Relapse Prevention: An Overview of Marlatts Cognitive-Behavioral Model

Although the magnitude was not as large, the average percentage of days on which participants were abstinent (PDA) tended to show an advantage in favor of AA/TSF interventions, especially in the more rigorous manualized RCTs compared to other active treatment orientations (e.g. CBT). Studies involving young people (Kelly, Kaminer, et al., 2017) and couples therapy (McCrady et al., 1996) showed equivalence, but not advantages, for PDA. One study with dual diagnosis participants in the US Veterans Administration healthcare system (Lydecker et al., 2010) found a disadvantage for PDA with AA/TSF. This may be because, although participants met criteria for AUD, the primary problem was mood disorder as opposed to AUD, which may represent a poorer fit with AA (Kelly et al., 2003). That said, a recent meta-analysis by Tonigan (Tonigan et al., 2018) found consistent abstinence benefits from participation in AA by those dually diagnosed.

Financial support and sponsorship

Conversely, a return to the target behavior can undermine self-efficacy, increasing the risk of future lapses. Outcome expectancies (anticipated effects of substance use; 27) also figure prominently in the RP model. Additionally, attitudes or beliefs about the causes and meaning of a lapse may influence whether a full relapse ensues. Viewing a lapse as a personal failure may lead to feelings of guilt and abandonment of the behavior change goal 24.

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Indeed, about 95% of people with SUD say they do not need SUD treatment (SAMHSA, 2019a). Even among those who do perceive a need for treatment, less than half (40%) make any effort to get it (SAMHSA, 2019a). Although reducing practical barriers to treatment is essential, evidence suggests that these barriers do not fully account for low rates of treatment utilization.

Specific Intervention Strategies

While a lapse might prompt a full-blown relapse, another possible outcome is that the problem behavior is corrected and the desired behavior re-instantiated–an event referred to as prolapse. A critical implication is that rather than signaling a failure in the behavior change process, lapses can be considered temporary setbacks that present opportunities for new learning to occur. In viewing relapse as a common (albeit undesirable) event, emphasizing contextual antecedents over internal causes, and distinguishing relapse from treatment failure, the RP model introduced a comprehensive, flexible and optimistic alternative to traditional approaches. Most notably, we provide a recent update of the RP literature by focusing primarily on studies conducted within the last decade.

Treatment strategies in the relapse prevention

• In a similar fashion, the nature of these attributions determines whether the violation will lead to full-blown relapse.
• If stressors are not balanced by sufficient stress management strategies, the client is more likely to use alcohol in an attempt to gain some relief or escape from stress.
• However, the downside is that it can also make us forget the pains that spurred us to change.
• Motivation enhancement therapy (MET) is a brief, program of two to four sessions, usually held before other treatment approaches, so as to enhance treatment response24.
• As a newer iteration of RP, Mindfulness-Based Relapse Prevention (MBRP) has a less extensive research base, though it has been tested in samples with a range of SUDs (e.g., Bowen et al., 2009; Bowen et al., 2014; Witkiewitz et al., 2014).

Self- efficacy increases and the probability of relapsing decreases when one is able to cope with this situation31. As seen in Rajiv’s case illustration, internal (social anxiety, craving) and external cues (drinking partner, a favourite brand of drink) were identified as triggers for his craving. Subsequently inadequate coping and lack of assertiveness and low self-efficacy maintained his drinking. The following section presents a brief overview of some Alcoholics Anonymous of the major approaches to managing addictive behaviours.

‘This Time Will Be Different’

Rajiv’s unsuccessful attempts at abstinence lead to a low sense of self-confidence and a belief that he would not be able help himself (low perceived self- efficacy) setting up a vicious cycle. The results also indicate that clinicians who have prejudged AA should give it another look. In a study of NHS workers, Day and colleagues (Day et al., 2005) found that clinicians were highly confident they understand what happens at AA meetings but had never actually visited one. To the extent that such attitudes emerge from a perception that AA is ineffective, we hope the Cochrane Review will prompt a re-evaluation and in turn a greater willingness to help AUD patients test out this remarkable fellowship for themselves.

Identifying and Coping With High-Risk Situations

This conceptualization provides a broader conceptual framework for intervening in the relapse process to prevent or reduce relapse episodes and thereby improve treatment outcome. The original AA intervention is thought to work via its social fellowship and 12-step program (Alcoholics Anonymous, 2001). The social components operate through peer support and role modeling of successful recovery and through providing close mentoring through ‘sponsorship’ (i.e. having a recovery coach/mentor who can serve as a contact and ‘guide’, especially early in recovery). The common suffering of AA members may provide a sense of belonging or ‘universality’ that can help to diminish negative affect, particularly shame, loneliness and guilt, which is similar in principle to the dynamics of professional group psychotherapy (Yalom 2008). Furthermore, the observation of others who are sustaining recovery in AA can instill hope for a better future. AA also provides an arena for members to learn, and model, effective communication and coping skills.

• Some other examples of things a person might abstain from include drugs, sexual behaviors, unhealthy foods, tobacco, and social media.
• These interventions integrate both cognitive behavioural and mindfulness based strategies.
• The evidence suggests that compared to other well-established treatments, clinical linkage using well-articulated TSF manualized interventions intended to increase AA participation during and following AUD treatment can lead to enhanced abstinence outcomes over the next months and years.
• 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.

Ultimately, nonabstinence treatments may overlap significantly with abstinence-focused treatment models. Harm reduction psychotherapies, for example, incorporate multiple modalities that have been most extensively studied as abstinence-focused SUD treatments (e.g., cognitive-behavioral therapy; mindfulness). However, it is also possible that adaptations will be needed for individuals with nonabstinence goals (e.g., additional support with goal setting and monitoring drug use; ongoing care to support maintenance goals), and currently there is a dearth of research in this area. An additional concern is that the lack of research supporting the efficacy of established interventions for achieving nonabstinence goals presents a barrier to implementation.

Abstinence Violation Effect: How Does Relapse Impact Recovery?

In many cases, relapse can also affect the brain by causing the abstinence violation effect discussed in this article. This can lead to a full relapse by making someone believe that because they’ve already messed up, there is no hope of achieving sobriety. As a result, they may also abstinence violation effect be less likely to try staying sober again after subsequent use.

That’s why adopting a more realistic, compassionate view of the recovery journey can be helpful, in addition to seeking the appropriate mental health support as needed. Life situations, relationships, and commitments all have to be parsed through carefully and continually evaluated for balance and harmony. That way, the individual may be better able to avoid the most likely causes of relapse and the potential resulting AVE. Regard Healthcare offers 100% confidential substance abuse https://mvp69slot.com/risk-factors-varied-vulnerability-to-alcohol/ assessment and treatment placement tailored to your individual needs. If you’re worried you might be heading towards a lapse or full-blown relapse, don’t struggle with this alone. If you’re currently lost within the confusion of the abstinence violation effect, we can help.