Module 14 Relapse Prevention Objectives To recognise that
Module 14: Relapse Prevention
Objectives • To recognise that maintaining change is difficult • To be able to identify things that help maintain change • To be able to identify what things trigger relapse • To be able to help someone develop a contingency plan
Dual Diagnosis Capabilities
Transtheoretical Model Osher and Kofoed’s Four Stages Precontemplation Engagement/early persuasion Contemplation Early persuasion Preparation Late persuasion Active Treatment Maintenance Relapse prevention
Relapse Prevention • Not experienced negative consequences of substances for 6 months • Maintaining abstinence (maintaining change)
Relapse Prevention • Increased vulnerability as people are trying to cope without substances (or with reduced supply) and, for some people, being drug free means that their mental health problems may escalate. • Building on lifestyle changes that support stability in both mental health and substance use problems. – – Housing Work Activity Supportive peer groups • Relapse can’t be prevented, but risks of lapse can be minimised. • Interventions aim to equip the person with: – – an awareness of their own personal triggers to lapse. appropriate skills (e. g. assertiveness training) contingency strategies to cope with such triggers. Self help groups.
Interventions For Relapse Prevention Stage • • • Supported or independent employment Independent housing Family problem solving Self help Peer support groups Social skills training
Marlatt & Gordon Model of Relapse Prevention Coping response Decreased probability of relapse Increased self-efficacy High-risk situation Decreased self-efficacy No coping response Slip Positive outcome expectancy of behaviour Rule Violation Effect – dissonance, conflict & self -attribution – guilt & perceived loss of control Increased probability of relapse
Marlatt & Gordon Model “Thanks but I have stopped smoking” Decreased probability of relapse Increased self-efficacy Going to pub, friend offers a cigarette “Oh go on then, I’ve had a bad day” Decreased self-efficacy. I am too weak to resist and anyway, I’m in a really bad mood, this will cheer me up Slipsmokes Rule Violation Effect – I am hopeless, I promised I would never smoke again. Might as well go an get a packet- I’ll never be able to give up! Increased probability of relapse
Risks for relapse • Lifestyle Imbalance – “shouldn’t > want to”, “duty vs. Pleasure” • Desire for Indulgence/ Feeling of Deprivation • Cravings & Urges • Rationalisation/ Justification • Seemingly Irrelevant Decisions – series of “minidecisions” that take a person into a High-Risk Situation • High-Risk Situation – “downers”, “rows” and “join the club”
Exercise 1: Your relapses • • • Discuss in pairs: (10 minutes) Think about a behaviour you changed, that you relapsed back into (e. g. stopping smoking, starting regular exercise etc) What triggered the relapse? How did you feel about the relapse? What happened as a result? How did other people react to your relapse?
Relapse and Dual Diagnosis • Relapse is highly likely • Change is very hard to maintain due to complexity of problems • Workers need to remain positive when lapses occur (Therapeutic optimism) • Help person to think about why it happened and what could help in the future
Exercise 2: Relapse for people with dual diagnosis • Make two lists of things that: – trigger relapse in people with dual diagnosis – things that help prevent relapse • What do you and your service offer in terms of relapse prevention work, or who would you refer to for this?
Factors Associated with Recovery Positive factors: • Social support networks • Stable living situation • Safe, structured environment • Sense of purpose – job/hobbies • Therapeutic discussion • Practical help • Insight & awareness • Physical well-being • Medication (maximum effectiveness, minimal inconvenience and side-effects • Hope Negative factors: • Difficulties with any of the +ve factors • Excessive stress • Interpersonal conflict • Substance use • Persistent symptoms
Further Reading • Marlatt GA & Gordon JR (1985) Relapse Prevention: Maintenance Strategies in the Treatment of Addictive Behaviours Guilford Press, New York • Miller WR (1996) What is a relapse? Fifty ways to leave the wagon Addiction 91 Supplement, S 15 -S 27 • Rassool GH (1998) Substance Use and Misuse – Nature, Context and Clinical Interventions Blackwell Science, Oxford • Wanigaratne S, Wallace W, Pullin J, Keaney F & Farmer R (1990) Relapse Prevention for Addictive Behaviours – A Manual for Therapists Blackwell Science, Oxford
- Slides: 15