Relaspe Prevention
Heading for a relaspe?
Relaspe Prevention: What is it?
Living strategies that:
Prevent an initial relapse and maintain abstinence or harm reduction treatment goals
Providing lapse management if a lapse occurs to prevent further relaspe
Unfortunately or Fortunately
Relaspe is common in addiction, but there is seemingly two paths that relaspe
most commonly takes:
Lapse leads back to full blown addiction, or:
Lapse can lead us back to getting on track - we learn something from the “slip so to speak”
Two Components to AVE
Affective and Cognitive
Affective: is brought about between the discrepancy between one’s prior
identity as the abstainer and one’s present behavior
Cognitive: if the individual attributes factors of the lapse due to internal,
global, and uncontrollable factors relaspe risk is heightened. On the other
hand, if we view our lapse as external, unstable, and controllable it is more
likely that the lapse will not lead to full blown relaspe
Abstinence Violation Effect (AVE)
Consequence of using brings about feelings of:
Self-blame
Guilt
Loss of perceived control of personal rules / values
Cognitive-Behavioural Model of Relaspe
Intra-personal Determinants
Self-efficacy - degree to which I feel confident and capable of performing a
certain behavior in a particular context
Research has shown that having a higher self-efficacy is related to greater
days of abstinence
Also has be shown to be predictive of time to first drink and time to relaspe
with 12 months
Outcome Expectancies
The effect that I expect will occur when I use (physical, psychological, or
behavioural)
Research has shown that the more positive I perceive my using to help me
with the 3 p’s, the more likely I am to relaspe (Connors, Tarbox, &
Faillace, 1993).
However, other research has downplayed the degree to which this
happens...
While other studies have revealed that targeting positive expectancy (with
alcohol) during treatment does not necessarily lead to changes in alcohol
consumption post-treatment (Jones, 2001).
Coping
According to Marlatt and Witkiewitz(2005) coping is the most critical predictor or
relaspe
Coping involves both cognitive and behavioural components
We deal with both stressors and temptations
Research by Chung (2001) has found that cognitive avoidance coping (not
thinking about stressor or accepting stressor) predicted fewer problems
with alcohol, interpersonal problems, and psychological problems
following 12 months post-treatment
Emotional States
In Marlatt’s original work emotional states was the strongest predicator of
alcoholic male relapse
Especially negative emotional states
Craving
According to Marlatt and Witkiewitz(2005) coping is the most widely studied, but
misunderstood concept in the addictions field
Craving is both the physical and psychological and is has been married to the
notion of loss of control
Research has disconfirmed loss of control hypothesis
Craving (cont.)
Research has also shown that there is a lack of strong association between
subjective reports of craving and relaspe.
However, the correlates and underlying mechanisms of craving may still predict
relaspe
Thus Marlatt et al. 1999 distinguish between an urge to use from that of a
subjective desire to use (which is closer to what they understand as craving)
Inter-personal
Social Support
Positive social support and social network is highly predictive of long-term
abstinence rates
Meanwhile negative social support (interpersonal conflict, social pressure
to use, anti-personality traits / cue exposure) is an increase risk for relaspe
Functional support (spouse sharing in goals) appears to predict best
outcomes following treatment at both 3months and 15 months
Toward the Future: Linear to Dynamic and Multidimensional Models
Need for greater understanding
What are we learning?