Marlatt’s Relapse Prevention Model Flashcards
Introduction
SLT
Social learning theory (SLT) describes the effect of cognitive processes on goal-directed behaviour in humans. It considers the human capacity for learning within a social environment through observation or listening to others.
Introduction
Marlatts Model
Marlatt and George (1984) have applied SLT to the understanding and treatment of addiction in the Relapse Prevention Model which focuses on the high-risk situations and the individual’s response in such situations. According to the model, if the individual lacks an effective coping response and/or confidence to deal with the situation (low self-efficacy), the tendency is to give in to temptation. The decision to use or not to use is then mediated by the individual’s outcome expectancies for the initial effects of using the substance. Individuals who decide to use the substance may be vulnerable to the “abstinence violation effect,” which is the self-blame and loss of perceived control that individuals often experience after the violation of self-imposed rules. This essay shall use Marlatt’s Relapse Prevention Model to discuss why individuals are often particularly sensitive to relapse when first leaving in-patient settings for their normal living environment.
• and according to the model high-risk situation is the immediate relapse trigger.
P1 High-risk situations
Negative emotionsl states
The Relapse prevention model predicts that relapse will be most likely in situations where drug use has instrumental value, high risk situations. Such as, negative emotional states (e.g., anger, anxiety) that may be caused by primarily intrapersonal perceptions of certain situations (e.g., feeling lonely coming home to an empty house) or by reactions to environmental events (e.g., feeling angry about being fired). Situations involving other people, particularly conflict, are interpersonal high-risk situations, also result in negative emotions and can precipitate relapse. Additionally, social pressure, including both direct verbal or nonverbal persuasion and indirect pressure (e.g., being around other people who are drinking), contributed to relapse episodes.
P1 High-risk situations
Positive emotional states
Finally, positive emotional states, exposure to alcohol related cues, testing one’s personal control, and nonspecific cravings also were identified as high-risk situations that could precipitate relapse. Thus, according to the relapse prevention model certain situations or events can pose a threat to the person’s sense of control and, consequently, cause a relapse crisis, individuals are often particularly sensitive to this when first leaving in-patient settings for their normal living environment.
P2
Evidence
One recent large-scale research effort assessing the RP model was the Relapse Replication and Extension Project (RREP) (Lowman et al, 1996). The RREP recruited 536 people seeking help for alcohol problems via a variety of in- and out-patient programmes using a range of approaches. Participants were assessed pre and up to 12 months post-treatment, at 2-monthly intervals, using indices of constructs in the RP model.
P2
Evidence
Findings and limitations
The study found that negative emotional states and exposure to social pressure to drink were the most commonly identified precursors to relapse. There was also evidence that the Abstinence Violation Effect and lack of coping responses were predictive of relapse. However, the predictors did not account for as much of the variance in outcome as predicted by Marlatt’s ‘linear’ model but the study provides relatively good support for other aspects of the RP model. The limitations of RP model found in RREP has led to a reconceptualisation which emphasises complex and dynamic interactions between variables.
P2.5 Revised ‘dynamic’ model
Revised ‘dynamic’ model of relapse (Marlatt and Witkiewitz, 2005) was proposed in response to RREP findings. A major development in this respect was the reformulation of Marlatt’s cognitive-behavioural relapse model to place greater emphasis on dynamic relapse processes. Whereas most theories presume linear relationships among constructs, the reformulated model 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.
P3
specific intervention strategies
Identifying and coping with High Risk Situations
The RP model includes a variety of cognitive and behavioural approaches designed to target each step in the relapse process. These approaches include specific intervention strategies that focus on the immediate determinants of relapse as well as global self-management strategies that focus on the covert antecedents of relapse. An example of a specific intervention strategy is Identifying and coping with High Risk Situations. These situations can be identified using a variety of assessment strategies (e.g., self-report questionnaire, interview). Once a person’s high-risk situations have been identified, two types of intervention strategies can be used to lessen the risks posed by those situations. The first strategy involves teaching the client to recognize the cues indicating that the client is about to enter a high-risk situation (e.g., stress). 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.
P3
Global self-management strategies
Balanced Lifestyle and Positive Addiction
An example of a global self-management strategy is a Balanced Lifestyle and Positive Addiction. Assessing lifestyle factors associated with increased stress and decreased lifestyle balance is the first step in teaching global self-management strategies. one global self-management strategy involves encouraging clients to pursue activities they once found pleasurable. In addition, specific cognitive-behavioural skills training approaches, such as relaxation training, stress-management, and time management, can be used to help clients achieve greater lifestyle balance. Helping the client to develop “positive addictions”, activities (e.g., meditation, exercise, or yoga) that have long-term positive effects on mood, health, and coping— is another way to enhance lifestyle balance.
P4
motivational interviewing
The relapse prevention approach has spawned a counselling technique known as ‘motivational interviewing’ (Miller & Johnson, 2001). The objective of this technique is to engage the individual with the idea of sustaining and committing to their behaviour change in the longer term. This level of intervention relies on the therapist and the individual to identify risky situations and evaluate potential coping strategies in a supportive environment.
P4
Evidence
There is evidence that the motivational interviewing technique based on PR model is of value. For instance, Allsop et al., (1997) randomised a sample of alcoholics to either a standard care package of basic drug education, a relapse prevention package or extra discussion sessions. Those receiving the relapse prevention package showed significantly higher abstinence rates and spent a longer time drug free before relapse. The impact of the RP programme is particularly relevant given the generally poor treatment outcomes reported with subjects, who have high levels of alcohol consumption, and dependence. However, as in other studies which have demonstrated positive treatment impact, improvements did not endure. It might be concluded that insufficient attention was given to maintenance factors.
conclusion
Marlatt’s Relapse Prevention Model suggests that individuals are often particularly sensitive to relapse when first leaving in-patient settings because of the high-risk situations they face in their normal living environment. The results of recent research, particularly the RREP study, led to modifications of the original RP model, particularly with regard to the assessment of high-risk situations as well as the conceptualization of covert and immediate antecedents of relapse. Overall, however, research findings support both the overall model of the relapse process and the effectiveness of treatment strategies based on the model.
Based on the classification of relapse determinants and high-risk situations proposed in the RP model, numerous treatment components have been developed that are aimed at helping the recovering alcoholic cope with high-risk situations.
