Academic journal article Alcohol Research

Relapse Prevention an Overview of Marlatt's Cognitive-Behavioral Model

Academic journal article Alcohol Research

Relapse Prevention an Overview of Marlatt's Cognitive-Behavioral Model

Article excerpt

Relapse prevention (RP) is an important component of alcoholism treatment. The RP model proposed by Marlatt and Gordon suggests that both immediate determinants (e.g., high-risk situations, coping skills, outcome expectancies, and the abstinence violation effect) and covert antecedents (e.g., lifestyle factors and urges and cravings) can contribute to relapse. The RP model also incorporates numerous specific and global intervention strategies that allow therapist and client to address each step of the relapse process. Specific interventions include identifying specific high-risk situations for each client and enhancing the client's skills for coping with those situations, increasing the client's self-efficacy, eliminating myths regarding alcohol's effects, managing lapses, and restructuring the client's perceptions of the relapse process. Global strategies comprise balancing the client's lifestyle and helping him or her develop positive addictions, employing stimulus control techniques and urgemanagement tech niques, and developing relapse road maps. Several studies have provided theoretical and practical support for the RP model. KEY WORDS: AODD (alcohol and other drug dependence) relapse; relapse prevention; treatment model; cognitive therapy; behavior therapy; risk factors; coping skills; self efficacy; expectancy; AOD (alcohol and other drug) abstinence; lifestyle; AOD craving; intervention; alcohol cue; reliability (research methods); validity (research methods); literature review

Relapse, or the return to heavy alcohol use following a period of abstinence or moderate use, occurs in many drinkers who have undergone alcoholism treatment. Traditional alcoholism treatment approaches often conceptualize relapse as an end-stare, a negative outcome equivalent to treatment failure. Thus, this perspective considers only a dichotomous treatment outcome--that is, a person is either abstinent or relapsed. In contrast, several models of relapse that are based on social-cognitive or behavioral theories emphasize relapse as a transitional process, a series of events that unfold over time (Annis 1986; Litman er al. 1979; Marlatt and Gordon 1985). According to these models, the relapse process begins prior to the first posttreatment alcohol use and continues after the initial use. This conceptualization provides a broader conceptual framework for intervening in the relapse process to prevent or reduce relapse episodes and thereby improve treatment outcome.

This artide presents one influential model of the antecedents of relapse and the treatment measures that can be taken to prevent or limit relapse after treatment completion. This relapse prevention (RP) model, which was developed by Marlatt and Gordon (1985) and which has been widely used in recent years, has been the focus of considerable research. This article reviews various immediate and covert triggers of relapse proposed by the RP model, as well as numerous specific and general intervention strategies that may help patients avoid and cope with relapse-inducing situations. The article also presents studies that have provided support for the validity of the RP model.

OVERVIEW OF THE RP MODEL

Marlatt and Gordon's (1985) RP model is based on social-cognitive psychology and incorporates both a conceptual model of relapse and a set of cognitive and behavioral strategies to prevent or limit relapse episodes (for a derailed description of the development, theoretical underpinnings, and treatment components of the RP model, see Dimeff and Marlatt 1998; Marlart 1996; Marlatt and Gordon 1985). A central aspect of the model is the detailed classification (i.e., taxonomy) of factors or situations that can precipitate or contribute to relapse episodes. In general, the RP model posits that those factors fill into two categories: immediate determinants (e.g., high-risk situations, a person's coping skills, outcome expectancies, and the abstinence violation effect) and covert antecedents (e. …

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