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Module 14: Relapse Prevention

Module 14: Relapse Prevention. Objectives. To recognise that maintaining change is difficult To be able to identify things that help maintain change To be able to identify what things trigger relapse To be able to help someone develop a contingency plan . Dual Diagnosis Capabilities.

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Module 14: Relapse Prevention

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  1. Module 14: Relapse Prevention

  2. Objectives • To recognise that maintaining change is difficult • To be able to identify things that help maintain change • To be able to identify what things trigger relapse • To be able to help someone develop a contingency plan

  3. Dual Diagnosis Capabilities

  4. Relapse Prevention • Not experienced negative consequences of substances for 6 months • Maintaining abstinence (maintaining change)

  5. Relapse Prevention • Increased vulnerability as people are trying to cope without substances (or with reduced supply) and, for some people, being drug free means that their mental health problems may escalate. • Building on lifestyle changes that support stability in both mental health and substance use problems. • Housing • Work • Activity • Supportive peer groups • Relapse can’t be prevented, but risks of lapse can be minimised. • Interventions aim to equip the person with: • an awareness of their own personal triggers to lapse. • appropriate skills (e.g. assertiveness training) • contingency strategies to cope with such triggers. • Self help groups.

  6. Interventions For Relapse Prevention Stage • Supported or independent employment • Independent housing • Family problem solving • Self help • Peer support groups • Social skills training

  7. Marlatt & Gordon Model of Relapse Prevention Decreased probability of relapse Copingresponse Increased self-efficacy High-risk situation Rule Violation Effect – dissonance, conflict & self-attribution – guilt & perceived loss of control Decreased self-efficacy Increased probability of relapse No coping response Slip Positive outcome expectancy of behaviour

  8. Marlatt & Gordon Model Decreased probability of relapse “Thanks but I have stopped smoking” Increased self-efficacy Going to pub, friend offers a cigarette Rule Violation Effect – I am hopeless, I promised I would never smoke again. Might as well go an get a packet- I’ll never be able to give up! Decreased self-efficacy- I am too weak to resist and anyway, I’m in a really bad mood, this will cheer me up Increased probability of relapse Slip-smokes “Oh go on then, I’ve had a bad day”

  9. Risks for relapse • Lifestyle Imbalance – “shouldn’t > want to”, “duty vs. Pleasure” • Desire for Indulgence/ Feeling of Deprivation • Cravings & Urges • Rationalisation/ Justification • Seemingly Irrelevant Decisions – series of “mini-decisions” that take a person into a High-Risk Situation • High-Risk Situation – “downers”, “rows” and “join the club”

  10. Exercise 1: Your relapses Discuss in pairs: (10 minutes) • Think about a behaviour you changed, that you relapsed back into (e.g. stopping smoking, starting regular exercise etc) • What triggered the relapse? • How did you feel about the relapse? • What happened as a result? • How did other people react to your relapse?

  11. Relapse and Dual Diagnosis • Relapse is highly likely • Change is very hard to maintain due to complexity of problems • Workers need to remain positive when lapses occur (Therapeutic optimism) • Help person to think about why it happened and what could help in the future

  12. Exercise 2: Relapse for people with dual diagnosis • Make two lists of things that: • trigger relapse in people with dual diagnosis • things that help prevent relapse • What do you and your service offer in terms of relapse prevention work, or who would you refer to for this?

  13. Positive factors: Social support networks Stable living situation Safe, structured environment Sense of purpose – job/hobbies Therapeutic discussion Practical help Insight & awareness Physical well-being Medication (maximum effectiveness, minimal inconvenience and side-effects Hope Negative factors: Difficulties with any of the +ve factors Excessive stress Interpersonal conflict Substance use Persistent symptoms Factors Associated with Recovery

  14. Further Reading • Marlatt GA & Gordon JR (1985) Relapse Prevention: Maintenance Strategies in the Treatment of Addictive Behaviours Guilford Press, New York • Miller WR (1996) What is a relapse? Fifty ways to leave the wagon Addiction 91Supplement, S15-S27 • Rassool GH (1998) Substance Use and Misuse – Nature, Context and Clinical Interventions Blackwell Science, Oxford • Wanigaratne S, Wallace W, Pullin J, Keaney F & Farmer R (1990) Relapse Prevention for Addictive Behaviours – A Manual for Therapists Blackwell Science, Oxford

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