Author: Charles Frank

Cognitive Behavioral Therapy for Relapse Prevention

For example, individuals work hard to achieve a goal, and when it is achieved, they want to celebrate. But as part of their all-or-nothing thinking, while they were working, they felt they didn’t deserve a reward until the job was done. Since they did not allow themselves small rewards during the work, the only reward that will suffice at the end is a big reward, which in the past has meant using. The tasks of this stage are similar to the tasks that non-addicts face in everyday life. When non-addicts do not develop healthy life skills, the consequence is that they may be unhappy in life. When recovering individuals do not develop healthy life skills, the consequence is that they also may be unhappy in life, but that can lead to relapse.

1. They often enter treatment saying, “We want our old life back — without the using.” I try to help clients understand that wishing for their old life back is like wishing for relapse.
2. Marlatt, based on clinical data, describes categories of relapse determinants which help in developing a detailed taxonomy of high-risk situations.
3. Conversely, around 8 percent of the general population experiences PTSD, but within the subset dealing with a substance use disorder, this figure surges to between percent.

Post-acute withdrawal begins shortly after the acute phase of withdrawal and is a common cause of relapse [17]. Unlike acute withdrawal, which has mostly physical symptoms, post-acute withdrawal syndrome (PAWS) has mostly psychological and emotional symptoms. Its symptoms also tend to be similar for most addictions, unlike acute withdrawal, which tends to have specific symptoms for each addiction [1].

The transition between emotional and mental relapse is not arbitrary, but the natural consequence of prolonged, poor self-care. When individuals exhibit poor self-care and live in emotional relapse long enough, eventually they start to feel uncomfortable in their own skin. As their tension builds, they start to think about using just to escape. But their emotions and behaviors are setting them up for relapse down the road. Because clients are not consciously thinking about using during this stage, denial is a big part of emotional relapse.

Growth Stage

Most often, a relapse prevention plan is a written document a person creates with their treatment team and shares with their support group. The plan offers a course of action for responding to triggers and cravings. In a meta-analysis by Carroll, more than 24 RCT’s have been evaluated for the effectiveness of RP on substance use outcomes. Review of this body of literature suggests that, across substances of abuse but most strongly for smoking cessation, there is evidence for the effectiveness of relapse prevention compared with no treatment controls.

The cognitive challenge is to encourage clients to measure their progress month-to-month rather than day-to-day or week-to-week. The tasks of this stage can be summarized as improved physical and emotional self-care. Clinical experience has shown that recovering individuals are often in a rush to skip past these tasks and get on with what they think are the real issues of recovery. Clients need to be reminded that lack of self-care is what got them here and that continued lack of self-care will lead back to relapse. There are many risks to recovery at this stage, including physical cravings, poor self-care, wanting to use just one more time, and struggling with whether one has an addiction. Clients are often eager to make big external changes in early recovery, such as changing jobs or ending a relationship.

Regardless of the reasons behind a relapse, it’s crucial to understand that it doesn’t signify failure. Each attempt at lifelong sobriety serves as a valuable learning experience and a step in the right direction. With the right support and the essential tools for recovery, the next attempt could be the one that endures.

What Role Does Trauma Play in Relapse?

Following this a decisional matrix can be drawn where pros and cons of continuing or abstaining from substance are elicited and clients’ beliefs may be questioned6. Approach coping may involve attempts to accept, confront, or reframe as a means of coping, whereas avoidance coping may include distraction from cues or engaging in other activities. Approach oriented participants may see themselves as more responsible for their actions, including lapse, while avoidance-based coping may focus more on their environment than on their own actions14. Relapse prevention initially evolved as a calculated response to the longer-term treatment failures of other therapies. The assumption of RP is that it is problematic to expect that the effects of a treatment that is designed to moderate or eliminate an undesirable behaviour will endure beyond the termination of that treatment. Twelve-step groups include Alcoholics Anonymous (AA), Narcotics Anonymous (NA), Marijuana Anonymous (MA), Cocaine Anonymous (CA), Gamblers Anonymous (GA), and Adult Children of Alcoholics (ACA).

When individuals do not change their lives, then all the factors that contributed to their addiction will eventually catch up with them. 5) People think that they have a better understanding of drugs and alcohol and, therefore, think they should be able to control a relapse or avoid the negative consequences. The clinician will use a range of strategies to facilitate these activities.

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It involves the degree of balance in the person’s life between perceived external demands and internally fulfilling or enjoyable activities. Urges and cravings precipitated by psychological or environmental stimuli are also important6. Individuals use drugs and alcohol to escape negative emotions; however, they also use as a reward and/or to enhance positive emotions [11]. In these situations, poor self-care often precedes drug or alcohol use.

Before we dive into the role of cognitive behavioral therapy in preventing relapse, let’s understand what relapse is and why it’s so common. A significant statistical connection exists between post-traumatic stress disorder (PTSD) and addiction. In the general population, approximately 3-7 percent of people grapple with a substance use disorder (SUD). However, when examining those with PTSD, the prevalence of SUD escalates to as high as 35 percent, while alcohol use disorder (AUD) stands at 52 percent. Conversely, around 8 percent of the general population experiences PTSD, but within the subset dealing with a substance use disorder, this figure surges to between percent.

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In other words, relapses are reinterpreted as opportunities for learning and improving coping skills. This perspective serves to keep relapses as time-limited and harmless as possible. Viewed in this manner, they might be also termed “slips” or “lapses” rather than relapses.

Motivation may relate to the relapse process in two distinct ways, the motivation for positive behaviour change and the motivation to engage in the problematic behaviour. This illustrates the issue of ambivalence experienced by many patients attempting to change an addictive behaviour. Motivational Interviewing provides a means of facilitating the change process7. A high-risk situation is defined as a circumstance in which an individual’s attempt to refrain from a particular behaviour is threatened. While analysing high-risk situations the client is asked to generate a list of situations that are low-risk, and to determine what aspects of those situations differentiate them from the high-risk situations. Seemingly irrelevant decisions (SIDs) are those behaviours that are early in the path of decisions that place the client in a high-risk situation.

Create a relapse prevention action plan for what to do instead of turning to drugs or alcohol. For example, if going through a breakup could lead to a relapse, think of other outlets for your pain and frustration. Instead of drinking or using, plan to attend a support meeting or call a family member or close friend right away. The more specific your action plan is, the better, as this means you will be less likely to come within close reach of a relapse. Oxford English Dictionary defines motivation as “the conscious or unconscious stimulus for action towards a desired goal provided by psychological or social factors; that which gives purpose or direction to behaviour.