Quite frankly, studies that have attempted to look at lapse and relapse rates across different substances have discrepant findings because the terms are often defined differently. In addition, many individuals in recovery consider a single slip as a full-blown relapse. In CBT for addictive behaviours cognitive strategies are supported by several behavioural strategies such as coping skills. 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 of the major approaches to managing addictive behaviours.
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Despite the empirical support for many components of the cognitive-behavioral model, there have also been many criticisms of the model for being too static and hierarchical. In response to these criticisms, Witkiewitz and Marlatt proposed a revision of the cognitive-behavioral model of relapse that incorporated both static and dynamic factors that are believed to be influential in the relapse process. The “dynamic model of relapse” builds on several previous studies of relapse risk factors by incorporating the characterization of distal and proximal risk factors. Distal risks, which are thought to increase the probability of relapse, include background variables (e.g. severity of alcohol dependence) and relatively stable pretreatment characteristics (e.g. expectancies). Proximal risks actualize, or complete, the distal predispositions and include transient lapse precipitants (e.g. stressful situations) and dynamic individual characteristics (e.g. negative affect, self-efficacy). Combinations of precipitating and predisposing risk factors are innumerable for any particular individual and may create a complex system in which the probability of relapse is greatly increased.
Celibacy vs. Abstinence
Clients are expected to monitor substance use (see Table 8.1) and complete homework exercises between sessions. When abstinence is violated, individuals typically also have an emotional response consisting of guilt, shame, hopelessness, loss of control, and/or a sense of failure; they may use drugs or alcohol in an attempt to cope with the negative feelings that resulted from their abstinence violation. A person may experience a particularly stressful emotional event in their lives and may turn to alcohol and/or drugs to cope with these negative emotions. An abstinence violation can also occur in individuals with low self-efficacy, since they do not feel very confident in their ability to carry out their goal of abstinence.
While abstinence is the only guaranteed method for avoiding disease and pregnancy, current discourse generally considers abstinence-only programs to be ineffective. Some educators advocate instead for emphasizing the benefits of abstinence and then teaching strategies for avoiding disease, promoting healthy sexuality, and ensuring emotional needs are met. Abstinence is commonly used to refer to complete avoidance of sexual behaviors, particularly among children and adolescents. A person, by contrast, who vows not to have sex until marriage has committed to abstinence until marriage. Helping clients develop positive addictions or substitute indulgences (e.g. jogging, meditation, relaxation, exercise, hobbies, or creative tasks) also help to balance their lifestyle6. Global self-management strategy involves encouraging clients to pursue again those previously satisfying, nondrinking recreational activities.
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An individual progresses through various stages of changes and the movement is influenced by several factors. Stages imply a readiness to change and therefore the abstinence violation effect TTM has been particularly relevant in the timing of interventions. Matching interventions to the stage of change at which an individual is, can maximize outcome.
These groups tend to include individuals who use a range of substances and who endorse a range of goals, including reducing substance use and/or substance-related harms, controlled/moderate use, and abstinence (Little, 2006). Additionally, some groups target individuals with co-occurring psychiatric disorders (Little, Hodari, Lavender, & Berg, 2008). Important features common to these groups include low program barriers (e.g., drop-in groups, few rules) and inclusiveness of clients with difficult presentations (Little & Franskoviak, 2010). Teasdale and colleagues (1995) have proposed a model of depressive relapse which attempts to explain the process of relapse in depression and also the mechanisms by which cognitive therapy achieves its prophylactic effects in the treatment of depression. It hypothesizes that following recovery, mild states of depression can reactivate depressogenic cycles of cognitive processing similar to those found during a major depressive episode.
AVE in the Context of the Relapse Process
In pretreatment DBT-SUD, the therapist also weaves in orientation to a number of other elements including treatment of SUDs and behavioral patterns that typically arise as a part of substance use (e.g., lying behaviors) and how those behaviors are targeted in DBT. A more recent development in the area of managing addictive behaviours is the application of the construct of mindfulness to managing experiences related to craving, negative affect and other emotional states that are believed to impact the process of relapse34. With regard to addictive behaviours Cognitive Therapy emphasizes psychoeducation and relapse prevention. Therefore, many of the techniques discussed under relapse prevention that aim at modification of dysfunctional beliefs related to outcomes of substance use, coping or self-efficacy are relevant and overlapping. It is now believed that relapse prevention strategies must be taught to the individual during the course of therapy, and various strategies to enhance patient involvement and adherence such as increasing patient responsibility, promoting internal attributions to events are to be introduced in therapy.
If you have completed a drug or alcohol treatment program, then you are probably considering trying to rebuild your life. Looking back does have its benefits in that it helps us identify weaknesses in our program. The problem is that https://ecosoberhouse.com/ magnifies these weaknesses and prevents us from seeking solutions. Our first instinct should be to figure out a relapse prevention plan that addresses the faults we have identified.
