Relapse prevention
Encyclopedia
Relapse prevention, or RP for short, is a cognitive-behavioral approach with the goal of identifying and preventing high-risk situations such as substance abuse, obsessive-compulsive behavior, sexual offending, obesity, and depression.
, or into the individual turning again towards positive change, called prolapse.
Relapse is thought to be multi-determined, especially by self-efficacy, outcome expectancies, craving, motivation, coping, emotional states, and interpersonal factors. In particular, high self-efficacy
, negative outcome expectancies
, potent availability of coping skills following treatment, positive affect
, and functional social support
are expected to predict positive outcome. Craving has not historically been shown to serve as a strong predictor.
and interpersonal therapy in improving substance use outcomes. Irvin and colleagues also conducted a meta-analysis
of RP techniques in the treatment of alcohol, tobacco, cocaine, and polysubstance use, and on the basis of 26 studies reviewed, concluded RP was successful for reducing substance use and improving psychosocial adjustment. RP seemed to be most effective for individuals with alcohol problems, suggesting that certain characteristics of alcohol use are amenable to the RP
, conceptualize relapse as a multidimensional, complex system
. Such a nonlinear dynamical system
is believed to be able to best predict the data witnessed, which commonly includes cases where small changes introduced into the equation seem to have large effects. The model also introduces concepts of self-organization, feedback loops, timing/context effects, and interplay between tonic and phasic processes.
Jumnoodoo and Coyne, in north London UK, have been working with Service users and carers over the past ten years to transfer RP theory into the field of adult mental health. The uniqueness of the model is the sustainment of change by developing service users and carers as 'experts' - following RP as an educational process and graduating as Relaspe Prevention Practitioners. The work has won many national awards, been presented at many conferences and has resulted in a number of publications.
GORSKI/CENAP RELAPSE PREVENTION MODEL
Terence T. Gorski is an internationally recognized expert on substance abuse, mental health, violence, & crime. He is best known for his contributions to relapse prevention, managing chemically dependent offenders, and developing community-based teams for managing the problems of alcohol, drugs, violence, and crime. He has extensive experience working with employee assistance programs (EAP) and has special expertise in working with emergency professionals including fire, medical, and law enforcement. He is a prolific author and has published numerous books and articles.
Underlying Assumptions
Relapse is seen as both an outcome and as a transgression in the process of behavior change. An initial setback, or lapse, may either translate into a return to the previous problematic behavior, known as relapseRelapse
Relapse, in relation to drug misuse, is resuming the use of a drug or a dependent substance after one or more periods of abstinence. The term is a landmark feature of both substance dependence and substance abuse, which are learned behaviors, and is maintained by neuronal adaptations that mediate...
, or into the individual turning again towards positive change, called prolapse.
Relapse is thought to be multi-determined, especially by self-efficacy, outcome expectancies, craving, motivation, coping, emotional states, and interpersonal factors. In particular, high self-efficacy
Self-efficacy
Self-efficacy is a term used in psychology, roughly corresponding to a person's belief in their own competence.It has been defined as the belief that one is capable of performing in a certain manner to attain certain set of goals. It is believed that our personalized ideas of self-efficacy affect...
, negative outcome expectancies
Expectancy theory
Expectancy Theory proposes that a person will decide to behave or act in a certain way because they are motivated to select a specific behavior over other behaviors due to what they expect the result of that selected behavior will be. In essence, the motivation of the behavior selection is...
, potent availability of coping skills following treatment, positive affect
Affect (psychology)
Affect refers to the experience of feeling or emotion. Affect is a key part of the process of an organism's interaction with stimuli. The word also refers sometimes to affect display, which is "a facial, vocal, or gestural behavior that serves as an indicator of affect" .The affective domain...
, and functional social support
Social support
Social support can be defined and measured in many ways. It can loosely be defined as feeling that one is cared for by and has assistance available from other people and that one is part of a supportive social network...
are expected to predict positive outcome. Craving has not historically been shown to serve as a strong predictor.
Efficacy and Effectiveness
Carroll et al.. conducted a review of 24 other trials and concluded that RP was more effective than no treatment and was equally effective as other active treatments such as supportive psychotherapySupportive psychotherapy
Supportive psychotherapy is a psychotherapeutic approach that integrates psychodynamic, cognitive-behavioral, and interpersonal conceptual models and techniques. The objective of the therapist is to reinforce the patient's healthy and adaptive patterns of thought behaviors in order to reduce the...
and interpersonal therapy in improving substance use outcomes. Irvin and colleagues also conducted a meta-analysis
Meta-analysis
In statistics, a meta-analysis combines the results of several studies that address a set of related research hypotheses. In its simplest form, this is normally by identification of a common measure of effect size, for which a weighted average might be the output of a meta-analyses. Here the...
of RP techniques in the treatment of alcohol, tobacco, cocaine, and polysubstance use, and on the basis of 26 studies reviewed, concluded RP was successful for reducing substance use and improving psychosocial adjustment. RP seemed to be most effective for individuals with alcohol problems, suggesting that certain characteristics of alcohol use are amenable to the RP
RP and Systems Theory
Some theorists, including Katie Witkiewitz and G. Alan Marlatt, borrowing ideas from systems theorySystems theory
Systems theory is the transdisciplinary study of systems in general, with the goal of elucidating principles that can be applied to all types of systems at all nesting levels in all fields of research...
, conceptualize relapse as a multidimensional, complex system
Complex system
A complex system is a system composed of interconnected parts that as a whole exhibit one or more properties not obvious from the properties of the individual parts....
. Such a nonlinear dynamical system
Dynamical system
A dynamical system is a concept in mathematics where a fixed rule describes the time dependence of a point in a geometrical space. Examples include the mathematical models that describe the swinging of a clock pendulum, the flow of water in a pipe, and the number of fish each springtime in a...
is believed to be able to best predict the data witnessed, which commonly includes cases where small changes introduced into the equation seem to have large effects. The model also introduces concepts of self-organization, feedback loops, timing/context effects, and interplay between tonic and phasic processes.
Jumnoodoo and Coyne, in north London UK, have been working with Service users and carers over the past ten years to transfer RP theory into the field of adult mental health. The uniqueness of the model is the sustainment of change by developing service users and carers as 'experts' - following RP as an educational process and graduating as Relaspe Prevention Practitioners. The work has won many national awards, been presented at many conferences and has resulted in a number of publications.
GORSKI/CENAP RELAPSE PREVENTION MODEL
Terence T. Gorski is an internationally recognized expert on substance abuse, mental health, violence, & crime. He is best known for his contributions to relapse prevention, managing chemically dependent offenders, and developing community-based teams for managing the problems of alcohol, drugs, violence, and crime. He has extensive experience working with employee assistance programs (EAP) and has special expertise in working with emergency professionals including fire, medical, and law enforcement. He is a prolific author and has published numerous books and articles.