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PSY 215 (Addictions) > Chap 10 (Policy Approaches) > Flashcards

Chap 10 (Policy Approaches) Flashcards

1
Q

failure to maintain behavioural change

A

Relapse

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2
Q

Majority of individuals eventually return to their 1. ________ patterns within 2. ________ after treatment

A
  1. pre-treatment behavior (relapse)
  2. the first year
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3
Q

Relapse prevention treatments can help individuals move towards change, rather than preventing _________

A

all recuring substance use episodes

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4
Q
  1. Binary versus C2. ontinuous Conceptualization
A
  1. Addiction & treatment outcomes have been conceptualized in a binary manner in the past (‘all-or-nothing’) i.e.; a person has alcoholism or doesn’t; Treatment outcome is either successful (abstinence) or unsuccessful (relapse)
    Such binary conceptualization does not consider behavioral change following treatment

ALSO RELAPSES BELIEVED AS BINARY

**Addiction, treatment outcome & relapse are continuous processes , rather than discrete all-or-none events
**

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5
Q

The definition of relapse should consider multiple factors

A
  • Threshold
  • Reset
  • Polydrugs
  • Consequences
  • Verification
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6
Q

amount of substance use in relapse

A

Threshold

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7
Q

period of abstinence required before one can be considered to have relapsed

A

Reset

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8
Q

the types of substance use that constitute a relapse

A

Polydrugs

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9
Q

behaviours & consequences required before one can be considered as having relapsed

A

Consequences

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10
Q

self-reports of relapse

A

Verification

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11
Q

an initial setback

A

Lapse

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12
Q

returning back to pre-treatment substance use

A

Relapse

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13
Q

recovering from a relapse by making positive behaviour change

A

Prolapse

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14
Q

Lapse & relapse can be differentiated by using

A

quantitative measures

(individual drinks 50% or more than pre-treatment = “relapse”, less than 50% of before treatment is a “lapse”)

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15
Q

In harm reduction  lapse refers to

A

any harmful consequence related to substance use

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16
Q

The criteria for determining whether relapse has occurred may _____________

A

vary across different substances
Any use of cocaine  relapse
Having a single cigarette  lapse

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17
Q

A client-centered definition of relapse should consider 3 factors

A
  1. Individual’s progress towards treatment goals
  2. Personal & social consequences related to substance use

3.Individual’s return to the problematic behavior (ie; substance use)

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18
Q

Cognitive-behavioural model of relapse  offering strategies for dealing with (& preventing) relapse

Relapse is conceptualized as a two-stage process  the precipitants of substance use are distinct from the factors that prolong / sustain such use over time

Relapse occurs due to lack of coping skills to successfully avoid substance use in challenging situations

Marlatt’s 8 relapse determinants (aka ‘risk situations’)

A

Marlatt’s Relapse Prevention Model

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19
Q

Marlatt’s 8 relapse determinants (aka ‘risk situations’)

A
  1. Unpleasant emotions
  2. Physical discomfort
  3. Pleasant emotions
  4. Tests of personal control
  5. Urges & temptations
  6. Conflicts with others
  7. Social pressure to use
  8. Pleasant time with others
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20
Q

Marlatt’s Relapse Prevention Model: Limitations

A
  • Relapse precipitants can be multidimensional & interact in complex ways
  • Failure to cope is not necessarily due to deficit in coping skills, but may be due to other factors (ie; motivation, ambivalence, poor health care access, poverty, etc)

-Craving can have a substantial impact on relapse risk

21
Q

Marlatt’s model has been extended to include

A

Both inter & intra-personal relapse determinants
Put more emphasis on cravings
Temporal relationships between cognitive, behavioural, affective & biological processes affecting relapse

22
Q

Biological factors of Relapse

A

Repeated substance use can affect brain structure & function (ie; executive functioning and reward system)
i.e., individuals with CUD = effects on learning & memory function can influence treatment outcomes (i.e., lead to greater likelihood of relapse

23
Q

Sex-related hormones may affect relapse risk

A

i.e., fluctuating hormone levels in women who are menstruating may contribute to intensity of cravings

24
Q

Distal relapse risks may be influenced by

A

genetic factors & genetic variations = may influence cravings
(biological risks)

