Relaspe
Prevention
Heading for a relaspe?
QuickTime™ and a
decompressor
are needed to see this picture.
Relaspe Prevention: What
is it?
• Living strategies that:
A. prevent an initial relapse and maintain
abstinence or harm reduction
treatment goals
B. 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:
1. Lapse leads back to full blown addiction,
or:
2. 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 laspe 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 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 preforming 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).
Stages of Change
• Precontemplation – not ready to change
• Contemplation – thinking about change
• Preparation – ready to change
• Action – action, taking steps, doing
• Maintenance – maintaining change
The Processes of Behavior Change:
How clients can move from one stage to the next
1.
Consciousness-raising —finding and learning new facts and suggestions
supporting the change (e.g., reading a book; watching a TV show; talking with a
friend, teacher, or doctor)
2.
Dramatic Relief — experiencing and expressing negative feelings about one's
problems such as worry or fear (e.g., communicating with a friend, partner,
counselor; writing in a journal)
3.
Self Re-evaluation — realizing that the behavioral change is part of one's
identity (e.g., seeing yourself as a non-smoker or a fit person)
4.
Environmental Re-evaluation — assessing how one's problem affects the
physical environment (e.g., realizing that second-hand smoke may affect nonsmoking children and partners or even pets)
5.
Self Liberation — choosing and committing to act on a belief that change is
possible (e.g., making a New Year's resolution); accepting responsibility for
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 posttreatment
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?