CHAPTER 10: Retaining Sobriety Substance Abuse Counseling: Theory and Practice Fifth Edition Patricia Stevens Robert L. Smith Prepared by: Dr. Susan Rose, University of the Cumberlands

Overview of Chapter Introduction Determinants of Relapse Models of Relapse Planning and Management Self-Help Recovery Organizations: Adjuncts to Professional Intervention

Introduction Definitions Recovery: not only abstinence from mind-altering chemicals or nonproductive compulsive behaviors but also as changes in physical, psychological, social, familial, and spiritual areas of functioning. Relapse has many definitions. A breakdown or setback in a person’s attempt to change or modify a target behavior. The act or an instance of backsliding, worsening, or subsiding. A recurrence of symptoms of a disease after a period of improvement. The continuous return to ATOD use or to the dysfunctional patterns of compulsive behavior.

Introduction Relapse can be seen in two dimensions: The “event” The “process” Definitions Lapse: the initial return to use after a period of sobriety. Concept Change Most now view relapse as a normal part of the recovery process and as a learning experience for the recovering individual.

Determinants of Relapse Environmental High-risk situations threaten the client’s control and increase the likelihood of return to use: Negative emotional states Interpersonal conflict Social pressure Environmental stimuli Craving Behavioral Clients who have few or no coping skills to respond to these high-risk situations are more likely to return to substance use.

Determinants of Relapse Cognitive Variables that affect relapse Individual’s attitude toward sobriety (motivation to quit or not) Individual’s perception of his/her ability to cope (self-efficacy) Expectation of relapse Affective Research identifies negative affect as the major cause of relapse. Two very strong emotions that must be dealt with in recovery are shame and guilt. Recognizing that positive emotional states also create stress is imperative when working with this population.

Determinants of Relapse Interpersonal Determinants The lack of a supportive family or social network has been highly correlated with a return to substance use. The family is usually the primary relationship and, therefore, the relationship that is most harmed in the process of abuse and dependency. If family is not involved in recovery process, results can be devastating. Other components that may create a problem in recovery: Work Leisure Time

Models of Relapse Planning and Management The Disease Model Developed by Jellinek in the 1940’s Alcoholics Anonymous (AA) adopted this model of addiction recovery Developmental Models Gorski views addiction as a chronic and progressive disease The Gorski Model’s Six steps: Transition Stabilization Early recovery Middle recovery Late recovery Maintenance

Models of Relapse Planning and Management Developmental Models The model assumes that change is intentional on the part of the individual. The Stage Model’s Stages of Change Precontemplation Contemplation Determination Action – When client becomes abstinent for first time Maintenance This transtheoretical model assumes that change is cyclical and dynamic.

Models of Relapse Planning and Management Cognitive-Behavioral/Social Learning Model Social Learning Theories Primary learning principle is operant conditioning. Another social theory perspective examines the effect of psychological stress on substance use. Important of self-efficacy in social learning theory Cognitive Behavioral Model Premise of Relapse Prevention (RP) model is that individuals attempt to stop or reduce substance use will face risks of relapse. Relapse is seen as a learning tool.

Cognitive Behavioral Model Models of Relapse Planning and Management: Cognitive Behavioral Model cont. Cognitive Behavioral Model Ward and Stewart’s Good Lives Model recognizes 10 primary good that every individual needs to pursue: Healthy living Knowledge Excellence in play and work Excellence in agency Inner peace Friendship Community Spirituality Happiness Creativity

Cognitive Behavioral Model Models of Relapse Planning and Management: Cognitive Behavioral Model cont. Cognitive Behavioral Model Abstinence Violation Effect (AVE) create cognitive dissonance Involves self-attribution effect

Self-Help Recovery Organizations: Adjuncts to Professional Intervention Alcoholics Anonymous Model Giving up control to gain control Making Amends Group Participation AA Outcome Studies Spirituality as a Resource Spirituality can be a helpful resource for understanding a past lifestyle of substance abuse and for making decisions about a future free from addiction.

Self-Help Recovery Organizations: Adjuncts to Professional Intervention AA-Associated 12-Step Programs All are based on the AA philosophy and use a variation of the 12 steps of AA. The difference is their scope. Moderation Management (MM) Based on the cognitive behavioral model Views moderate use as success Specific Guidelines for participation in the program (Table 10.2, page 279) Harm Reduction Model

Self-Help Recovery Organizations: Adjuncts to Professional Intervention Rational Recovery Developed as an alternative for individuals who had difficulty with the spiritual aspect of AA Based in cognitive-behavioral theory on the work of Albert Ellis Used framework of Rational Emotive Therapy Secular Organizations for Sobriety/Save Our Selves (SOS) Claims to be a self-empowerment approach based on the belief that sobriety is an issue apart from any other issues in the person’s life.

Self-Help Recovery Organizations: Adjuncts to Professional Intervention Women for Sobriety (WFS) A group founded by women for women Self-help for Dually Diagnosed Persons Nearly 50% of persons diagnosed with a mental illness have a co-existing substance abuse or dependence disorder. Self-help groups that have been started to help dually diagnosed individuals: Double Trouble in Recovery Dual Recovery Anonymous Special AA meetings for alcohol-dependent individuals with a mental disorder SMART

A Well-Rounded Life with Joy Self-Help Recovery Organizations: Adjuncts to Professional Intervention A Well-Rounded Life with Joy Addicts must learn to manage their “pleasure threshold” Ward and Stewart’s “Good Lives Model”