RELAPSE PREVENTION & EARLY INTERVENTION STRATEGIES

RELAPSE PREVENTION & EARLY
INTERVENTION STRATEGIES

Windsor University School of
Medicine

Psychiatry Rotation
Consultant Psychiatrist – Dr. Sharon
Halliday

Presentation by:
OLADAPO SAMSON OLUWABUKOLA
RD

Brief Outline of Topic
 In the Substance Abusing or Dependent patient
 Relapse Prevention Strategies
 and Early Intervention Strategies
 In the Mentally ill patient
 Relapse Prevention Strategies
 and Early Intervention Strategies

Definition of terms
 Relapse – in a broader sense, is the return of signs and
symptoms of a disease after a remission.
 In the case of some psychiatric disorders, relapse is the
worsening of symptoms or the reoccurrence of unhealthy
behaviors, such as avoidance or substance use, after a
period of improvement.
 Relapse Prevention – A set of skills designed to reduce
the likelihood that symptoms of the illness in question will
worsen or that a person will return to an unhealthy
behavior, such as substance use.
 Skills include, for example, identifying early warning signs
that symptoms may be worsening, recognizing high risk
situations for relapse, and understanding how everyday,
seemingly mundane decisions may put you on the road to
relapse (for example, skipping lunch one day may make you
more vulnerable to get in a bad mood).
 Relapse can be prevented through the use of specific
coping strategies, such as identifying early warning signs.
 Early Intervention is simply bridging the gap between

Incidence
 According to recent statistics, relapse rates are
approximately 33% for people who gamble
pathologically (within three months of treatment),
90% for people who quit smoking, and 50% for
people who abuse alcohol. Within one year of
treatment, people struggling with obesity typically
regain 30% to 50% of the weight they lost.
 Relapse among people who commit sex offenses is
a constant safety concern for those in the
community. However, some statistics show that this
population has a very low rate of relapse. A recent
report by Robin J. Wilson and colleagues indicated
rates as low as 3.7% to 6.3%. This same report
stated that, among various criminal offenses, those
who commit sex offenses relapse at lower rates
than those who commit general offenses.

An Overview of the Prevention,
Treatment and Maintenance Triad!

Treatment and Maintenance
Protractor!
 In 1994, the Institute of Medicine commissioned an
investigation on Mental Health Interventions that
resulted in the development of the IOM Model
summarized in the IOM ―protractor.‖
 Levels of prevention are:
 Universal (all populations),
 Selective (e.g. populations with high risk factors),
 Indicated (individuals with an indication of a problem
such as early substance use).
 Early intervention is appropriate for indicated
individuals.

Treatment and Maintenance
Protractor!
 Prevention is a proactive process. This means that we anticipate a
problem and address it before it becomes a reality. We don't wait for a
problem to surface and then take action.
 Prevention also involves connecting people and resources with
innovative ideas, strategies, and programs. It is important to create
partnerships with all sectors of society to create a holistic prevention
agenda. The goal is to promote the concept of no use of any illegal
drug and no high-risk use of alcohol or other legal drugs.
 The overall goal of preventing substance abuse problems can be
reached by empowering individuals, families, and communities to take
action. This means helping them develop problem-solving skills and
the ability to manage difficult situations. It also means helping them
develop skills to cope with a situation while working to develop long-
term solutions.
 Prevention is different from intervention and treatment in that it is
aimed at general population groups with various levels of risk for
alcohol and other drug-related problems.

Pathogenesis – Reward Pathway
 A HEALTHY PATHWAY: The ‗reward pathway ‗
produces feelings of pleasure in response to naturally
enjoyable stimuli, such as food and sex. Connected to
other brain regions, including memory storage, the
pathway motivates us to repeat activities that
perpetuate the species.
 AN ADDICTED PATHWAY: Drinking or doing drugs
hijacks the reward pathway. But in genetically
vulnerable people, this altered state leads to an
addiction that they are, on their own, powerless to
overcome. Someone with an addiction can‘t talk
herself out of the compulsion any more than someone
can talk herself out of depression.

Pathogenesis
 Electrical and chemical signals pass between neurons in the
reward pathway that trigger the release of dopamine.
Dopamine is, among other things, the pleasure chemical.
 REWARD Activating the reward pathway is a gradual,
step-by-step process that first engages the five senses,
slowly triggering a dopamine release and making us feel
good. For example, in a hungry person the release would
start with the anticipation of food and decline as desire is
sated.
 IN CONTRAST Psychoactive substances such as alcohol,
methamphetamines and tobacco bypass the senses to
work directly on brain circuitry, launching the pathway to a
sudden high.
 THE HIGH The result provokes an exaggerated release of
dopamine, leading to an over-accumulation of the pleasure
chemical in the brain. This produces the feelings of
euphoria, increased energy, confidence and relaxation.

