“Quitting smoking is easy. I’ve done

it hundreds

of times.” – Attributed to Mark Twain

Relapse is broadly defined as an act or instance of backsliding, worsening, or going back to a habit or addiction such as alcohol or drug misuse. Most individuals who make an attempt to change health-related behaviour, such as when trying to lose weight or stop smoking, will come to experience setbacks or slips that will sometimes deteriorate and become relapses.

It could be argued that this process of relapsing is similar to knocking over a line of dominoes. The first domino hits the second, which then hits the third, and soon a chain reaction is started. The sequence of problems that lead from a stable sobriety to a relapse can be compared to the dominoes. Using this analogy, tipping over one small domino could create a series of reactions, which may seem insignificant, but which will feel much more difficult to stop, once the chain is progressing back to relapse.

As evidenced in Mark Twain’s quote, people usually report that quitting is not nearly as difficult as keeping it up. Thus, understanding the concept of relapse and how to prevent it becomes paramount in the outcome of treatments so that projected changes in behaviour are maintained and therefore relapse avoided.

Preventing relapse

Continuing with the analogy of the dominoes, the answer to avoiding a relapse is not found in stopping the last domino before it reaches the target, but in learning not to tip over the first domino in the first place. By avoiding the initiation of this reaction, and by developing an emergency plan for stopping the chain reaction quickly, one can find ways of staying away from relapsing.

This progression of “domino problems” that lead to relapse is called the relapse process. By trying to understand it, one can then find ways, or coping strategies, that are useful in maintaining the change the person is trying to make in their life. Specifically, preventing relapse can be achieved by recognising early warning signs and stopping them before one has returned to the addiction.

Relapse prevention therapy

Relapse Prevention Therapy is a therapeutic approach based on a cognitive-behavioural model of the relapse process developed over the past 30 years by G. Alan Marlatt PhD and his colleagues. This involves teaching coping strategies, such as more constructive ways of thinking and behaving, especially in relation to urges and cravings for substances in the early stages. Clients will be assisted with maps of high-risk situations and strategies on how to avoid the pitfalls, and will acquire skills for coping with such challenges.

Research shows that 60 to 75 per cent of all those who try to abstain from an addiction relapse at least once. In many cases, multiple serious attempts are necessary before achieving long term abstinence or a lifestyle change. This also clearly depicts that the journey of change continues and needs to continue from abstinence and does not, contrary to what many might believe, come to an end when abstinence has been achieved.

Many professionals are reluctant to address the issue of relapse for fear of possibly discouraging or reducing their client’s motivation by giving information on the likely obstacles ahead, or for fear of being seen as permissive of substance abuse. In relapse prevention therapy, clients are taught to anticipate high-risk situations and possible relapses.

Thus, lapses and relapses are being viewed as possibilities for growth and learning, and not as failure. This is not to state that one needs to relapse, but simply that most people do, whether it is when attempting to stop smoking, eat healthily or stop other substance abuse. By removing some of the guilt and shame of lapses and relapses, a more objective analysis of what happened can be made and strategies can be developed accordingly, with the aim of the person getting back on track quickly but with increased self-awareness and coping skills.

Clients or patients undergoing relapse prevention therapy are expected to be fully involved in every stage of their treatment planning. The overall goal is for the individual to increase awareness and choices regarding their behaviour, to develop coping skills, to increase their ability of self-control and to develop more general confidence or self efficacy.

This in turn requires a collaborative therapist-client relationship, whereby the client is perceived as the co-therapist, and the expert on their own particular cues, triggers and environmental situations.

This form of treatment will also illustrate to clients the early warning signals and the apparently irrelevant decisions, apart from other cognitive distortions such as denial and rationalisation. Relapse prevention therapy will also help clients replace the pleasure previously gained from, for example, substance misuse, with other non-destructive and equally satisfying activities. Most importantly, relapse prevention therapy will help clients to have a realistic approach to the road ahead and equip them with the necessary tools in preparation for the necessities of maintenance and repair and for an at times bumpy ride.

Training opportunity

Sedqa agency is organising an intense training course in Relapse Prevention Therapy, which will be held from 21 to 25 May. The facilitator will be George A. Parks PhD, and the training will be theoretical as well as practical. Dr Parks is a clinical psychologist licensed in the State of Washington in the USA and associate director of the Addictive Behaviours Research Centre in the Department of Psychology at the University of Washington. He is an internationally known expert on Relapse Prevention Therapy, and serves as a trainer, technical advisor or consultant on evidence-based alcohol and drug prevention and treatment for numerous private and public colleges and universities, substance abuse treatment centres, mental health centres and correctional facilities, as well as state, provincial and national government offices in the US and Canada.

Anyone interested in obtaining more information can contact Agenzija sedqa on 2388-5138, by sending an email to [email protected], or by visiting sedqa’s website on www.sedqa.gov.mt A limited number of places are available, and experience in working with addictions or related fields in which long-term behavioural change is desirable is a necessary prerequisite to attend training. Registrations must be made by not later than Friday, 4 May.

Article provided by the Foundation for Social Welfare Services