Relapse prevention An overview of Marlatt’s cognitive-behavioral model

They often assume that non-addicts don’t have the same problems or experience the same negative emotions. Therefore, they feel it is defensible or necessary to escape their negative feelings. The cognitive challenge is to indicate that negative feelings are not signs of failure, but a normal part of life and opportunities for growth. Helping clients feel comfortable with being uncomfortable can reduce their need to escape into addiction. AVE occurs when someone who is striving for abstinence from a particular behavior or substance experiences a setback, such as a lapse or relapse. Instead of viewing the incident as a temporary setback, the individual perceives it as evidence of personal failure, leading to increased feelings of guilt, shame, and hopelessness (Collins & Witkiewitz, 2013; Larimer, Palmer, & Marlatt, 1999).

Global Lifestyle Self-Control Strategies

abstinence violation effect relapse prevention

This process may lead to a relapse setup or increase the client’s vulnerability to unanticipated high-risk situations. One of the most critical predictors of relapse is the individual’s ability to utilize effective coping strategies in dealing with high-risk situations. Coping is defined as the thoughts and behaviours used to manage the internal and external demands of situations that are appraised as stressful. A person who can execute effective coping strategies (e.g. a behavioural strategy, such as leaving the situation, or a cognitive strategy, such as positive self-talk) is less likely to relapse compared with a person lacking those skills.

  • Occasional, brief thoughts of using are normal in early recovery and are different from mental relapse.
  • They feel they are doing something wrong and that they have let themselves and their families down.
  • Pathways involved in how a person feels pleasure and processes rewards, memory, and decision-making can be altered through substance abuse.
  • The tasks of this stage are similar to the tasks that non-addicts face in everyday life.
  • A setback can be any behavior that moves an individual closer to physical relapse.
  • A relapse is a return to drinking or drug use after attempts have previously been made to stop.
  • One of the important tasks of therapy is to help individuals redefine fun.

Growth Stage

  • In particular, these modifications fail to specify accurately the AVE’s occurrence and influence in the offense cycle.
  • The AVE was introduced into the substance abuse literature within the context of the “relapse process” (Marlatt and Gordon 1985, p. 37).
  • Additionally, the support of a solid social network and professional help can play a pivotal role.

In the early stages of substance abuse, using is mostly a positive experience for those who are emotionally and genetically predisposed. Later, when using turns the abstinence violation effect refers to into a negative experience, they often continue to expect it to be positive. It is common to hear addicts talk about chasing the early highs they had.

Outcome Studies for Relapse Prevention

abstinence violation effect relapse prevention

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 situation, or a cognitive strategy, such as positive self-talk) is less likely to relapse compared with a person lacking those skills. Conversely, people with low self-efficacy perceive themselves as lacking the motivation or ability to resist drinking in high-risk situations. Although specific intervention strategies can address the immediate determinants of relapse, it is also important to modify individual lifestyle factors and covert antecedents that can increase exposure or reduce resistance to high-risk situations. Global self-control strategies are designed to modify the client’s lifestyle to increase balance as well as to identify and cope with covert antecedents of relapse (i.e., early warning signals, cognitive distortions, and relapse set-ups). Counteracting the drinker’s misperceptions about alcohol’s effects is an important part of relapse prevention.

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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. The RP model of relapse is centered around a detailed taxonomy of emotions, events, and situations that can precipitate both lapses and relapses to drinking. This taxonomy includes both immediate relapse determinants and covert antecedents, which indirectly increase a person’s vulnerability to relapse. 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. Overall, however, research findings support both the overall model of the relapse process and the effectiveness of treatment strategies based on the model.

  • Motivational Interviewing provides a means of facilitating the change process7.
  • A person’s coping behavior in a high-risk situation is a particularly critical determinant of the likely outcome.
  • Subsequently, the therapist can address each expectancy, using cognitive restructuring (which is discussed later in this section) and education about research findings.
  • Moderation analyses suggested that RP was consistently efficacious across treatment modalities (individual vs. group) and settings (inpatient vs. outpatient)22.
  • The RP model proposes that at the cessation of a habit, a client feels self-efficacious with regard to the unwanted behaviour and that this perception of self-efficacy stems from learned and practiced skills3.

The Stages of Recovery

Relapse Prevention and the Five Rules of Recovery

abstinence violation effect relapse prevention

Theoretical and Practical Support for the RP Model