Pathogenesis
 THE LOWS The brain adjusts for the overabundance of
pleasure chemicals by reducing the number of receptors in an
effort to moderate dopamine levels.
 REPEAT USE The cravings motivate a user to seek drugs to
activate the reward pathway again, as memories connecting
to past highs feed and reinforce the urge. Research has found
that, even decades after a user has been clean, the mere
image of a drug can stimulate the pathway.
 DAMAGE Due to the shrinking numbers of dopamine
receptors, however, users require greater amounts of a drug
to achieve the same high. In turn, this again prompts the brain
to limit dopamine receptors, creating a vicious circle.
 ADDICTION The motivation to continue using drugs becomes
an addiction, driven more by fear of the negative emotional and
physical feelings associated with withdrawal than the desire to
be high. ―More and more experts agree … addictions are
themselves a mental illness. ‖ – Remi Quirion, professor of
psychiatry at McGill University and scientific director of the
Institute of Neurosciences for the Canadian Institutes of Health
Research

Pathophysiology
 Alcohol and Dopamine
 Drugs, such as nicotine, alcohol, opiates and marijuana work
indirectly by stimulating neurons that modulate dopamine cell
firing through their effects on various dopamine receptors.
Alcohol consumption produces very large and rapid
dopamine releases enhancing the excitatory effect of
dopamine in the nucleus accumbens (NAc) from ventral
tegmental neurons. Nerve signals are sent to the cortex,
where they are registered as "experience" and memories of
the rewarding effects of alcohol, such as its taste or the
feelings of relaxation after drinking. The brain responds to the
large dopamine release by reducing normal dopamine activity.
Eventually, the disrupted dopamine system renders the
alcohol dependent person incapable of feeling any pleasure
even from the substance they seek to feed their addiction.
Continual dopamine stimulation of the nucleus accumbens
region of the brain from repeated substance use also
strengthens the motivational properties of the substance,
which does not occur for natural reinforcers of dopamine.

Pathophysiology
 Specifically, it seems that the reinforcing effects of
substances of dependence are due to their ability to
surpass the magnitude (at least five- to tenfold) and
duration of the fast dopamine increases that occur in
the NAc when triggered by natural reinforcers such as
food and sex. It seems that increases in dopamine are
not directly related to actual reward but rather to the
prediction of reward, the ability to affect attention and
motivation, and the ability to facilitate conditioned
learning (i.e. neutral stimuli like an environment
associated with drinking can increase dopamine by
itself) and behavior. This conditioned learning and
behavior can lead to reward drinking or drinking
intended to produce a particular pleasurable outcome
by stimulating dopamine activity.

Pathophysiology
SUBSTANCE USE EFFECT
Caffeine increase adrenaline and dopamine
short term increase of dopamine, long
Nicotine term decrease of dopamine
(desensitized receptors)
Alcohol increase GABA, increase Dopamine
Marajuana THC binds to cannabinoid receptors
increase dopamine (blocks reuptake),
Cocaine
increase epinephrine, NE, and 5-HT
Amphetamines Increase dopamine
increases dopamine (blocks reuptake),
Ecstasy initially increases serotonin--2 days
later--decreases serotonin
Opiates bind to opiate receptors
stimulants caffeine and cocaine/amphetamines

RELAPSE, RELAPSE
PREVENTION & EARLY
INTERVENTION IN
SUBSTANCE DEPENDENT
PATIENTS

Relapse
 As earlier mentioned, relapse is the worsening of
symptoms or the reoccurrence of unhealthy behaviors,
such as avoidance or substance use, after a period of
improvement.
 Relapse is a process, it's not an event. In order to
understand relapse prevention you have to understand the
stages of relapse. Relapse starts weeks or even months
before the event of physical relapse. There are three
stages of relapse.
 Emotional relapse
 Mental relapse
 Physical relapse

Emotional Relapse
 In emotional relapse, the patient is not thinking about
using the drug, but his emotions and behaviors are
setting up for a possible relapse in the future.
 The signs of emotional relapse are:
 Anxiety
 Intolerance
 Anger
 Defensiveness
 Mood swings

Emotional Relapse
 Isolation
 Not asking for help
 Not going to meetings
 Poor eating habits
 Poor sleep habits
 The signs of emotional relapse are also the
symptoms of post-acute withdrawal.
 Understanding the modalities of post-acute withdrawal
makes it easier to avoid relapse, this is because the
early stage of relapse is easiest to pull back from. In
the later stages the pull of relapse gets stronger and
the sequence of events moves faster.

Emotional relapse – Prevention
strategies
 Relapse prevention at this stage has to do more of the
patient recognizing that he‘s in emotional relapse and
making conscious efforts to change behavior.
 Recognizing that he‘s isolating and remind himself to
ask for help.
 Recognizing sense of anxiety and practicing relaxation
techniques.
 Recognizing that sleeping and eating patterns are
slipping and practice self-care.
 Staying too long enough in emotional relapse brings
exhaustion and trying to break loose from
exhaustion takes patient into mental relapse.

