Foundations of Addictions Counseling, 3/E David Capuzzi & Mark D. Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Chapter 13 Maintenance and Relapse Prevention Updated by Melinda Haley, Walden University

Relapse Prevention for Addictive Behaviors Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Relapse: Return of disease after full or partial recovery Rates of relapse Difficult to determine 90% of alcoholics return to drinking within 4-year period 40-60% relapse for drug addiction Relapse defined differently by different treatment approaches

Relapse vs. Lapse Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Lapse Modest breach of agreed goals Can be a learning experience Relapse A more serious violation of treatment goals, learning is not evident Relapse Prevention A range of therapeutic methods applied to a range of behaviors

Relapse Prevention (RP) Model Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Relapse is complex and multidimensional Counselor must understand factors leading to abstinence or relapse  Intrapersonal  Self-efficacy  Outcome expectancies  Craving  Level of motivation  Coping ability  Emotional states  Interpersonal  Social support

Preventing Lapses or Relapses Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Lapses or relapses more likely immediately after treatment Plan for common issues 1. High risk situations 2. Seemingly irrelevant decisions 3. Abstinence violation effect

High Risk Situations (HRS) Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Identify client’s particular HRS Frequent HRSs Frustration and anger Emotional “highs” Interpersonal conflict Easily used to blame others Social pressures Subtle and pervasive in Western society Once identified they can be easily managed

Specific Coping Strategies for High Risk Situations Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Plan ahead Must be considered, planned, and implemented Begins with brainstorming Which strategies to use Multiple methods of stress relief Rehearse alternative responses to drinking Identify strengths and resources

Seemingly Irrelevant Decisions Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Also known as “Setups” Decisions that may seem irrelevant at the time but often lead to relapse Thought processes/thinking errors and psychological traps Multimodal treatment and 12-step attendance offers the best chance for long term recovery and abstinence Help to catch thinking errors Others experience same “traps”

The Abstinence Violation Effect (AVE) Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Psychological Trap Temptation to break rules once set Minor violations seem to justify major ones (already failed) Coping strategies can prevent the progression Does AA’s message of powerlessness make relapse after a single drink an inevitability? Self- fulfilling prophecy?

Lifestyle Change Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Restoring balance to life – work/leisure Balancing “shoulds” and “wants”

Developing a Management Plan Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Stabilization plan Assessment Relapse education Identify warming signs Identify problem solving strategies Recovery planning Inventory training Family involvement Follow up

Case Study of Relapse Prevention Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Thomas, 27-year old male Married, father of 2-year old daughter Employed as salesman Cannot keep a job Frequent angry outbursts Anxiety attacks Considering suicide Long time drinker/case of beer daily

Case Study:Recovery Phase Begins Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Anti-depressant and anti-anxiety medications Withdrawal and stabilization Identify HRS’s and self-monitor Develop coping strategies Education about lapse and relapses Therapeutic contract/time out for relapse Reminder cards

Case Study: Support Systems Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Involvement of family Marital relationship System of non-using friends Social modeling Disengaging from using friends

Case Study: Other Lifestyle Changes Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Change unhealthy environments Body awareness techniques Confront relapse possibilities Job/major stressor Financial Strains

Final Points to Remember Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Pacing is important Don’t overwhelm client with too many interventions at once Set realistic goals Go slow Balance “shoulds” with pleasure

Useful Web Sites Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved About.com: Alcoholism & Substance Abuse evention.htm evention.htm Information for Individuals and Families