Relapse Prevention the Treatment of Addictive Behaviors - Term Paper Example

Relapse Prevention Johnson (765) argues that as individuals make attempts to be free from addictions, repeated trials are necessary for most people in order to be able to stop the addictive behavior. Numerous trials to change coupled with treatments are the norms witnessed among many people rather than the exception from addiction recoveries. Johnson notes that there seem to be a cycle within the path to recovery. He also notes that once a person has become addicted to a particular substance, they become convicted that they needed to change their addiction behaviors such as drinking of alcohol, smoking tobacco, and cocaine among others (765). In most cases, such individuals attempt to quit completely or try to modify such addictive behaviors such as by reducing their alcohol intake or smoking (Fisher and Harrison 2). A majority of individuals who make attempts in most cases become successful in changing such behaviors. However, among those who make attempts by seeking medical attention to change addictive behaviors, about 60 to 80% are seen to return to the same behavior after some time (Jonson 765). This is what is termed as relapse. Despite all the challenges that an individual faces in an attempt to move away from addictive behavior, it is necessary that such individuals be helped to cope with the challenge. Johnson (766) argues that the ultimate goal of relapse prevention and recycling success entails helping such individuals stop drug abuse or help them become more successful as they learn from experience. The purpose of this paper is to review the literature of relapse prevention and substance abuse. Johnson (769) notes that interventions designed for relapse prevention have been made under the clinical application of Marlatt and Gordon’s model. The model came about after the advent of a focus on maintenance and relapse prevention. Under this model, interventions are designed so as to enhance the maintenance of behavior change and to ensure that there is self-management and skills for withstanding the challenges posed by relapses (Fisher and Harrison 12). Johnson notes that relapse prevention goals are two fold: preventing initial relapse and management of relapse to abate a complete relapse in case it fails to occur. Nevertheless, treatment goals based on reduction of harm and reduction of substance use have also been tried. The effectiveness of relapse prevention models have been reviewed with regard to different substances and then matched with numerous intervention alternatives. Johnson (766) notes that relapse prevention programs have mostly been developed for marijuana, smoking, alcohol, cocaine and other drugs. He reports that initial reviews found out that there is little evidence for differential efficacy of relapse prevention across substance abuse classes (765). However, later reviews reveal that there is greater relapse prevention with regard to polydrug and alcohol use disorder coupled with medication treatments. In relation to comparative effectiveness, prevention of relapse has been found to be better than treatment control groups. This is also equally effective just like other treatments such as the application of social support, supportive therapy, and interpersonal psychotherapy. Moreover, another relapse review found out that prevention of relapse has a greater impact in terms of enhancing psychological functioning than in the reduction of drug use. The review also reveals that relapse prevention is more effective when used together with prescribed medications (Johnson 769). Johnson suggests that these results involved the use of small samples and should be relied on with a lot of caution. A survey done by Irvin et al. reveals that, groups, individuals and marital modalities were found to be equally effective in relapse prevention among a legion of substance abusers (Johnson 769). Review of Efficacy and Use of Relapse Prevention Strategies with Different Types of Addictive Behaviors Johnson notes that much research has been conducted on the effectiveness of relapse prevention especially for nicotine and alcohol addictions than any other substance with addiction effects (769). For quite a number of substances abused, relapse prevention constructs and plans have been used in clinical setting. Despite such attempts, Johnson notes that there is not enough relapse prevention literature regarding specific treatment methods separate from the cognitive-behavioral approaches. Most research conducted is found to consist of trials that focus on Abstinence Violation Effect or any other dimension used by the model. Johnson states that it is so disappointing that no much study have been conducted for the entire model and its effectiveness with regard to relapse prevention across multiple behaviors. Nevertheless, due to the fact that cognitive behavior therapy approach have factored in many aspects of relapse prevention strategies and assessment of approaches of cognitive behaviors in addictions have been preferred