Cessation of Smoking of Adolescents through Implementation of Congnitive Behavioral Model of Relapse Process - Coursework Example

CESSATION OF SMOKING OF ADOLESCENTS THROUGH IMPLEMENTATION OF CONGNITIVE BEHAVIORAL MODEL OF RELAPSE PROCESS Introduction to Cognitive-Behavioral Model of the Relapse Process This Cognitive-Behavioral Model of the Relapse Process represents an influential method of coping with antecedents of relapse and measures of treatment that are taken to prevent or reduce the relapse of patients after treatment completion. This model was developed by Marlatt and Gordon in 1985 and is now widely used in most cases of addiction, especially among youngsters. Relapse Prevention Therapy (RPT) was constructed as a prevention program and a treatment for addictive behaviors Miller, 2004). RPT is a behavioral self-restraint program designed to help individuals who intend to implement this and change their behavior. This theoretical model helps to cope with relapse problems. Rationale: Cognitive-Behavioral Model of the Relapse Process can prove to be helpful in the treatment of preventing adolescents from smoking. The Relapse Process [RP] Model suggested by Marlatt and Gordon advocates that both immediate determinants and covert antecedents may contribute to relapse. This model also includes intervention strategies where the therapist and clients are allowed to talk about every step of the relapse process. Sometimes it includes recognizing certain high-risk situations for the client and enhances his skills in order to cope with those kinds of delicate situations (Relapse Prevention: Theory and Practice, n.d.). The RP model also helps to increase the particular clients self-efficacy, breaking the myths regarding the effects of smoking, etc. The Cognitive Behavioral Model of Relapse Process enables to manage the sufferer’s lapses, restructure the sufferer’s perceptions about relapse processes. The RP Model can help the adolescents in growing positive and desirable addictions and utilize stimulus control techniques. Urge-management techniques are an important part of the Relapse Process model. It helps in development of relapse road maps (Larimer, Palmer, and Marlatt,1999; McCance-Katz and Clark, 2003; Caruthers and Deyell and Colleen, 2002). Cognitive-Behavioral Coping-Skills Therapy Cognitive-behavioral coping-skills training (CBST) is a treatment approach which aims at improving the addicted adolescents’ smoking behavior. It includes various kinds of treatment-oriented approaches that keep varying with situations. CBST is considered the most effective approach for treating patients suffering from addiction. "Cognitive-Behavioral Coping-Skills Therapy" (CBST) refers to a family of interconnected approaches of treatment for addiction problems and various other psychiatric disorders. This kind of theory aims at treating the patients by improving their cognitive and behavioral skills so as to change their problem creating behaviors. Recent studies have revealed that this model has been quite influential and effective is treating addiction world-wide. Since this therapy involves direct confrontation with addiction stimuli the addict learns to fight the actual cause of the problem. The relapse process can make the sufferer realize how vulnerable he is and how fast he lets his addiction consume him (Larimer, Palmer and Marlatt, 1999; Longabaugh and Morgenstern, 1999). The Process Marlatt and Gordons Relapse Process model is supported by the social-cognitive psychology and includes – 1] conceptual model of relapse 2] set of behavioral and cognitive strategies, for reduction and prevention of replaces amongst the patients. They key aspect of the RP model is taxonomy, the detailed classification of the factors or circumstances that can result in or contribute to the relapse episodes of the addicted person. As mentioned before, these main factors of contribution are classified into: (a) immediate determinants, and (b) covert antecedents. The immediate determinants can be – high risk situations, violation of abstinence and its effects, coping capabilities etc. The covert antecedents are – cravings, urges, lifestyle factors etc. Treatment approaches based on the RP model begins with an evaluation of the adolescent’s environmental and emotional features of situations that generally contribute to the relapse situations. These are called the high-risk situations. (Miller, 2004, p.156) After identifying these characteristics, the treatment is further advanced by analyzing the patient’s response to such situations. Sometimes a backward analysis is made by higher amount of exposure to his high-risk situations and factors. Careful examination of his relapse process can help in framing the strategies and devices to target his weaknesses in his cognitive and behavioral styles and in doing so, reduce the risk of relapse (Larimer, Palmer and Marlatt, 