Relapse Prevention Over Time
For individuals in the U.S. & U.S. territories
In Relapse Prevention Over Time, G. Alan Marlatt demonstrates his approach to helping clients with substance addictions prevent or cope with relapses during efforts to change addictive behavior. Relapse prevention is a cognitive–behavioral, "maintenance stage" approach taken only after a client commits to either abstinence or moderation, and it is usually used in conjunction with or following clients' participation in another treatment program.
In this series of six sessions, Dr. Marlatt works with a man in his 30s who is striving to overcome a cocaine addiction. During these six sessions, Dr. Marlatt helps the client determine high-risk situations and potential triggers for relapse and teaches skills for getting through these situations. Together they work to restructure the guilt and shame that arise after lapses in abstinence. This compassionate intervention effectively reframes relapse as a mistake to learn from—and avoid—as the client moves toward recovery.
Relapse prevention (RP) is a cognitive–behavioral treatment (CBT) intervention designed to prevent or cope with relapse for clients who are committed to changing their addictive behavior, either by pursuing abstinence or moderation as a treatment goal. In terms of the "Stages of Change" model of behavior change, RP is often described as a maintenance stage approach once the client's initial commitment to change has been established. RP has two main goals:
- To help clients prevent the occurrence of relapse
- To help clients who have experienced relapse to get "back on track" on the road to recovery
The first goal of RP is to identify the client's high-risk situations or potential triggers for relapse. Assessment methods are used to pinpoint high-risk situations such as negative emotional states, social pressure, or interpersonal conflict.
RP intervention strategies include both cognitive and behavioral coping skills that are matched to the client's profile of potential triggers.
Cognitive intervention strategies include assessment and modification of unrealistic outcome expectancies for the initial effects of engaging in the addictive behavior (to counter the demand for immediate gratification), strengthening the client's confidence or self-efficacy in their ability to successfully cope with high-risk situations, developing cognitive imagery designed to help the client identify and manage craving and urges (e.g., "urge surfing"), and practicing mindfulness of thoughts and feelings that may be related to risk of relapse.
Behavior intervention strategies include avoidance or escape from trigger situations, including exposure to environmental cues that may trigger craving or cue reactivity related to urges to use. For social pressure situations, clients are taught effective communication skills to resist the pressure, rather than relying on will power alone (strengthening "skillpower"). Behavioral interventions such as exercise, relaxation and establishing a balanced lifestyle are also offered as stress-reduction techniques, particularly for clients who are at risk for relapse related to a desire for self-medication to cope with negative affect.
The second goal of RP is to help clients who are experiencing setbacks or relapse episodes during treatment. The therapist works with the client to restructure the guilt and shame that often arise following lapses (coping with the "Abstinence Violation Effect") so as to reframe the lapse as a mistake or error in the recovery process, an event that can be learned from in the process of recovery. Relapse management is designed to keep the client working on change, rather than giving up or dropping out when setbacks occur.
The therapist style in RP is based on a client-centered approach, with acceptance of the client based on a compassionate relationship (vs. a confrontational or judgmental approach). The therapist's role is that of an understanding and helpful ally or guide to work with the client in the pursuit of his or her own treatment goals.
In RP, the typical client is someone who is committed to either abstinence or a harm-reduction goal of moderation. Often this client is faced with co-occurring mental health and addictive behavior problems (e.g., a woman who has alcohol problems because she drinks as an attempt to cope with severe episodes of depression). Many clients come to RP after they have completed an initial treatment program (e.g., residential or intensive outpatient therapy). The therapist provides an integrative approach to working with dual disorder clients. Other clients come to RP because other treatment approaches (e.g., 12-Step groups) are not working for them and they prefer a more individualized treatment approach.
G. Alan Marlatt, PhD, is a professor of psychology and director of the Addictive Behaviors Research Center at the University of Washington, Seattle. He received his doctorate in clinical psychology from Indiana University in 1968. After serving on the faculties of the University of British Columbia (1968–1969) and the University of Wisconsin (1969–1972), he joined the University of Washington faculty in the fall of 1972.
