Unit 9 Relapse Prevention PDF

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summary of relapse prevention...

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Unit 9: Relapse Prevention Part 1: Relapse Risk Factors ● Biological Factors: excessive use of alcohol and other drugs has a pharmacological impact on body chemistry ○ Tolerance: increased frequency of use and higher doses over time ○ Withdrawal: negative effects of stopping addictive behaviors ● Psychological Risk Factors ○ Thoughts, beliefs and negative emotions put people at specific risk for relapse ○ Negative emotions: doubt, sadness, shame, frustration, fear, guild, boredom, anger, jealousy, and anxiety ○ Cravings, urges, temptations, sensation seeking, impulsivity, testing personal control ○ Motivation, coping strategies, outcome expectancy, attributions of effects of use, reasons for relapse, and self-efficacy ■ Outcome expectancies: proposes that people engage in certain behaviors based on their beliefs about what the behavior will give them

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Substance use reduces ability to: understand/remember, stay organized and pay attention, judge and plan, recognize consequences, feel hope and optimistic Social risk factors ○ Family and social support for use ○ Culture and ethnic background ○ Interpersonal conflict ○ Abuse and trauma ○ Exposure to media Social risks: social exclusion/stigma, isolation, victimization

Part 2: Lapse and Relapse ● Intervention strategies ○ Motivation enhancement strategies: precontemplation and contemplation stages ○ Assessment and treatment matching: contemplation, preparation, and action stage ○ Relapse prevention and management: action, maintenances, and relapse stage

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■ Goal of maintenance stage= abstinence Lapse: initial use after a period of abstinence Relapse: full blown return to active use and the negative consequences of use ○ Relapse is a process Prolapse: process of getting back on track in the direction of positive behavior change Relapse prevention: A cognitive-behavioral approach to anticipating and coping with setbacks ○ Aims to reduce relapse by: ■ Minimizing the impact of high-risk situations ■ Increasing awareness and building coping skills ■ Promoting a healthy and balanced lifestyle

Part 3: Marlatt Model of Relapse Prevention ● Dynamic Model of Relapse ○ Tonic processes: continuous or sustained activity and chronic vulnerability ■ Digital risks and cognitive processes ○ Phasic responses: transient stares/activating events that precede lapse

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■ Coping behavior and substance use behaviors High risk situations- contextual factors ○ Events, places, persons, emotions, behaviors, and cognitions

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Relapse prevention theory: assessing relapse potential ○ Internal variables: inheritance, course of illness, current strengths and impairments ○ External variables: social supports and recovery resources ○ High risk situations: events that occur at or just before a lapse happens ○ Transitional Factors: things that influence a return to abstinence Relapse Prevention Therapy

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The recovery process

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Relapse Intervention Strategies are required

Part 4: Strategies, Assessment, and Planning ● Relapse prevention principles ○ Active approaches ○ Understand outcome expectancies ○ Develop plans to positively cope with lapses ○ Focus on improving wellness ● Prevention Relapse strategy: help people identify their high risk situations ○ The 5 W’s: when, where, why, whom, what happened ● Strategy: help people develop positive coping responses ○ The cognitive and behavioral methods a person uses to deal with stressful situations ● Coping with high risk situations ○ Need action plans for: daily low-risk activities, high risk events, dealing with lapses and relapse

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○ Self help groups Coping with lapses ○ Plan emergency procedures ○ Contract to limit use ○ Relapse reminder card

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Stop, look, and listen Keep calm Renew commitment Review situation leading up to lapse Make a plan for recovery Deal with abstinence violation effect

COGNITIVE

AVOIDANCE (early recovery)

APPROACH (advanced recovery)

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•distraction from cues •thought stopping •engage in alternate activity, creative pursuits

•accept •confront •reframe

Signs of relapse ○ Return to drinking/using drugs

BEHAVIORAL

•stay away from people, places, and things

•refusal skills •problem solving skills •asking for help •take medication

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○ Aggressiveness ○ Panic attacks ○ Depression ○ Suicidal thinking Relapse warning signs ○ Withdrawing from others and reducing social and recreational activities. ○ Stopping meetings or other therapeutic activities. ○ Failing to practice and use new coping skills and productive thinking. ○ Returning to denial and helplessness/hopelessness. ○ Believing that the use of alcohol/drugs is the only way to have fun or fix the problem. ○ Believing that alcohol/drugs won't make uncomfortable feelings worse.

Part 5: Coping with Cravings ● Strategy: help people identify and manage cravings and “cues” that precede cravings ● Cravings are normal and expected ○ Craving and coping reaction -> abstinence or use ● Cravings can be due to stress ○ Physical- withdrawal or illness ○ Psychological- obsessional thinking, pessimism, or mental illness ● Environmental cues/triggers can also cause triggers ● Positive Coping Reactions ○ Engage in alternate activity ■ Ex: call a friend ○ Get plenty of rest, avoid loneliness, and be good to yourself ○ mindfulness/acceptance techniques, crave or urge surfing, thought stopping, or medication ● Strategy: help people to manage medications and consider the use of relapse prevention medications ○ There are medications for specific phases of substance use ○ For alcohol, opiates, nicotine, and benzodiazepines ○ Actions of medications: agonist, antagonist, aversive, and treatment illness Part 6: Psycho-social strategies ● Strategy: help people enhance communication skills, interpersonal relationships and social networks ● Relationships- teach social skills, develop healthy relationships by severing ties across settings ● Strategy: help people identify and challenge cognitive distortions ○ Ex: catastrophizing, jumping to conclusions, over-generalizing ○ Be aware of risky and disputing beliefs

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Self efficacy: personal belief in one’s ability to do something Self schema: how one views oneself Outcome expectancies: ○ Advantages of using: ■ “It keeps me from being lonely, I have something to do; it makes me feel good, even if it is temporary. I don’t have to worry about not getting along with other people and getting into fights.” ○ Advantages of not using ■ “I have no hangovers, no guilt, no remorse and people respect me more; I’m closer to regaining custody of my kids” ○ Disadvantages of using ■ “I don’t like the feeling of hangovers, I feel guilty and remorse for what I have done; I end up hurting the ones I love; I lost my kids because of my use and my parents have lost trust in me.” ○ Disadvantage of not using ■ “I am lonely and lost my old drinking buddies; I lost the relationship I had with my ex-husband; I get bored easily now and need to find new outlets to compensate for the loss of liquor.”

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Strategy: help people manage negative emotional states ○ Emotional triggers- hunger, anger, lonely, tired (HALT) Discontinuity of change: change is not linear or continuous...