1999; Relapse Prevention: Theory and Practice, n.d.). Factors that cause Lapses in an Addict The RP model suggests that high-risk situations often act as the immediate and swift contributors of initial smoking after self-discipline. According to the model, when an adolescent has started exhibiting a change in his behavior, for instance, abstinence of smoking, he is supposed to begin realizing the increased and better effects of cessation of smoking and also increased self-efficacy over his own behavior. This should keep growing as he continues to maintain this behavioral change. However, it should be kept in mind that there are certain factors and circumstances that stimulate the patient to lose his sense of control. Such kinds of events and situations create a relapse crisis and thus, have to be avoided. Based on research, the factors leading to relapse among those who had received inpatient treatment, Marlatt classified those factors into interpersonal, emotional and environmental features (Larimer, Palmer and Marlatt, 1999). Anger, depression, frustration, rejection and boredom - such kind of negative mental states act as intrapersonal high-risk contributors. These emotional states can be caused due to many reasons like being detained in school, poor grades, being bullied by seniors, bad company of friends etc. As per Marlatt’s study, social pressure i.e. persuasion by friends, verbally or non-verbally, watching them smoke also contribute to more than 20% of relapses. Supportive and positive emotional state acquired during birthday celebrations, picnics, parties, sports and movies can support their acquired behavioral change towards self-restriction. Exposure to smoking-related stimuli, like watching advertisements, hanging out or dining at a hookah-bar, can be a test for one’s will power and sense of control. Such factors are also sometimes considered as high-risk contributors to relapses (Marlatt and Donovan, 2007) This model considers high-risk situations as the immediate relapse trigger. A persons controlled and coping behavior in such situation is particularly decisive determinant of the expected result. Thus, an adolescent who proves his self-efficacy to cope up with his smoking addiction by any means bears less chance to relapse. Moreover, those who have been successful in coping up with high-risk situations are expected to experience a greater sense of self-efficacy i.e., mastering his compulsion towards smoking addiction. This is considered to be a huge success, since adolescents have lesser control over impulse. Their age, addictions and environment compel them to lose their control (Basco and Rush, 2005). Research conducted among college students, shows that among those who smoke, most of them tend to have higher expectations about the positive effects regarding getting rid of alcohol and that too they expect immediate positive results. They ignore the potential consequences of excessive smoking (Larimer, Palmer and Marlatt, 1999, Lugate, 2009; Buri, Mogi, Giovanoli, and Strik 2007) On the other hand, a person might fail in implementing an effective self-restraint response when in exposure to a high-risk situation. Failure to master such high-risk situation is expected to create reduced self-effectiveness and a sense of being unsuccessful. In such a situation a lapse is more likely to happen. If a lapse occurs, abstinence violation effect (AVE) follows. This comprises of cognitive differences and the acknowledgment of responsibility for the lapse to the mental and stable characteristics of the individual. The AVE combined with the compelling and addictive effects of smoking, increases the possibilities of a full-blown relapse. (Larimer, Palmer and Marlatt, 1999) Program designing – solution for addicts Setting up Relapse Commonly it is observed in most of the relapse episodes that the first lapse precipitates during a high-risk situation, where generally clients might complain that they were unprepared to confront it. Often it is found that the addicted adolescents start coping with circumstances much rapidly than before. This happens because previously their determination to recover was lacking, but now they have come to a firm decision. Even after such a strong determination during the treatment it might be seen that the addicted people are themselves inclined towards relapse. This is because they cannot see and realize the warnings of the approaching situations. Cognitive distortions in the form of rejection and determination can make it easier for him to setup his own relapse episode. Setting up relapse can be governed by his covert antecedents that can create relapse-inducing situations and also allow the adolescent to keep in mind that he should be denying it. Relapse Preventing Strategies to be followed Relapse preventing strategies can be grouped into three categories – 1) Training to develop coping skills – training for coping skills shall include both behavioral and cognitive processes. 