Relapse prevention: an Overview

However, sometimes that compassion has to be firm in order to communicate that, while the agency is willing to help the employee get assistance, the employee is ultimately responsible for his or her own rehabilitation, recovery, and performance. The Department of Transportation (DOT) has issued rules regarding alcohol testing for certain groups of employees such as those who are required to possess a Commercial Driver’s License, and certain employees in aviation-related positions. These rules call for mandatory alcohol testing, using EBTs, of applicants for identified positions and in cases of reasonable suspicion of alcohol use, and for random testing of employees in these positions. Any agencies conducting this type of testing will have a specific program spelled out in agency policy. After the employee’s return to duty, there will be some type of follow-up care such as a 12-Step program or other group meetings, therapy, EAP sessions, or any combination of the foregoing (please see the Appendix ).

• CBT implemented with success via phone to address fatigue and lack of activity in chronically ill people, dietary change, hiv.
• Real-time treatment for co-occurring issues and addictions is essential for recovery.
• Even if the EAP counselor is unable to see the employee immediately, EAP personnel should be informed of the situation.
• The groups incorporated direct instructions, modeling, behavioral rehearsal and coaching, both for the actual behavioral response (e.g., anger management) and the cognitive processes involved in selecting an effective coping response.
• Research on determinants of relapse began in the late 1970s, during a follow-up of a group of male alcoholic patients who were treated with aversion therapy while participating in a residential treatment program (Marlatt, 1978).
• The role of withdrawal symptoms—as a motivational factor—on relapse is another important consideration.

Coping is defined as the thoughts and behaviours used to manage the internal and external demands of situations that are appraised as stressful. A person who can execute effective coping strategies (e.g. a behavioural strategy, such as leaving the situation, or a cognitive strategy, such as positive self-talk) is less likely to relapse compared with a person lacking those skills. Moreover, people who have coped successfully with high-risk situations are assumed to experience a heightened sense of self-efficacy4. These covert antecedents include lifestyle factors, such as overall stress level, one’s temperament and personality, as well as cognitive factors. These may serve to set up a relapse, for example, using rationalization, denial, or a desire for immediate gratification.

Relapse

Further, there are reasons to presume a problem will re-emerge on returning to the old environment that elicited and maintained the problem behaviour; for instance, forgetting the skills, techniques, and information taught during therapy; and decreased motivation5. The initial transgression of problem behaviour after a quit attempt is defined as a “lapse,” which could eventually lead to continued abstinence violation effect transgressions to a level that is similar to before quitting and is defined as a “relapse”. Another possible outcome of a lapse is that the client may manage to abstain and thus continue to go forward in the path of positive change, “prolapse”4. Many researchers define relapse as a process rather than as a discrete event and thus attempt to characterize the factors contributing to relapse3.

Ii)    Creating new descrimitive stimuli, signaling that new response will be reinforced. I)      Important that person perceive themselves as similar to type of person engaging in behavior. Ii)    Behavior more resistant to extinction if maintained by variable or intermittent reinforcement schedual than continusous. I)      Assess frequency of a target behavior and antecedents and concequences of behavior. B)    Could take attempts to changes peoples attitudes in a defensive or irrational way.

Therapist’s Guide to Evidence-Based Relapse Prevention – Academic Press

It would be appropriate to consider having a family member take the employee home. There could be some serious liability issues involved here so it is important to consult with Human Resources, Employee Relations, and the legal counsel’s office. An area that is often troublesome for supervisors is what to do when an employee is apparently under the influence or intoxicated at work. Agencies have a fair amount of latitude about what to do in these situations. The following is a list of steps you should take in dealing with such a situation.

Meditation has been shown to improve individual’s responses to stress and conflict, as well as increase a sense of well-being and confidence. Cognitive behavioral therapy works on reducing negative thought patterns and giving way to logic and addiction-free thought. Cognitive behavioral therapy also seeks to reduce destructive behaviors by helping people gain control of their responses to stress and other conditions that may have contributed to their former addictions. The CMRPT is based on the belief that total abstinence plus personality and lifestyle change are essential for full recovery. People raised in dysfunctional families often develop self-defeating personality styles (AA calls them character defects) that interfere with their ability to recover.

Relapse road maps

The therapist also can use examples from the client’s own experience to dispel myths and encourage the client to consider both the immediate and the delayed consequences of drinking. 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. In the original relapse taxonomy (Marlatt & Gordon, 1985) and in the replication of the taxonomy (Lowman, Allen & Stout, 1996), negative affect was the best predictor of outcomes. Negative emotions may manifest differently for different individuals, thus it is hard to pinpoint one emotional state (e.g., anxiety, depression, anger) that is most predictive of relapse. Furthermore, it may not be absolute level of emotion that predicts lapses, but rather one’s situational ability to regulate that emotion (Baker, Piper, McCarthy, Majeskie & Fiore, 2003; Burish, Maisto & Shirley, 1982; Marlatt, Kosturn & Lang, 1975). One study demonstrated that high emotional arousal during an alcohol intervention can have iatrogenic effects (Moos & Moos, 2005), presumably the heightened emotional responding combined with a lack of skills for regulating the emotion will set a client up for failure.

It was also found to have moderate ability to accurately predict the risk of future relapse. However, the same study acknowledged that ‘‘Marlatt’s abstinence violation effect, also increased predictive power of the model’’ (Cherry Lowman, Allen, Stout, & Group, 1996, p. 66). The initial model of relapse prevention has been criticized for lacking a multidimensional therapeutic approach (Donovan, 1996). Although it takes into consideration https://ecosoberhouse.com/article/how-to-write-a-goodbye-letter-to-addiction/ the role of factors such as mood, craving, recall bias, and outcome expectancies, it does not fully acknowledge the complex nature, and influence of these factors (Donovan, 1996)(Longabaugh, Rubin, Stout, Zywiak, & Lowman, 1996). The linear nature of the initial relapse prevention model limits the application of more analytical approaches towards the understanding of the relapse process (Hendershot, Witkiewitz, George, & Marlatt, 2011).