His major focus in both research and clinical work is the field of addictive behaviors. In addition to over 200 journal articles and book chapters, he has published several books in the addictions field, including Relapse Prevention (1985), Assessment of Addictive Behaviors (1988), Harm Reduction (1998), and Brief Alcohol Screening and Intervention for College Students (BASICS): A Harm Reduction Approach (1999).
Over the past 30 years, he has received continuous funding for his research from a variety of agencies including the National Institute on Alcohol Abuse and Alcoholism, the National Institute on Drug Abuse, the Alcoholic Beverage Medical Research Foundation, and the Robert Wood Johnson Foundation.
Dr. Marlatt received the Jellinek Memorial Award for outstanding contributions to knowledge in the field of alcohol studies in 1990, the Innovators in Combating Substance Abuse Award by the Robert Wood Johnson Foundation in 2001, and the Distinguished Research Award from the Research Society on Alcoholism in 2004.
- Daley, D. C., & Marlatt, G. A. (2006). Overcoming your alcohol or drug problem: Therapist guide (2nd ed). New York: Oxford Press.
- Daley, D. C., & Marlatt, G. A. (2006). Overcoming your alcohol or drug problem: Client workbook (2nd ed.). New York: Oxford Press.
- Daley, D. C., & Marlatt, G. A. (2004). Relapse prevention. In J. H. Lowinson, P. Ruiz, R. B. Millman, J. G. Langrod (Eds.). Substance abuse: A comprehensive textbook (4th ed.). New York: Lippincott Williams & Wilkins.
- Dimeff, L. A., Baer, J. S., Kivlahan, D. R., & Marlatt, G. A. (1999). Brief alcohol screening and intervention for college students (BASICS): A harm reduction approach. New York: The Guilford Press.
- Donovan, D. M., & Marlatt, G. A. (Eds.). (2005). Assessment of addictive behaviors (2nd ed.). New York: Guilford Press.
- Laws, D. R., Hudson, S. M., & Ward, T. (2000). Remaking relapse prevention with sex offenders: A sourcebook. Newbury Park, CA: Sage Publications.
- Larimer, M. E., Palmer, R. S., & Marlatt, G. A. (1999). Relapse prevention: Overview of Marlatt's cognitive–behavioral model. Alcohol Research and Health, 23(2), 151–160.
- Marlatt, G. A., & Donovan, D. M. (Eds.). (2005). Relapse prevention: Maintenance strategies in the treatment of addictive behaviors (2nd ed.). New York: Guilford Press.
- Marlatt, G. A., & Witkiewitz, K. (2005). Relapse prevention for alcohol and drug problems. In G. A. Marlatt & D. M. Donovan (Eds.), Relapse prevention: Maintenance strategies in the treatment of addictive behaviors. New York: Guilford Press.
- Parks, G. A., & Marlatt, G. A. (1999). Keeping "what works" working: Cognitive–behavioral relapse prevention therapy with substance abusing offenders. In E. J. Latessa (Ed.), Strategic solutions: The International Community Corrections Association examines substance abuse. Lanham, MD: American Correctional Association.
- Parks, G. A., Anderson, B. K., & Marlatt, G. A. (2004). Relapse prevention therapy. In N. Heather & T. Stockwell (Eds.), The essential handbook of treatment and prevention of alcohol problems. West Sussex, England: John Wiley & Sons, Ltd.
- Witkiewitz, K., & Marlatt, G. A. (2007). Therapist's guide to evidence-based relapse prevention. New York: Elsevier.
- Witkiewitz, K., Marlatt, G. A., & Walker, D. D. (2005). Mindfulness-based relapse prevention for alcohol use disorders: The meditative tortoise wins the race. Journal of Cognitive Psychotherapy, 19 (3), 221–228.
- Witkiewitz, K., & Marlatt, G. A. (2004). Relapse prevention for alcohol and drug problems: That was Zen, this is Tao. American Psychologist, 59 (4), 224–235.
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