Efforts to develop, test and refine theoretical models are critical to enhancing the understanding and prevention of relapse [1,2,14]. A major development in this respect was the reformulation of Marlatt’s cognitive-behavioral relapse model to place greater emphasis on dynamic relapse processes [8]. Whereas most theories presume linear relationships among constructs, the reformulated model (Figure (Figure2)2) views relapse as a complex, nonlinear process in which various factors act jointly and interactively to affect relapse timing and severity. Similar to the original RP model, the dynamic model centers on the high-risk situation.
First, as we wanted to keep the generation of statements feasible and non-confusing for the participants, we formulated one focus statement in which the predictors of physical activity and dietary behavior were combined and no distinction between lapse and relapse was made. Although, based on the underlying statements, the majority of the indicated perceived predictors apply to both physical activity and dietary behavior, some of the perceived predictors were behavior specific. For example, ‘maladaptive abstinence violation effect coping skills’ was specifically aimed at dietary behavior, whereas ‘perceived weather barriers’ was specifically aimed at physical activity. Future research could further investigate potential differences between the predictors of relapse in physical activity and dietary behavior, and between lapse and relapse. Although high-risk situations can be conceptualized as the immediate determinants of relapse episodes, a number of less obvious factors also influence the relapse process.
4. Consequences of abstinence-only treatment
According to these models, the relative balance between controlled (explicit) and automatic (implicit) cognitive networks is influential in guiding drug-related decision making [54,55]. Dual process accounts of addictive behaviors [56,57] are likely to be useful for generating hypotheses about dynamic relapse processes and explaining variance in relapse, including episodes of sudden divergence from abstinence to relapse. Implicit cognitive processes are also being examined as an intervention target, with some potentially promising results [62]. In the first study to examine relapse in relation to phasic changes in SE [46], researchers reported results that appear consistent with the dynamic model of relapse.
Many who embark on addiction recovery see it in black-and-white, all-or-nothing terms. They see setbacks as failures because the accompanying disappointment sets off cascades of negative thinking and feeling, on top of the guilt and shame that most already feel about having succumbed to addiction. Nevertheless, the first and most important thing to know is that all hope is not lost.
Medical Director, Board Certified in Addiction Medicine
Our treatment options include detox, inpatient treatment, outpatient treatment, medication-assisted treatment options, and more. These patterns can be actively identified and corrected, helping participants avoid lapses before they occur and continue their recovery from substance use disorder. As a result, it’s important that those in recovery internalize this difference and establish the proper mental and behavioral framework to avoid relapse and continue moving forward even if lapses occur.
The dynamic model of relapse assumes that relapse can take the form of sudden and unexpected returns to the target behavior. This concurs not only with clinical observations, but also with contemporary learning models stipulating that recently modified behavior is inherently unstable and easily swayed by context [32]. While maintaining its footing in cognitive-behavioral theory, the revised model also draws from nonlinear dynamical systems theory (NDST) and catastrophe theory, both approaches for understanding the operation of complex systems [10,33]. Detailed discussions of relapse in relation to NDST and catastrophe theory are available elsewhere [10,31,34].
G Alan Marlatt
Even though you may think this time is different, if your drinking and drug use has gotten out of hand in the past, it is unlikely to be different now. The conscious thought may become that the only way you can cope with your current situation is by taking drugs or alcohol. Unconscious cravings may turn into the conscious thought that the drug or alcohol is all you need to cope. An individual who feels guilt often uses substances to ease their guilt, which can lead to AVE. Guilt is a difficult emotion for someone to bear, one that can constantly replay in their minds, leading them to use substances again.
- They may not recognize that stopping use of a substance is only the first step in recovery—what must come after that is building or rebuilding a life, one that is not focused around use.
- For example, in this study self-value and resilience received high importance ratings, but these are not reflected in current models.
- Although non-dieters ate less after consuming the milkshakes, presumably because they were full, dieters paradoxically ate more after having the milkshake (Figure 1a).
- The client is taught not to struggle against the wave or give in to it, thereby being “swept away” or “drowned” by the sensation, but to imagine “riding the wave” on a surf board.
- These individuals also experience negative emotions similar to those experienced by the abstinence violators and may also drink more to cope with these negative emotions.
So long as an individual maintains a perceived sense of self-control, he/she has a better chance at evading further lapses. AVE has been studied and supported for the cessation of sex offenses, heroin, marijuana, and other illicit drug use. What is more, negative feelings can create a negative mindset that erodes resolve and motivation for change and casts the challenge of recovery as overwhelming, inducing hopelessness. A relapse or even a lapse might be interpreted as proof that a person doesn’t have what it takes to leave addiction behind.
Many clients report that activities they once found pleasurable (e.g., hobbies and social interactions with family and friends) have gradually been replaced by drinking as a source of entertainment and gratification. Therefore, one global self-management strategy involves encouraging clients to pursue again those previously satisfying, non-drinking recreational activities. In addition, specific cognitive-behavioral skills training approaches, such as relaxation training, stress-management, and time management, can be used to help clients achieve greater lifestyle balance. The second strategy, which is possibly the most important aspect of RP, involves evaluating the client’s existing motivation and ability to cope with specific high-risk situations and then helping the client learn more effective coping skills.
- Combinations of precipitating and predisposing risk factors are innumerable for any particular individual and may create a complex system in which the probability of relapse is greatly increased.
- One of the most common mistakes addicts make is focusing on whether they are strong enough to change rather than on specific methods of coping.
- Marlatt’s work inspired the development of multiple nonabstinence treatment models, including harm reduction psychotherapy (Blume, 2012; Denning, 2000; Tatarsky, 2002).
- Cori’s key responsibilities include supervising financial operations, and daily financial reporting and account management.
- The first thing we must do after a relapse is check our thinking for signs of irrationality.
Testing the model’s components will require that researchers avail themselves of innovative assessment techniques (such as EMA) and pursue cross-disciplinary collaboration in order to integrate appropriate statistical methods. Irrespective of study design, greater integration of distal and proximal variables will aid in modeling the interplay of tonic and phasic influences on relapse outcomes. As was the case for Marlatt’s original RP model, efforts are needed to systematically evaluate specific theoretical components of the reformulated model [1]. The empirical literature on relapse in addictions has grown substantially over the past decade. Because the volume and scope of this work precludes an exhaustive review, the following section summarizes a select body of findings reflective of the literature and relevant to RP theory. The studies reviewed focus primarily on alcohol and tobacco cessation, however, it should be noted that RP principles have been applied to an increasing range of addictive behaviors [10,11].
Discussing the relapse can yield valuable advice on how to continue recovery without succumbing to the counterproductive feelings of shame or self-pity. Typically, those recovering from addiction are filled with feelings of guilt and shame, two powerful negative emotions. Guilt reflects feelings of responsibility or remorse for actions that negatively affect others; shame reflects deeply painful feelings of self-unworthiness, arising from the belief that one is inherently flawed in some way.
- This relapse prevention (RP) model, which was developed by Marlatt and Gordon (1985) and which has been widely used in recent years, has been the focus of considerable research.
- Those who break sobriety with a single drink or use of a drug are at a high risk of a full relapse into addiction.
- However, it’s important to recognize that no one gets through life without emotional pain.
- This process may lead to a relapse setup or increase the client’s vulnerability to unanticipated high-risk situations.