and thus are quite limited in scope. However, these interventions also typically lack an abstinence focus and sometimes result in reductions in drug use. The past 20 years has seen growing acceptance of harm reduction, evidenced the abstinence violation effect refers to in U.S. public health policy as well as SUD treatment research. Thirty-two states now have legally authorized SSPs, a number which has doubled since 2014 (Fernández-Viña et al., 2020).

For people in recovery, a relapse can mean the return to a cycle of active addiction. While relapse doesn’t mean you can’t achieve lasting sobriety, it can be a disheartening setback in your recovery. Ark Behavioral Health Is an accredited drug and alcohol rehabilitation program, that believes addiction treatment should not just address “how to stay sober” but needs to transform the life of the addict and empower him or her to create a more meaningful and positive life. We are dedicated to transforming the despair of addiction into a purposeful life of confidence, self-respect and happiness. We want to give recovering addicts the tools to return to the outside world completely substance-free and successful. Several studies over the past two decades have evaluated the reliability and predictive validity2 of the RP model as well as the efficacy of treatment techniques based on this model.

With the right help, preparation, and support, you and your loved ones can still continue to build a long-lasting recovery from substance abuse. For instance, a person recovering from alcohol use disorder who has a drink may feel a sense of confusion or a lack of control and they may make unhealthy attributions or rationalizations to try to define and understand what they’re doing. As a result, it’s important that those in recovery internalize this difference and establish the proper mental and behavioral framework to avoid relapse and continue moving forward even if lapses occur.