Relapse Prevention Plan: Strategies and Techniques for Addiction

According to this metaphor, learning to anticipate and plan for high-risk situations during recovery from alcoholism is equivalent to having a good road map, a well-equipped tool box, a full tank of gas, and a spare tire in good condition for the journey. Marlatt and Gordon (1980, 1985) have described a type of reaction by the drinker to a lapse called the abstinence violation effect, which may influence whether a lapse leads to relapse. This reaction focuses on the drinker’s emotional response to an initial lapse and on the causes to which he or she attributes the lapse. People who attribute the lapse to their own personal failure are likely to experience guilt and negative emotions that can, in turn, lead to increased drinking as a further attempt to avoid or escape the feelings of guilt or failure.

These can be classified as intrapersonal or interpersonal. Intrapersonal Determinants

• Asking clients questions designed to assess expectancies for both immediate and delayed consequences of drinking versus not drinking (i.e., using a decision matrix) (see table, p. 157) often can be useful in both eliciting and modifying expectancies.
• It involves the degree of balance in the person’s life between perceived external demands and internally fulfilling or enjoyable activities.
• Clinical experience has shown that self-help groups help individuals overcome their guilt and shame of addiction by seeing that they are not alone.
• Third, the main tools of relapse prevention are cognitive therapy and mind-body relaxation, which change negative thinking and develop healthy coping skills [3].
• Global strategies comprise balancing the client’s lifestyle and helping him or her develop positive addictions, employing stimulus control techniques and urge-management techniques, and developing relapse road maps.
• Research supports a correlation between longer lengths of time in treatment and improved treatment outcomes.8 Adequate lengths of treatment may help to ensure that the full range of a patient’s unique problems and needs are addressed.

Relapse is the return to substance abuse after being drug- or alcohol-free. It’s not uncommon for people who struggle with addictions to relapse after completing treatment, and it doesn’t mean treatment failed. Instead, a relapse signifies that additional and/or a different form of treatment is necessary. Understanding relapse, triggers, and treatment are important steps toward relapse prevention.

Drugs & Supplements

It has been shown that the way to get the most out of 12-step groups is to attend meetings regularly, have a sponsor, read 12-step materials, and have a goal of abstinence [24,25]. Approach coping may involve attempts to accept, confront, or reframe as a means of coping, whereas avoidance coping may include distraction from cues or engaging in other activities. Approach oriented participants may see themselves as more responsible for their actions, including lapse, while avoidance-based coping the abstinence violation effect refers to may focus more on their environment than on their own actions14. 3) Clients feel they are not learning anything new at self-help meetings and begin to go less frequently. Clients need to understand that one of the benefits of going to meetings is to be reminded of what the “voice of addiction” sounds like, because it is easy to forget. For example, I am a failure (labeling) and will never be successful with abstaining from drinking, eating healthier, or exercising (jumping to conclusions).

Global Lifestyle Self-Control Strategies

Nevertheless, the study provides relatively good support for other aspects of the RP model. For example, Miller and colleagues (1996) found that although mere exposure to specific high-risk situations did not predict relapse, the manner in which people coped with those situations strongly predicted subsequent relapse or continued abstinence. Furthermore, in that study the majority of relapse episodes after treatment occurred during situations involving negative emotional states, a finding that has been replicated in other studies (Cooney et al. 1997; McKay 1999; Shiffman 1992). Finally, the results of Miller and colleagues (1996) support the role of the abstinence violation effect in predicting which participants would experience a full-blown relapse following an initial lapse. Specifically, those participants who had a greater belief in the disease model of alcoholism and a higher commitment to absolute abstinence (who were most likely to experience feelings of guilt over their lapse) were most likely to experience relapse in that study. In a recent review of the literature on relapse precipitants, Dimeff and Marlatt (1998) also concluded that considerable support exists for the notion that an abstinence violation effect can precipitate a relapse.

Balanced lifestyle and Positive addiction

Cognitive restructuring, or reframing, is used throughout the RP treatment process to assist clients in modifying their attributions for and perceptions of the relapse process. In particular, cognitive restructuring is a critical component of interventions to lessen the abstinence violation effect. This perspective considers lapses key learning opportunities resulting from an interaction between coping and situational determinants, both of which can be modified in the future.

This lapse, in turn, can result in feelings of guilt and failure (i.e., an abstinence violation effect). The abstinence violation effect, along with positive outcome expectancies, can increase the probability of a relapse. 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. These covert antecedents include lifestyle factors, such as overall stress level, as well as cognitive factors that may serve to “set up” a relapse, such as rationalization, denial, and a desire for immediate gratification (i.e., urges and cravings) (see figure 2). These factors can increase a person’s vulnerability to relapse both by increasing his or her exposure to high-risk situations and by decreasing motivation to resist drinking in high-risk situations. 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 cigarette ad attracts us, or someone in a group puts us down, or we strain ourselves by overdoing exercise.
• 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).
• An important part of RP is the notion of Abstinence violation effect (AVE), which refers to an individual’s response to a relapse where often the client blames himself/herself, with a subsequent loss of perceived control4.
• Post-acute withdrawal begins shortly after the acute phase of withdrawal and is a common cause of relapse [17].

Recovering individuals tend to see setbacks as failures because they are unusually hard on themselves [9]. Setbacks can set up a vicious cycle, in which individuals see setbacks as confirming their negative view of themselves. Eventually, they stop focusing on the progress they have made and begin to see the road ahead as overwhelming [16].

• 3) Clients feel they are not learning anything new at self-help meetings and begin to go less frequently.
• The second strategy, which is possibly the most important aspect of RP, involves evaluating the client’s existing motivation and ability to cope with specific high-risk situations and then helping the client learn more effective coping skills.
• In contrast to the former group of people, the latter group realizes that one needs to “learn from one’s mistakes” and, thus, they may develop more effective ways to cope with similar trigger situations in the future.
• Clients need to be reminded that lack of self-care is what got them here and that continued lack of self-care will lead back to relapse.
• Here the assessment and management of both the intrapersonal and interpersonal determinants of relapse are undertaken.

Relapse Prevention Strategies

• The repair stage of recovery was about catching up, and the growth stage is about moving forward.
• Unlike acute withdrawal, which has mostly physical symptoms, post-acute withdrawal syndrome (PAWS) has mostly psychological and emotional symptoms.
• One day, when he was faced with a stressful situation, he felt overwhelmed, gave in to the urge, and had a drink.
• Another efficacy-enhancing strategy involves breaking down the overall task of behavior change into smaller, more manageable subtasks that can be addressed one at a time (Bandura 1977).
• For Jim and Taylor, this might involve acknowledging the months of sobriety and healthier lifestyle choices and understanding that a single incident does not erase that progress.

Abstinence Stage