Clinical practice in Addiction. Tulane School of Social Work

1. Relapse Prevention as an
Intervention
Marc M. Tittlebaum
SOWK 7365: Clinical Practice in Addiction
Dr. Parker Robinson
2/7/22

3. Relapse Prevention
(RP)
• a tertiary intervention strategy for
reducing the likelihood and severity of
relapse
• RP model provides a conceptual
framework for understanding relapse and
a set of treatment strategies

4. Defining and
Conceptualizing
Relapse
May be defined according to the
individual’s goals for change.
A treatment program that identifies any
drinking behavior such as one drink after
a period of abstinence as a relapse, it is
more probable for him or her to engage
in heavier drinking behavior

5. Relapse continued
• • If slip is not considered a full relapse, then it
is more probable for them have an increased
awareness of their reactions to drinking and
therefore they may be less vulnerable to a full
on relapse involving heavy use or drinking
• Abstinence Violation Effect.

6. AVE is a form of black and white
thinking. Individuals blame
themselves based on internal factors
they believe are out of their control.
Sensing defeat, they stop trying.

7. The traditional view is to conceptualize
relapse as an end-state, a negative
outcome equivalent to treatment failure.
Dichotomous treatment outcome—
either abstinent or relapsed.
RP uses social-cognitive or behavioral
theories to frame relapse as a
transitional process

8. Marlatt’s Creation
• Alan Marlatt was the pioneer that really
challenged the notion that addictions were
incurable
• Marlatt, along with Dr. Judith Gordon, created
the Relapse Prevention Model (RP)
• This model is based on social-cognitive
psychology and incorporates both the conceptual
model of relapse and a set of cognitive and
behavioral strategies to prevent or limit relapse
episodes

9. HIGH RISK
SITUATIONS
High-Risk Situations are a key concept in
RP. This is what is commonly called a
trigger or a person place or thing.
High-risk situations serve as the
immediate precipitators of initial alcohol
use after abstinence i.e. a Relapse
RP suggest that during treatment one
should begin to experience increased
self-efficacy .

10. • RP model suggests that:
• both immediate determinants, including not only
the triggers or high-risk situations, but also coping
skills, outcome expectancies, and the abstinence
violation effect; and
• covert antecedents such as lifestyle factors and
urges and cravings contribute to relapse.
• The former – Figure 1
• The latter –Figure 2

12. Covert Antecedent
The portion of RP involves a
holistic view and states that
lifestyle balance is an important
aspect of prevention.
If stressors are not balanced by
sufficient stress management
strategies, one is more likely to
use alcohol to gain some relief.
This reaction develops into
cravings and urges.

14. Techniques and Strategies
Identifying and coping with high-risk situations, enhancing self-efficacy,
eliminating myths and placebo effects,lapse management, and cognitive
restructuring—is to teach clients to anticipate the possibility of relapse and
to recognize and cope with high-risk situations.
Focus on enhancing the client’s awareness of cognitive, emotional, and
behavioral reactions in order to prevent relapse

15. In the RP model, one is to become an objective observer of own behavior.
In developing a sense of objectivity, the client is better able to view use as an addictive
behavior and may be more able to accept greater responsibility both for the drinking
behavior and for the effort to change that behavior.
Predetermined plan to response stimuli.
Placebo effect addressed through self identifying behavior, i.e. look at the facts as they
relate to you the user.
Lapse-management strategies (like contracts etc.) focus on halting the relapse and
combating the abstinence violation effect to prevent an uncontrolled relapse episode.

16. Take Away
• The classification of relapse determinants and
high-risk situations proposed in the RP model, has led
to the evolution of many treatment components, that
have been developed that are aimed at helping the
recovering alcoholic cope with high-risk situations. In
other words, it has become the foundation for the
treatment of substance abuse with regard to relapse
and recovery.

17. References
Bowen, S., Witkiewitz, K., Clifasefi, S. L., Grow, J., Chawla, N., Hsu, S. H., Carroll, H. A.,
Harrop, E., Collins, S. E., Lustyk, M. K., & Larimer, M. E. (2014). Relative efficacy of
mindfulness-based relapse prevention, standard relapse prevention, and treatment as
usual for substance use disorders: A randomized clinical trial. JAMA Psychiatry, 71(5),
547-556. doi:10.1001/jamapsychiatry.2013.4546
Hendershot, C.S., Witkiewitz, K., George, W.H. et al. Relapse prevention for addictive
behaviors. Subst Abuse Treat Prev Policy 6, 17 (2011). https://doi.org/10.1186/1747-597X-6-
17
Larimer, M.E., Palmer, R.S., & Marlatt, G.A. (1999). Relapse Prevention: An Overview of
Marlatt’s Cognitive-Behavioral Model. Alcohol Research & Health, 23, 151-160.
Rawson, R. A., Obert, J. L., McCann, M. J., & Marinelli-Casey, P. (1993). Relapse prevention
models for substance abuse treatment. Psychotherapy: Theory, Research, Practice, Training,
30(2), 284–298. https://doi.org/10.1037/0033-3204.30.2.284