25
Q

Psychological factors in relapse

A

Different personality variables have been associated with relapse risk

  • Negative Cognitive Style ; feelings of inadequacy ; ineffective coping; rigid personality style; external locus of control
  • Higher anxiety sensitivity
  • Lower self-efficacy (Bandura)
    both lead to relapse vunerability
  • Association between high levels of motivation & short- & long-term abstinence
  • Continuous assessment of self-efficacy & motivation –> feedback about treatment effectiveness & relapse risk
  • Assessing for personality factors –> helps with treatment planning & identifying supports during & after treatment
26
Q

control over events (i.e., addiction) lies within oneself

A

High internal locus of control

27
Q

control over events lies within the external world (i.e., fate)

A

High external locus of control

28
Q

Social factors in relapse

A

Can increase the risk of relapse & protect one against it

Protective factors:
**Number of individuals in one’s social network & one’s attachment to one’s social support **(even if someone has only two people who they are very close with, the strength of the relationships help too)

Risk factors:
Living alone & being single

  • Experience of chronic life stressors & drug availability = predict post-treatment substance use
  • Levels of support within one’s network & specific behaviours of individuals in one’s network –> predict drinking outcome
  • Important to help clients build strong social supports who are supportive of their goals during & after treatment
29
Q

Social-Structural & Spiritual factors in relapse

A

Social-structural predictors of relapse: neighborhood factors (ie., crime rates), levels of education, living independently, lack of continuing substance use treatment & substance availability

Access to stable housing, high-quality health care & meaningful opportunities –> may sustain treatment progress & goals

There are associations between spirituality levels during treatment, & cravings & relapse (Less spirituality, higher chances of relapse, high = lower)
It is important to consider spirituality as engaging in prayer, relying on a higher power & finding a deeper meaning to life  important complements to treatment interventions

30
Q

A counselling approach for individuals with moderate to severe levels of addiction
Blends CBT with a motivational approach & is based on Marlatt’s relapse prevention model
Substance use triggers are addressed & structured coping skills training are provided
Includes a basic two-phase approach –> initiation-of-change strategies (i.e., avoidance & reliance on support) are complemented/replaced with more internalized coping strategies
All adaptations of ____ conform to this two-phase approach

Includes 5 components, which can be delivered to clients sequentially or in an “ad hoc” (as needed) fashion depending on client’s needs, motivation & readiness to change

A

Structured Relapse Prevention Treatment Intervention

31
Q

5 components of Structured Relapse Prevention Treatment Intervention

A

Component 1: Assessment

Assessing: quantity & frequency of substance use, psychosocial resources & issues, co-occurring problems

Component 2: Motivational Interviewing (MI)

Component 3: Individual treatment planning
1. Goal setting & self-monitoring

  1. Identifying Problem Drinking & Other Drug Use Situations
    Discussing IDTS & daily self-monitoring
    Clients rank the 3 most problematic triggers & give examples of past substance use for each situation  allows clients to identify what they might do differently in similar future situations
  2. Identifying Coping Strengths

Component 4: Initiation Counselling

Component 5: Maintenance Counselling

32
Q

ad hoc

A

as needed

33
Q
  • Successful coping responses in other areas may be effective for addressing problematic substance use situations
  • Help clients focus on successes rather than failures
  • Making use of client’s successful coping behaviours, personal strengths & environmental resources
  • Providing coping skills training through different exercises & homework assignments
    • Client selects priority areas for coping skills development
  • Client is informed of program orientation, attendance requirement, limits of confidentiality , expectations for participation in planning & homework, other possible treatment options
  • Client is asked whet
A

Identifying Coping Strengths (Component 3 of SRP)

34
Q
  • Focuses on counseling strategies suitable for clients who are still struggling to change their substance use (or those who are newly abstinent)
  • Helps clients anticipate substance use triggers (& high-risk situations) for the coming week, then identify & commit to alternative coping strategies
  • Clients are encouraged to use coping strategies effective in initiating short-term behavioural change: avoiding risky situations, taking medications to help with cravings, seeking social support
  • Weekly Plan (Initiation Phase) form – helps clients anticipate substance use triggers & use safe initiation strategies
A

Component 4: Initiation Counselling

35
Q

clients make note of: substance use goal, level of confidence in achieving goal, daily record of substance use & circumstances surrounding use (risky situations) & coping strategies used

A
  1. Goal setting & self-monitoring/ Component 3: Individual treatment planning
36
Q

Clients are provided with individualized feedback of assessment results during MI sessions
MI will help engage clients who are reluctant to enter treatment

A

Component 2: Motivational Interviewing (MI)

37
Q

quantity & frequency of substance use, psychosocial resources & issues, co-occurring problems

