Rehab 4 Addiction

Addiction is defined as a person who has lost control of how they use a substance.

The person will continually relapse despite the knowledge of how chronic their condition is and its serious negative consequences.

Fisher and Harrison (2009) defined relapse as a process of parts:

  • Slip – This is where a person has been abstinent and has a slip. The act is so small the person doesn’t feel bad about it and will return to abstinence immediately. This might be, for instance, accepting a line of cocaine from a friend without thinking about it.
  • Lapse – A lapse is where the person uses the substance after having been abstinent. They’ll drink or take more of the substance than what is defined as a slip, but will return to abstinence. This might be an evening where a person uses cocaine but stops again the day after.
  • Relapse – This is where a person has been abstinent for a while and begins using the substance again in an uncontrolled way. Use usually returns to the same severity as before any treatment began.

What is relapse prevention?

Relapse prevention is defined by all the methods used in treatment programmes that support the person not to relapse.

A huge part of this is supporting each person to view any substance use after a period of abstinence as something that can be learnt from (rather than a negative event).

Many people define a slip or lapse as a relapse. When this happens, they might really beat themselves up about it.

This isn’t helpful. In fact, some people might then go into a full relapse because they feel they’ve already messed up beyond repair. This is untrue.

Using terms like “slip” and “lapse” is much more helpful for people in recovery. It helps to define the moment in a helpful light that can be moved on from.

What is recovery?

Recovery

Recovery is where a person has become abstinent and has changed the focus of their lives away from substances towards being healthy in all areas. Recovery focuses on the physical, mental, emotional, and spiritual parts of a person.

People will often develop new hobbies and interests in order to support abstinence and self-development. Recovery is a life-long lifestyle.

The 4 Relapse Prevention theories

Four Theories

1. Marlatt’s Model (1996)

This is a model of two levels:

  1. Immediate high-risk situations and the person’s reactions to them.
  2. Interactions with other people and high-risk situations.

This theory indicates that where a person has developed healthy coping skills, they have more chances of remaining abstinent. Using substances is a coping strategy.

Quitting a substance is highly stressful. During stressful moments an addicted person would usually turn to the substance. This is why healthy coping strategies are critical.

A person who has developed healthy coping strategies and is able to use them in high-risk situations becomes more confident in their ability to maintain abstinence. This increases the chances of a successful recovery overall.

A person without healthy coping mechanisms is much more likely to relapse. This is because they’re less equipped.

They don’t have any other coping mechanism in place other than the substance to turn to. This lowers a person’s self-belief in being able to maintain sobriety.

Additionally, where a person feels they have “failed” the “rules” they’re trying to follow to remain sober and have lapsed, relapse is more likely.

This is especially so where people believe their addiction is linked to who they are (rather than it begin caused by a reaction to trauma, for instance).

Another part of relapse is related to high-risk situations. People in recovery might become stressed by what they feel they “should” do and what they “want” to do.

This stress makes the desire for the substance, the (unhealthy) coping mechanism, increase.

In summary:

The following factors increase chances of relapse:

  • Exposure to high-risk situations.
  • Lack of healthy coping strategies.
  • How a person expects their recovery to go.
  • The person feels as though they’ve lost control of rules they’ve put in place (known as abstinence violation effect).
  • Cravings and other unhealthy lifestyle behaviours.

Marlatt et all (2002) outlined two different types of triggers and lifestyle influences that lead to relapse:

  1. Intrapersonal-environmental – how a person copes with emotional and physiological states and cravings.
  2. Interpersonal – how a person responds to what they feel is external pressure to use and also how they respond to positive emotions.

2. Dynamic Model of Relapse, Witkiewitz & Marlatt (2004)

This model focuses on behaviour and the factors that influence it. It’s a model that presents relapse as the whole picture.

There are two types of risk factors substance users’ experience:

  1. Distal risks would be an underlying risk factor such as a genetic predisposition to develop an addiction.
  2. Proximal risks are immediately stressful situations that increase the chances of use. This might be the loss of a loved one or a person’s belief that they’re unable to recover.

This theory considers all the risks that can contribute to a relapse occurring.

They’re completely unique to each individual. Each risk factor can, of course, exacerbate and increase the risk of others occurring.

For instance, where a person is depressed, they might drink alcohol to ease the low mood, but the effects of drinking also lower mood.

