By Parks, George A.
Corrections Today , Vol. 69, No. 6
Origins and Current Status of Relapse Prevention Therapy
G. Alan Marlatt's cognitive-behavioral model of relapse prevention (RP), as described in his 1985 book co-edited with Judith R. Gordon, was originally developed as a theory of alcohol relapse and a related set of intervention strategies designed to help clients who had completed treatment maintain abstinence by anticipating and coping with the problem of relapse. Soon after, the principles and practices of relapse prevention therapy (RPT) were applied to tobacco use, illicit drugs and addictive behaviors not related to substance abuse such as problem gambling, overeating and compulsive sexual behavior. A narrative review by Kathleen Carroll and a meta-analysis by Jennifer E. Irvin and her colleagues concluded that RPT is an empirically supported treatment that is effective in the prevention and treatment of substance use disorders. The National Institute of Drug Abuse also classifies RPT as an evidence-based practice.
The increasing implementation of correctional programs based on RPT suggests that corrections professionals would benefit from a greater understanding of relapse and how relapse and criminal recidivism are related. While it was Marlatt and Gordon's 1985 book that stimulated correctional program development in the past 20 years, a 2005 revision and update of RPT by Marlatt and Donovan provides a contemporary review.
RPT in Corrections
RPT for substance-abusing offenders. Most corrections professionals are aware of the growing research evidence that rehabilitation programs based on cognitive-behavior therapy (CBT) are among the most effective treatments to reduce recidivism. So, it is not surprising that the flood of drug-involved offenders into correctional systems in the 1980s and the influence of the "what works" movement emphasizing evidence-based correctional practice led to the implementation of correctional programs based on RPT.
During the 1990s, both the U.S. Federal Bureau of Prisons (BOP) and the Correctional Service of Canada (CSC) developed, implemented and tested prison-based programs based on the RP model--the Residential Substance Abuse Treatment program in the U.S. and the Offender Substance Abuse Pre-Release Program in Canada. These programs utilized RPT as their treatment platform and as their source for specific cognitive-behavioral relapse prevention interventions. Evaluation research on the effectiveness of these offender substance abuse programs reviewed by Parks and Marlatt has demonstrated decreases in substance abuse relapse and criminal recidivism. The strongest treatment effects for RPT with substance abusing offenders occur when the in-prison substance abuse program is followed by continuing care in the community.
RPT with sex offenders. In the past 30 years, RPT has also become the dominant psychosocial treatment modality used in sex offender treatment programs, providing both the theoretical framework and specific strategies to reduce sex offense. In 1989, D. Richard Laws helped to launch the field of modern sex offender treatment with the publication of his book Relapse Prevention with Sex Offenders. In 2000, Laws and his colleagues provided a review of the applications of RPT to sex offenders and offered suggestions for remaking RPT to be more effective with this population. A recent review by Steve Aos and colleagues from the Washington State Institute for Public Policy concluded that sex offender treatment based on RPT has a moderate, but reliable, impact in reducing sex offender recidivism.
Meta-analysis of RPT in correctional programming. In 2003, Craig Dowden and his colleagues conducted a meta-analysis that provided an estimate of the overall impact of correctional programming based on RPT in reducing recidivism. They concluded that rehabilitation programs incorporating RPT consistently showed a moderate reduction in recidivism with larger recidivism reductions occurring when: there was a greater number of RPT core components; there was a more detailed description of the program; and the program targeted criminogenic needs. …