A

Assessing

38
Q

Assessing: quantity & frequency of substance use, psychosocial resources & issues, co-occurring problems
Inventory of Drug-Taking Situations (IDTS)
Reveals specific risk areas to target in relapse prevention planning & coping skills training
The frequency of client’s past substance use is assessed across Marlatt’s eight risk areas

A

Component 1: Assessment
(SRP)

39
Q

Discussing IDTS & daily self-monitoring

A

Clients rank the 3 most problematic triggers & give examples of past substance use for each situation –> allows clients to identify what they might do differently in similar future situations

40
Q

Component 5: Maintenance Counselling Includes 4 steps

A
  1. Graduated real-life exposure to high-risk situations for substance use
  2. Homework tasks within each type of high-risk situation
    - Assignments must be designed to help clients experience success & begin to build self-efficacy

-Multiple assignments must be agreed upon at each session  to learn that high-risk situations don’t imply a relapse

  • Assignments should draw on a wide variety of client’s coping strengths & resources
  • As client’s confidence grows, they move up the hierarchy to more difficult situations
  • A lapse in this stage of treatment is less likely to be a major setback – as it might have been earlier in treatment
  1. Slow reduction of reliance on initiation strategies
  2. Giving homework tasks that promote self-attribution of control
    Client must take responsibility for designing their own homework assignments
41
Q

Focuses on strategies suitable for clients who are in the maintenance stage of change
Have achieved relative stability regarding substance use goals (using initiation strategies) & now need skills to maintain change over the long term

A

Component 5: Maintenance Counselling

42
Q

SRP: Summary

A
  • In practice, a dynamic interplay occurs between counselling components & client’s readiness to change
  • While some may proceed in a linear fashion through the counselling components & stages of change, others may not
  • The purpose of treatment  increase client’s self-efficacy across all areas of perceived risk
  • Self-efficacy (confidence in oneself) has been associated with relapse onset
    If a client fails to show improved Self-efficacy in a particular high-risk situation –> further work is required before client is discharged
43
Q

Relaspe and Gender

A
  • Women are less prone to relapse compared to Men
  • Men tend to report more negative social influences, more exposure to substances & poorer coping skills
  • Marriage affects relapse risk differently between the sexes:
    Women with AUD  more likely to have partners who are heavy drinkers (increasing risk of relapse)
  • Marriage seems to be a protective factor for Males with alcohol issues
  • Women may be at higher risk for relapse after experiencing negative emotions/personal conflict
  • Men may be at higher risk of relapse when experiencing positive experiences (i.e., pleasant time with others, experiencing pleasant emotions)
44
Q

Youth relapse

A
  • The rates of post-treatment relapse & time to relapse are similar for adults & youth
  • Youth-specific treatment approaches  different challenges youth experience
  • Relapse prevention for youth must focus on youth-parent relationships & group membership
  • Substance use by youth is associated with parental support , awareness & monitoring
  • Avoid confrontation in counselling, as it may trigger rebellious responses & inhibit therapeutic alliance

-Help clients prepare for relapse in high-risk situations
Groups are the most widespread used modality with youth
Developing a relapse contract

45
Q

Older adults in relapse

A
  • High-risk situations among older adults more frequently involve intrapersonal issues
  • Negative emotional states (anxiety, loneliness, social isolations, etc.)
    Retirement, death of a partner / child, stressor of aging
46
Q

Ethnocultural factors in relapse

A

Challenging for treatment programs to attract & retrain clients from diverse ethnocultural communities:
Differing languages, treatment philosophies & methods, norms & values regarding substance use, etc.
Clinicians must develop skills to work with diverse clients
“Ethnocultural competence”  ability to function effectively in the context of ethnocultural differences
Clinicians must offer culture-appropriate therapy

47
Q

ability to function effectively in the context of ethnocultural differences

A

Ethnocultural competence

48
Q

Concurrent mental health disorder / Comorbidity on Relapse

A

Clinicians must routinely screen for presence of concurrent disorders
Not recognizing concurrent disorders can affect client’s recovery:
Premature dropout out of treatment
Higher risk of relapse
Risk of harmful interactions between drugs of abuse & Psychiatric medications
Individuals with severe psychiatric disorders:
More sensitive to effects of alcohol & drugs
May experience more negative consequences from smaller amounts of use
Quantity of use may be less important than the consequences of use

Effective modifications to relapse prevention groups:
Shorter group durations
Modifying clinical tools to incorporate disorder-specific treatment goals
Dedicating time to discuss access to services
Easier & simpler homework tools

PSY 215 (Addictions) (9 decks)

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