After reading, Treating Alcohol and Drug Problems in Psychotherapy Practice: Doi

After reading, Treating Alcohol and Drug Problems in Psychotherapy Practice: Doing What Works, describe relapse dynamics in your own words. What can you, as the counselor, do to impart relapse prevention strategies to your clients?
One source must be Treating Alcohol and Drug Problems in Psychotherapy Practice: Doing What Works. By
A.M. Washton and J.E. Zweben, Guilford Publications, 1996.
Treating Alcohol and Drug Problems in Psychotherapy Practice: Doing What Works
1. Introduction
“It’s easy to stop smoking- I’ve done it hundreds of times.” When Mark Twain made this humorous remark, he was referring to the problem of relapse as applied to his own nicotine addiction. In this one simple statement he described a major dilemma encountered by people trying to overcome addictions; specifically, that stopping an addiction in the short term is relatively easy and not nearly as difficult as staying stopped over the long term. In other words, quitting may be fairly easy, but staying quit tends to be a more formidable challenge. Many addicted individuals are able to stop for a few days, weeks, or months (sometimes even years), but many if not most fall back into using again despite their best intentions to quit for good. This experience is so common among addicted persons that it is safe to say that one of the most distinguishing features of an addiction- whether to drugs or something else- is the proclivity for relapse, especially during the weeks and months immediately following cessation of use.
This phenomenon was demonstrated quite dramatically in a study comparing relapse rates in cigarette smokers, alcoholics, and heroin addicts, Hunt, Barnett, and Branch (1971) found that relapse rates, based on the numbers of subjects who returned to using their substance of choice during successive weeks after quitting, were nearly identical to one another. This study suggests that the relapse dynamic cuts across different substances of abuse and may be a fundamental aspect of all addictive behaviors.
Marlatt and Gordon (1985) proposed a cognitive behavioral theory of relapse and formulated a set of specific relapse prevention (RP) strategies and interventions designed specifically to prevent a resumption of addictive behaviors. High relapse rates have long been the nemesis of attempts to treat alcohol and drug dependencies. But prior to the appearance of Marlatt’s work, relapse and its prevention had not been given much attention in addiction treatment programs. This can be attributed partly to clinicians’ fears that even raising the topic of relapse with patients might communicate an expectation of failure and promote a self-fulfilling prophesy of failure by giving patients “permission” inadvertently to use alcohol and drugs again. However, as the RP model became more widely accepted and its efficacy was supported by empirical research (Rawson, Obert, McCann, & Marinelli-Casey, 1993), addiction treatment programs began to incorporate RP strategies more routinely into their work with patients. During the past two decades, RP strategies have been applied to many different types of chemical and behavioral addictions (Washton & Boundy, 1989) and different substances of abuse, including alcohol (Gorski & Miller, 1986; Monti, Kadden, Rohsenow, Cooney, & Abrams, 2002), cocaine and other stimulants (Rawson, 1999; Rawson, Obert, McCann, Smith, & Ling, 1990; Washton, 1988, 1989), opioids (Zackon, McAuliffe, & Ch’ien, 1993), and nicotine (Fiore et al., 2000).
Although in addiction treatment programs, RP is often provided as a distinct component or phase of the program delivered in a group format, RP strategies are embedded in all good treatment of SUDs and are easily integrated into individual sessions provided in office-based practice. RP strategies rest on the premise that the factors that help to initiate abstinence from addictive behaviors are different from those needed to maintain abstinence. These techniques involve a combination of education, therapeutic confrontation, and skill development. Educating patients about the relapse process and helping them acquire problem-solving and affect management skills are essential components of the RP approach, as described more fully in this chapter.
In this phase of treatment, as in all other phases, one of the key elements in working with patients who have SUDs is the attitude and stance of the therapist towards these individuals. Therapists must be cognizant of their personal attitudes and beliefs about relapse and their countertransference reactions to patients who return to using alcohol and drugs despite the therapist’s best efforts to help prevent this from happening (Imhof, 1995; Kaufman, 1994). Negative, judgmental, controlling attitudes by therapists are likely to fracture the therapeutic alliance and cause patients to drop out of treatment prematurely. The therapist must never downplay the potential dangers of relapses or ignore them, but it is essential to show empathy, concern, and a positive problem-solving attitude that reframes relapses as avoidable mistakes, not tragic failures. A genuine belief that patients can learn from these mistakes and move forward in their recovery, must be communicated unequivocally.