Relaspe Prevention

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Relaspe Prevention
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Heading for a relaspe?
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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

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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

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Two Components to AVE

• Affective and Cognitive
• Affective is brought about between the
  discrepancy between ones prior identity as the
  abstainer and ones 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

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Abstinence Violation Effect (AVE)

• Consequence of using brings about feelings of
• Self-blame
• Guilt
• Loss of perceived control of personal rules /
  values

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Cognitive-Behavioural Model of Relaspe
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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

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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 ps, 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).

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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

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Emotional States

• In Marlatts original work emotional states was
  the strongest predicator of alcoholic male
  relapse
• Especially negative emotional states

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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

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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)

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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

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Toward the Future Linear to Dynamic and
Multidimensional Models

• Need for greater understanding

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What are we learning?
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