2) Cognitive Training – this training shall be done by cognitive therapy, which will provide means to change their habits while learning and experiencing both positive and negative results, as their mastery keeps developing. 3) Modifications in Lifestyle – this shall include knowledge acquiring, exercises, meditation etc. which will facilitate their abstinence. Under clinical practice, confronting capabilities and coping skills become the key factors to get rid of their addiction. The addicts need to be taught the following 1) Identify and adjust appropriately to high-risk situations 2) Perceive relapse as a process 3) Lapse control - confront individual urges and craving, 4) Minimizing negative consequences and effects after lapse 5) Continuing treatment after relapse 6) Having faith in treatment and self 7) Maintaining a balanced and improved lifestyle. Lapse Management – Despite treatment many clients committed to abstinence might experience a lapse after initial self-restraint. Lapse-management strategies shall focus on combating the recurrence of lapses. Lapse management shall include contacting therapist immediately after the lapse, and to assess the situation for the factors responsible for the lapse. Instructions provided by the therapist shall echo the necessity of preventing from further smoking. Lapse management will be presented as - "emergency preparedness" program for further improvement. Some clients might not need to use lapse-management strategy. Balanced lifestyle and desirable addiction are necessary steps in training effective self-management strategies. This evaluation can be achieved through approaches in which the addicts can self-monitor their daily activities. They can identify each activity as a “want”, "should," and blend of both. They can also evaluate the extent to which they perceive their stress factors to be balanced by delightful life events. Conclusion Even though particular involvement strategies can address the immediate factors of relapse, it is also essential that one modifies individual lifestyle system and covert antecedents that are capable of triggering addiction. Situations that can increase exposure or reduce resistance to high-risk factors should be avoided at the very point where they arise. Global self-control strategies are designed to modify lifestyle to “increase balance as well as to identify and cope with covert antecedents of relapse” (Larimer, Palmer and Marlatt, 1999, p.9). This abstention from lapse episodes can help in reducing their tendency to perceive lapses as a consequence of personal failure and mental weakness. This can eradicate the belief that a lapse will surely lead to another relapse. Addiction is nothing but a psychological dependence on another object, which makes a person obsessed by it. Any sort of undesirable addiction should be treated immediately by adopting self-initiatives. References 1. Basco, M. R., and Rush, A. J. (2005), Cognitive-behavioral therapy for bipolar disorder, Guilford Press 2. Buri, C., Mogi, F., Giovanoli, A. and W. Strik (2007). PRESCRIPTION PROCEDURES IN MEDICATION FOR RELAPSE PREVENTION AFTER INPATIENT TREATMENT FOR ALCOHOL USE DISORDERS IN SWITZERLAND, Alcohol & Alcoholism Vol. 42, No. 4, pp. 333–339 3. Carruthers, Cynthia P., Deyell and H. Colleen (2002), Coping skills programs for individuals with alcoholism, Therapeutic Recreation Journal, vol. 34(2) pp.154-71 4. Larimer, ME, Palmer, RS and GA Marlatt (1999) Relapse Prevention: an Overview of Marlatts Cognitive-Behavioral Model, Alcohol Research & Health, Vol. 23, available at: http://thegoalgroup.co.uk/Documents/Relapse%20Prevention.pdf (accessed on December 7, 2009) 5. Lugate, J. (2009), Cognitive behavioral therapy and relapse prevention, Dec., Available at http://www.psychotherapybrownbag.com/psychotherapy_brown_bag_a/2009/12/cognitive-behavioral-therapy-and-relapse-prevention-december-2009-psychotherapy-brown-bag-featured-a.html (accessed on December 7, 2009) 6. Longabaugh. R. and Morgenstern, J. (1999), Cognitive-Behavioral Coping-Skills Therapy for Alcohol Dependence Current Status and Future Directions, Alcohol Research and Health, available at: http://pubs.niaaa.nih.gov/publications/arh23-2/078-85.pdf (accessed on December 7, 2009) 7. Marlatt, G. A., Donovan, D. M. (2007), Relapse Prevention: Maintenance Strategies in the Treatment of Addictive Behaviors, Guilford Press, 2007 8. McCance-Katz , E.F., Clark, W.H. (2003), Psychosocial Treatments: Volume 3 of Key readings in addiction psychiatry, London: Routledge 9. Miller, G. (2004) Learning the language of addiction counseling, New York: John Wiley and Sons 10. Relapse Prevention: Theory and Practice. (n.d.). Recovery RoadMap, available at: http://recoveryroadmap.com/BigList/RP-TheoryPractice.html (accessed on December 7, 2009) Read More