in terms of effectiveness and efficacy in trials. Johnson (769) argues that relapse prevention has been found to be effective in treating alcohol and poly-substance use compared with all the other substances including cigarettes, marijuana and cocaine just to name a few, or abusive behaviors. A review of alcohol and drug treatment reveals varying outcomes among them being a reduction in use, improvement of functioning, and increased time before relapse (Fisher and Harrison 22). With regard to smoking cessation, a comprehensive review of relapse prevention conducted by Cochrane Collaborative found inadequate evidence to back up the use of interventions designed specifically for prevention of smoking relapse for those who had quit it successfully (Marlatt and Donovan 228). Nevertheless, many strategies regarding relapse prevention have been incorporated in standard tobacco dependence treatments. This includes delaying and craving management, understanding environmental and personal cues for smoking, rewards and relaxation among others (Johnson 170). These are incorporated into self-help and programs assisted by internet. This explains the reason as to why relapse prevention has become a vital component in the cessation of smoking behaviors instead of a separate and autonomous intervention designed specifically for relapse prevention. Johnson (170) notes that the advent of pharmacotherapy can be used in promoting smoking cessation and enhancing long-term success and has formed part of standard experimentally supported approaches to ceasing and maintaining smoking cessation. Mechanisms for Relapse Prevention Johnson (170) notes that many studies show that relapse prevention or its inverse promotion and successful maintenance of change entails several overarching constructs. The dimensions that are key to relapse's prevention include motivation, self-efficacy and coping. He notes that the three components are vital to the long success of recovery and are valuable elements to address in any program seeking to prolong relapse prevention and abstinence. Motivation Johnson (170) states that one’s motivation can help in relapse prevention. He notes that evidence exist that shows that motivation for change coupled with treatment outcome expectancy and an individual’s goals of abstinence are related to outcome of treatments. A study reveals that motivation at the beginning of treatment and interventions and attitudes that people bring into treatments are related to the outcome of drug use and drinking, as well as long-term success (Witkiewitz and Marlatt 301). Moreover, those who enter treatment after making a decision to change and effort toward the realization of the change have a better prognosis when compared to individuals who enter treatment before making such a decision. A study also shows that those who are committed and make tireless efforts toward changing addiction behaviors have high chances of succeeding. Consequently, a study reveals that relapse prevention is less effective for those people who have low initial readiness towards ending addictive behaviors. This explains the reason why they leave the behavior for sometime and then later return to it. Self-Efficacy Bandura terms self-efficacy as the degree to which a person feels confident and able to carry out a certain behavior under a given situation (Johnson 171). He also argues that self-evaluation of an individual’s confidence to remain teetotal has been found to be associated with lower relapse rate for both women and men, inpatient and outpatient environments as well as for shot and long-term follow-ups (Witkiewitz and Marlatt 306). A number of studies have found that deficit in self-efficacy is a significant predictor of relapse. Additionally, the longer an individual abstains the stronger will be their self-efficacy and sense of personal control. In connection to this, higher levels of self-efficacy have been found to be predictive of improved treatment of alcohol in different contexts. Coping Many studies are in support of the relationship between coping and relapse prevention. In this case, individuals who are not in a position to use coping response during a crisis have been found to be more likely relapse (Johnson 771). Two theories have been developed to explain coping response: the focus of coping and the methods of coping. In respect of the theories, there exist a difference between active and avoidant coping. Johnson (771) notes that strategies regarding coping are those oriented towards the actual problem while avoidant coping strategies depends on avoidance of the problem. He notes that active avoidance is effective especially when a person has some degree of control over the situation. On the other hand, avoidant strategies are more useful especially when an individual is dealing with a situation or event in which there is very little or no control at all (Witkiewitz and Marlatt 308). Cognitive Strategies for Relapse Prevention Johnson (775) reveals quite a number of cognitive strategies that can be used to prevent relapse. More