Relaspe Prevention

Heading for a relaspe?

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Relaspe Prevention: What is it?

•Living strategies that:

A.prevent an initial relapse and maintain abstinence or harm reduction treatment goals

B.providing lapse management if a lapse occurs to prevent further relaspe

Unfortunately or Fortunately

• Relaspe is common in addiction, but there is seemingly two paths that relaspe most commonly takes:

1. Lapse leads back to full blown addiction, or:

2. Lapse can lead us back to getting on track - we learn something from the “slip so to speak”

Two Components to AVE

•Affective and Cognitive

• Affective: is brought about between the discrepancy between one’s prior identity as the abstainer and one’s 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

Abstinence Violation Effect (AVE)

•Consequence of using brings about feelings of:

• Self-blame

• Guilt

• Loss of perceived control of personal rules / values

Cognitive-Behavioural Model of Relaspe

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

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 p’s, 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).

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

Emotional States•In Marlatt’s original work emotional

states was the strongest predicator of alcoholic male relapse

•Especially negative emotional states

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

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)

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

Toward the Future: Linear to Dynamic and Multidimensional

Models

•Need for greater understanding

What are we learning?