1. Relaspe Prevention

2. Heading for a relaspe?

3. Relaspe Prevention: What is it?
Living strategies that:
prevent an initial relapse and maintain abstinence or harm reduction treatment goals
providing lapse management if a lapse occurs to prevent further relaspe

4. Unfortunately or Fortunately
Relaspe is common in addiction, but there is seemingly two paths that relaspe most commonly takes:
Lapse leads back to full blown addiction, or:
Lapse can lead us back to getting on track - we learn something from the “slip so to speak”

5. Affective and Cognitive
Two Components to AVE
Affective and Cognitive
Affective: is brought about between the discrepancy between one’s prior identity as the abstainer and one’s present behavior
Cognitive: if the individual attributes factors of the laspe due to internal, global, and uncontrollable factors relaspe risk is heightened. On the other hand, if we view our lapse as external, unstable, and controllable it is more likely that the lapse will not lead to to full blown relaspe

6. Abstinence Violation Effect (AVE)
Consequence of using brings about feelings of:
Self-blame
Guilt
Loss of perceived control of personal rules / values

8. Cognitive-Behavioural Model of Relaspe

9. Intra-personal Determinants
Self-efficacy - degree to which I feel confident and capable of preforming a certain behavior in a particular context
Research has shown that having a higher self-efficacy is related to greater days of abstinence
Also has be shown to be predictive of time to first drink and time to relaspe with 12 months

10. Outcome Expectancies
The effect that I expect will occur when I use (physical, psychological, or behavioural)
Research has shown that the more positive I perceive my using to help me with the 3 p’s, the more likely I am to relaspe (Connors, Tarbox, & Faillace, 1993).
However, other research has downplayed the degree to which this happens...
While other studies have revealed that targeting positive expectancy (with alcohol) during treatment does not necessarily lead to changes in alcohol consumption post-treatment (Jones, 2001).

12. Coping
According to Marlatt and Witkiewitz(2005) coping is the most critical predictor or relaspe
Coping involves both cognitive and behavioural components
We deal with both stressors and temptations
Research by Chung (2001) has found that cognitive avoidance coping (not thinking about stressor or accepting stressor) predicted fewer problems with alcohol, interpersonal problems, and psychological problems following 12 months post- treatment

13. Emotional States
In Marlatt’s original work emotional states was the strongest predicator of alcoholic male relapse
Especially negative emotional states

14. Craving
According to Marlatt and Witkiewitz(2005) coping is the most widely studied, but misunderstood concept in the addictions field
Craving is both the physical and psychological and is has been married to the notion of loss of control
Research has disconfirmed loss of control hypothesis

15. Craving (cont.)
Research has also shown that there is a lack of strong association between subjective reports of craving and relaspe.
However, the correlates and underlying mechanisms of craving may still predict relaspe
Thus Marlatt et al distinguish between an urge to use from that of a subjective desire to use (which is closer to what they understand as craving)

16. Inter-personal Social Support
Positive social support and social network is highly predictive of long-term abstinence rates
Meanwhile negative social support (interpersonal conflict, social pressure to use, anti-personality traits / cue exposure) is an increase risk for relaspe
Functional support (spouse sharing in goals) appears to predict best outcomes following treatment at both 3months and 15 months

17. Toward the Future: Linear to Dynamic and Multidimensional Models
Need for greater understanding

18. What are we learning?