than often, relapse in is precipitated by external cues as well as self-statements and the interpretations within the individual especially when faced with a high-risk situation. Johnson argues that cognitive strategies are premeditated to challenge and alter the way an individual disseminates information and self-statements that are problematic and undermines efficacy and coping. Cognitive strategies in this case include relapse rehearsal, restructuring, detachment and labeling as well as coping imagery (Marlatt and Donovan 227). Cognitive Restructuring Johnson (775)argues that cognitive restructuring is the process of correcting addiction related distortions of cognitive and frequent thinking patterns such as seeming irrelevant decisions and violation effects of abstinence. Seemingly irrelevant decisions are those that are not inherently related to actual use of substance but can put clients in high-risk situations. Johnson (775) uses an example in which a client takes a car to be repaired next to a bar in which he is fond of drinking. In this case, he suggests that doing so may prompt the person to go in with the intention of seeing their friend in the bar in question as a way of alleviating boredom as he waits for his car to be repaired. Cognitive intervention goals are aimed at assisting individuals prevent the making of decisions that seemingly irrelevant and may put an individual in harm’s way leading to a relapse (Marlatt and Donovan 230). In case clients feel that they have failed and feel a significant decrease in abstinence self-efficacy after relapse, more than often they would go back to using much of the substance the same way they were used to instead of attempting to regain abstinence. Based on this fact, it is important to place the lapse in a good standpoint for the clients to be able to return to the process of recovery instead of returning to their prior behaviors (Witkiewitz and Marlatt 299). In this regard, recovery from a drawback seems to call for lapse interpretation and attribution as caused by environmental factors or external, an individual’s continuous commitment to change, reactivation of active coping, and confidence in the ability to recover from a lapse so as to be able to manage or avoid the trigger of negative cues or situations. Relapse Rehearsal Johnson (775) argues that relapse rehearsal is a means of linking the coping skills acquired during treatment with a predicament situation. He suggests that by imagining a predicament and using coping skills that are effective to abstain from substance use, a client will be able to prepare for a number of risky situations and determine the expected efficacy regarding different coping strategies. Labeling and Detachment Johnson (775)notes that labeling and detachment are coping strategies geared toward helping clients experience cravings and urges without falling prey to them. The strategies usually reframe cravings as a non-permanent sensation of want and, therefore, can end after sometime as opposed to compulsions which dictate the behaviors of clients. Johnson notes that helping clients perceive cravings as something triggered by environmental cues and not from within themselves can reduce the subjective strength brought about by them. Other coping strategies that may be used in managing cravings include thinking of the benefits of not using a substance, recalling negative consequences, thinking of stopping, getting support from others, delaying a decision to use or not to use a substance and distraction. Johnson (775) notes that coping imagery is another cognitive technique that may be applied in combating risky situations. This involves the use of guided fantasy, therapy or personal imagery that is capable of boosting an individual’s self-efficacy to abate relapse. In conclusion, it evident that once an individual has become addicted to a particular drug or substance, ceasing it is not that rosy. This is shown by the numerous studies that have shown that in most circumstances, addicted persons will leave the substance for some time and then use it again. This is what is termed as relapse. According to Johnson, among all the drug addicts who seek medical treatments in order to change their addictive behaviors, over 50% percent return to the same behavior after some time. This, therefore, calls for the institution of relapse prevention programs in an attempt to help these individuals abstain from using such addictive substances. Work Cited Fisher, Gary L., & Harrison, Thomas C. Substance Abuse: Information for School Counselors, Social workers, Therapists and Counselors. New York: Pearson College division. 2012 Print. Johnson, Bankole A. Addiction Medicine: Science and Practice (Vol. 1). Virginia: Springer. 2010 Print. Marlatt, Allan & Donovan, Dennis Relapse Prevention: Maintenance Strategies in the Treatment of addictive Behaviors, (Second Edition). Gilford Press. 2007 Print. Witkiewitz, Katie, & Marlatt, Allan. Therapist's Guide to Evidence-Based Relapse Prevention. London: Academic Press. 2007 Print. Read More