Foundations of Addictions Counseling, 3/E

David Capuzzi & Mark D. Stauffer

Chapter 13
Maintenance and Relapse
Prevention
Updated by Melinda Haley, Walden University

Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved
Relapse Prevention for Addictive
Behaviors

 Relapse: Return of disease after full or partial

recovery
 Rates of relapse
 Difficult to determine
 90% of alcoholics return to drinking within 4-year
period
 40-60% relapse for drug addiction
 Relapse defined differently by different
treatment approaches

Copyright © 2016, 2012, 2008

Foundations of Addictions Counseling, 3e
by Pearson Education, Inc.
Capuzzi & Stauffer
All Rights Reserved
 Relapse vs. Lapse

 Lapse
 Modest breach of agreed goals
 Can be a learning experience
 Relapse
 A more serious violation of treatment goals,
learning is not evident
 Relapse Prevention
 A range of therapeutic methods applied to a range
of behaviors

Copyright © 2016, 2012, 2008

Foundations of Addictions Counseling, 3e
by Pearson Education, Inc.
Capuzzi & Stauffer
All Rights Reserved
 Relapse Prevention (RP) Model

Relapse is complex and multidimensional

Counselor must understand factors
leading to abstinence or relapse
 Intrapersonal
 Self-efficacy
 Outcome expectancies
 Craving
 Level of motivation
 Coping ability
 Emotional states
Copyright © 2016, 2012, 2008
Foundations of Addictions Counseling, 3e
by Pearson Education, Inc.
Capuzzi & Stauffer
All Rights Reserved
 Preventing Lapses or Relapses

 Lapses or relapses more likely immediately

after treatment
 Plan for common issues
 1. High risk situations
 2. Seemingly irrelevant decisions
 3. Abstinence violation effect

Copyright © 2016, 2012, 2008

Foundations of Addictions Counseling, 3e
by Pearson Education, Inc.
Capuzzi & Stauffer
All Rights Reserved
 High Risk Situations (HRS)

 Identify client’s particular HRS

 Frequent HRSs
 Frustration and anger
 Emotional “highs”
 Interpersonal conflict
 Easily used to blame others
 Social pressures
 Subtle and pervasive in Western society
 Once identified they can be easily managed

Copyright © 2016, 2012, 2008

Foundations of Addictions Counseling, 3e
by Pearson Education, Inc.
Capuzzi & Stauffer
All Rights Reserved
Specific Coping Strategies for High
Risk Situations

 Plan ahead
 Must be considered, planned, and implemented
 Begins with brainstorming
 Which strategies to use
 Multiple methods of stress relief
 Rehearse alternative responses to drinking
 Identify strengths and resources

Copyright © 2016, 2012, 2008

Foundations of Addictions Counseling, 3e
by Pearson Education, Inc.
Capuzzi & Stauffer
All Rights Reserved
 Seemingly Irrelevant Decisions

 Also known as “Setups”

 Decisions that may seem irrelevant at the time but
often lead to relapse
 Thought processes/thinking errors and
psychological traps
 Multimodal treatment and 12-step attendance
offers the best chance for long term recovery
and abstinence
 Help to catch thinking errors
 Others experience same “traps”

Copyright © 2016, 2012, 2008

Foundations of Addictions Counseling, 3e
by Pearson Education, Inc.
Capuzzi & Stauffer
All Rights Reserved
The Abstinence Violation Effect (AVE)

 Psychological Trap
 Temptation to break rules once set
 Minor violations seem to justify major ones (already
failed)
 Coping strategies can prevent the progression
 Does AA’s message of powerlessness make
relapse after a single drink an inevitability? Self-
fulfilling prophecy?

Copyright © 2016, 2012, 2008

Foundations of Addictions Counseling, 3e
by Pearson Education, Inc.
Capuzzi & Stauffer
All Rights Reserved
 Lifestyle Change

 Restoring balance to life – work/leisure

 Balancing “shoulds” and “wants”

Copyright © 2016, 2012, 2008

Foundations of Addictions Counseling, 3e
by Pearson Education, Inc.
Capuzzi & Stauffer
All Rights Reserved
 Developing a Management Plan

 Stabilization plan
 Assessment
 Relapse education
 Identify warming signs
 Identify problem solving strategies
 Recovery planning
 Inventory training
 Family involvement
 Follow up

Copyright © 2016, 2012, 2008

Foundations of Addictions Counseling, 3e
by Pearson Education, Inc.
Capuzzi & Stauffer
All Rights Reserved
Case Study of Relapse Prevention

 Thomas, 27-year old male

 Married, father of 2-year old daughter
 Employed as salesman
 Cannot keep a job
 Frequent angry outbursts
 Anxiety attacks
 Considering suicide
 Long time drinker/case of beer daily

Copyright © 2016, 2012, 2008

Foundations of Addictions Counseling, 3e
by Pearson Education, Inc.
Capuzzi & Stauffer
All Rights Reserved
Case Study:Recovery Phase Begins

 Anti-depressant and anti-anxiety medications

 Withdrawal and stabilization
 Identify HRS’s and self-monitor
 Develop coping strategies
 Education about lapse and relapses
 Therapeutic contract/time out for relapse
 Reminder cards

Copyright © 2016, 2012, 2008

Foundations of Addictions Counseling, 3e
by Pearson Education, Inc.
Capuzzi & Stauffer
All Rights Reserved
 Case Study: Support Systems

 Involvement of family
 Marital relationship
 System of non-using friends
 Social modeling
 Disengaging from using friends

Copyright © 2016, 2012, 2008

Foundations of Addictions Counseling, 3e
by Pearson Education, Inc.
Capuzzi & Stauffer
All Rights Reserved
Case Study: Other Lifestyle Changes

 Change unhealthy environments

 Body awareness techniques
 Confront relapse possibilities
 Job/major stressor
 Financial Strains

Copyright © 2016, 2012, 2008

Foundations of Addictions Counseling, 3e
by Pearson Education, Inc.
Capuzzi & Stauffer
All Rights Reserved
 Final Points to Remember

 Pacing is important
 Don’t overwhelm client with too many
interventions at once
 Set realistic goals
 Go slow
 Balance “shoulds” with pleasure

Copyright © 2016, 2012, 2008

Foundations of Addictions Counseling, 3e
by Pearson Education, Inc.
Capuzzi & Stauffer
All Rights Reserved
 Useful Web Sites

 About.com: Alcoholism & Substance Abuse

 www.alcoholism.about.com/od/relapse/Relapse_Pr
evention.htm
 Information for Individuals and Families
 www.addictionsandrecovery.com

Copyright © 2016, 2012, 2008

Foundations of Addictions Counseling, 3e
by Pearson Education, Inc.
Capuzzi & Stauffer
All Rights Reserved