Menon, J., & Kandasamy, A. (2018). Relapse Prevention. Indian Journal of Psychiatry, 60, 473-478.
Specific Intervention Strategies
- Identifying and coping with high-risk situations
Along with the client, the therapist needs to explore past circumstances and triggers of relapse. The cues may be both internal and external. Also, the client is asked to keep a current record where s/he can self-monitor thoughts, emotions or behaviours prior to a binge. Once this is done, two strategies may be employed. One is to help clients identify warning signs such as on-going stress, seemingly irrelevant decisions and significant positive outcome expectancies with the substance so that they can avoid the high-risk situation. The second is assessing coping skills of the client and imparting general skills such as relaxation, meditation or positive self-talk or dealing with the situation using drink refusal skills in social contexts when under peer pressure through assertive communication.
- Enhancing self-efficacy
In a relapse prevention client and therapist are equal partners and the client is encouraged to actively contribute solutions for the problem. Client is taught that overcoming the problem behaviour is not about will power rather it has to do with skills acquisition. Another technique is that the road to abstinence is broken down to smaller achievable targets so that client can easily master the task enhancing self-efficacy. Also, therapists can provide positive feedback of achievements that the client has been able to make in other facets of life.
- Eliminating myths and placebo
The myths related to substance use can be elicited by exploring the outcome expectancies as well as the cultural background of the client. Following this a decisional matrix can be drawn where pros and cons of continuing or abstaining from substance are elicited and clients' beliefs may be questioned.
- Lapse management
Lapse management includes drawing a contract with the client to limit use, to contact the therapist as soon as possible, and to evaluate the situation for factors that triggered the lapse.
- Cognitive restructuring
Cognitive restructuring can be used to tackle cognitive errors such as the abstinence violation effect. Clients are taught to reframe their perception of lapses, to view them not as failures but as key learning opportunities resulting from an interaction between various relapse determinants, both of which can be modified in the future.
Balanced Lifestyle and Positive Addiction
Global self-management strategy involves encouraging clients to pursue again those previously satisfying, nondrinking recreational activities. In addition, relaxation training, time management, and having a daily schedule can be used to help clients achieve greater lifestyle balance.
Helping clients develop positive addictions or substitute indulgences (e.g., jogging, meditation, relaxation, exercise, hobbies, or creative tasks) also help to balance their lifestyle.
Stimulus Control Techniques
These techniques encourage the client to remove all items directly associated with substance use from his or her home, office. To remove all paraphernalia associated with drug use such as needles, mirror, pipes, glasses, bottles. More subtle items may include the favourite chair or the music the client listened to while using alcohol. In these cases, a temporary change in seating or listening habits may be helpful. Similarly, certain social events may have become associated with excessive drinking; client may need to decline these invitations.
Relapse Road maps
Cognitive-behavioural analyses of high-risk situations that emphasize the different choices available to clients for avoiding or coping with these situations as well as their consequences. Such a “mapping out” of the likely outcomes associated with different choices along the way can be helpful in identifying seemingly irrelevant decisions.
