1. 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

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

3. 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.

4. 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.

5. 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.

6. 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.

7. 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

8. 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

9. 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.

10. 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.

11. 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

12. 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

13. 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.

14. 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

15. 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.

16. 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

17. 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”