The following six areas can help predict how likely it is that a person will relapse:

  • Cognitive functioning – this includes how a person perceives themselves and their ability to cope and recover. It includes a commitment to abstinence, how a person feels about their future, and how the person experiences cravings.
  • Coping strategies – if a person has healthy coping mechanisms to replace that of substance use, they’re more likely to remain sober.
  • Distal risks – this might be a genetic predisposition or a family history of addiction. These types of factors affect the brain and how a person thinks as well as how a person experiences withdrawal.
  • Perceived effects – some people might use substances as they feel it helps with other issues. If a person thinks a substance eases feelings of low mood better than participating in a new hobby, then they’re more likely to return to the substance.
  • Phasic responses – these are where a person experiences a particular emotional or physiological state. They can arise from how a person thinks due to their cognitive functioning or how they cope with a situation.
  • Tonic responses – this is connected to how vulnerable a person is due to underlying factors. This includes their cognitive functioning, how they manage responses to triggers and experience withdrawal.

The Dynamic Model of Relapse identifies seven factors within the individual that influences relapse…

  1. A person’s emotional state.
  2. Distress tolerance. How much stress a person can tolerate.
  3. Craving.
  4. How much confidence and self-belief a person has that they can remain abstinent.
  5. Outcome expectations. How a person imagines their future in relation to addiction and quitting the substance.
  6. Coping and self-regulation. How a person responds to situations.
  7. The severity of substance use at the start of treatment.

What improves chances of recovery?

Chances of Recovery

Social support is identified as being hugely important in influencing a person’s ability to remain abstinent.

This includes connections to people who are supportive of the recovery journey (and those who aren’t in active addiction), including family members, friends, and 12 Step groups.

It’s imperative that these connections are healthy and positive in order to support the addicted person to recover.

3. Gorski’s CENAPS Model

This is a relapse prevention therapy model that was developed by a counsellor who was in addiction recovery themselves.

It was more accessible for addiction counsellors, especially those who hadn’t come from academic backgrounds but had instead ground-level experience.

Relapse is seen as being caused by brain and social dysfunction, as well as personality dysregulation.

Brain dysfunction is caused by substances that impair a person’s ability to think in a healthy way and to respond in an emotionally helpful way.

Addiction is treated as a disease through various counselling approaches. The cognitive, behavioural, and social aspects of the individual are approached. It has five goals:

  1. To understand what contributes to relapse, taking a holistic approach.
  2. Creating a list of signs that might lead to relapse.
  3. Developing strategies to cope with relapse.
  4. Creating a thorough recovery programme.
  5. Creating a plan of what to do should relapse occur.

The model uses cognitive behavioural approaches to support the person in identifying thoughts and feelings they have. This treatment is based on abstinence and focuses on emotions that have developed linked to unhelpful thinking patterns.

The CENAPS model of relapse prevention therapy consists of a treatment programme of at least six weeks. The programme includes individual counselling, group sessions, and educational sessions.

What creates a long-lasting recovery?

Long Lasting Recovery

This model proposes that abstinence along with lifestyle changes are essential for recovery to be successful and long-lasting.

Gorski’s stages of recovery

Gorski’s model outlines six stages of recovery including:

  • Transition – where the person acknowledges they have a problem and abstinence is a goal.
  • Stabilization – the withdrawal period.
  • Early recovery – the focus here is changing addictive functioning to thoughts, feelings, and behaviours that are linked to sobriety.
  • Middle recovery – includes repairing the damage that addiction has caused.
  • Late recovery – addressing issues from the past and family history that may have caused deep-rooted issues with substances.
  • Maintenance – ongoing abstinence within a treatment programme.

4. The Matrix Model

This is what is known as a neurobehavioral method within the treatment setting.

This means it addresses the processes occurring in the brain as well as behaviours being displayed. It was developed to treat people addicted to stimulants.

This model focuses on how a person goes through various stages of recovery.

The Matrix stages of recovery

There are five stages according to this model including:

  1. Withdrawal.
  2. Honeymoon.
  3. The Wall. This is where a person is most likely to relapse.
  4. Adjustment.
  5. Resolution.

It follows a six-month programme. After four weeks, people begin 90-minute group sessions which are focused on relapse prevention.

As a group, participants discuss issues that come up, feelings around this, and also address relapse prevention.

Counsellors support the addicted person to talk about a slip, lapse, or relapse as soon as possible after it happens.

This is done through discussion. The person shares what led to the substance use and then with the counsellor unpicks the various aspects as to how it happened.

There is a heavy focus on encouraging the person to see the substance use not as a failure, but as a learning aspect of recovery.

boris

Boris is our editor-in-chief at Rehab 4 Addiction. Boris is an addiction expert with more than 20 years in the field.  His expertise covers a broad of topics relating to addiction, rehab and recovery. Boris is an addiction therapist and assists in the alcohol detox and rehab process. Boris has been featured on a variety of websites, including the BBC, Verywell Mind and Healthline.