Emotional relapse – Prevention
strategies
 Encourage patients about the following:
 Practice self-care. The most important thing you can do to
prevent relapse at this stage is take better care of yourself.
Think about why you use. You use drugs or alcohol to
escape, relax, or reward yourself. Therefore you relapse
when you don't take care of yourself and create situations
that are mentally and emotionally draining that make you
want to escape.
 For example, if you don't take care of yourself and eat poorly
or have poor sleep habits, you'll feel exhausted and want to
escape. If you don't let go of your resentments and fears
through some form of relaxation, they will build to the point
where you'll feel uncomfortable in your own skin. If you don't
ask for help, you'll feel isolated. If any of those situations
continues for too long, you will begin to think about using the
substance again. But if you practice self-care, you can avoid

Mental relapse
 In mental relapse there's a war going on in your mind. Part
of you wants to use, but part of you doesn't. In the early
phase of mental relapse you're just idly thinking about
using. But in the later phase you're definitely thinking about
using.
 The signs of mental relapse are:
 Thinking about people, places, and things you used with
 Glamorizing your past use
 Lying
 Hanging out with old using friends
 Fantasizing about using
 Thinking about relapsing
 Planning your relapse around other people's schedules
 It gets harder to make the right choices as the pull of
addiction gets stronger.

Techniques for Dealing with Mental
Urges
 Play the tape through. When you think about using, the
fantasy is that you'll be able to control your use this time.
You'll just have one drink. But play the tape through. One
drink usually leads to more drinks. You'll wake up the next
day feeling disappointed in yourself. You may not be able
to stop the next day, and you'll get caught in the same
vicious cycle. When you play that tape through to its
logical conclusion, using doesn't seem so appealing.
 A common mental urge is that you can get away with
using, because no one will know if you relapse. Perhaps
your spouse is away for the weekend, or you're away on a
trip. That's when your addiction will try to convince you that
you don't have a big problem, and that you're really doing
your recovery to please your spouse or your work. Play the
tape through. Remind yourself of the negative
consequences you've already suffered, and the potential
consequences that lie around the corner if you relapse
again. If you could control your use, you would have done
it by now.

Urges
 Tell someone that you're having urges to use. Call a friend,
a support, or someone in recovery. Share with them what
you're going through. The magic of sharing is that the
minute you start to talk about what you're thinking and
feeling, your urges begin to disappear. They don't seem
quite as big and you don't feel as alone.
 Distract yourself. When you think about using, do
something to occupy yourself. Call a friend. Go to a
meeting. Get up and go for a walk. If you just sit there with
your urge and don't do anything, you're giving your mental
relapse room to grow.
 Wait for 30 minutes. Most urges usually last for less than
15 to 30 minutes. When you're in an urge, it feels like an
eternity. But if you can keep yourself busy and do the
things you're supposed to do, it'll quickly be gone.

Urges
 Do your recovery one day at a time. Don't think about
whether you can stay abstinent forever. That's a paralyzing
thought. It's overwhelming even for people who've been in
recovery for a long time.
 One day at a time, means you should match your goals to
your emotional strength. When you feel strong and you're
motivated to not use, then tell yourself that you won't use
for the next week or the next month. But when you're
struggling and having lots of urges, and those times will
happen often, tell yourself that you won't use for today or
for the next 30 minutes. Do your recovery in bite-sized
chunks and don't sabotage yourself by thinking too far
ahead.
 Make relaxation part of your recovery. Relaxation is an
important part of relapse prevention, because when you're
tense you tend to do what‘s familiar and wrong, instead of
what's new and right. When you're tense you tend to
repeat the same mistakes you made before. When you're
relaxed you are more open to change.

Physical Relapse
 Once you start thinking about relapse, if you don't use
some of the techniques mentioned above, it doesn't
take long to go from there to physical relapse. Driving
to the liquor store. Driving to your dealer. Injecting
yourself, sniffing the powder, smoking the weed, and
lots more.
 It's hard to stop the process of relapse at that point.
That's not where you should focus your efforts in
recovery. That's achieving abstinence through brute
force. But it is not recovery.
 If you recognize the early warning signs of
relapse, and understand the symptoms of post-acute
withdrawal, you'll be able to catch yourself before it's
too late.

GOALS of Relapse Prevention
 The primary goals are to:
 Reduce use, limiting the number of users and the
types of substances used and
 Delay use in those that will use. This means that
delaying the start of use reduces harm during a
child‘s development and reduces risk for developing
addiction and abusive patterns of use.
 Preventing the transition from ―use‖ to ―abuse,‖ and
 Diminishing harm resulting from use. This does not
include only ways to make use safer (e.g., needle
exchanges, safer-drinking strategies), but also
movement into treatment and prevention of relapse
once treatment is completed.

Relapse Prevention
Broadly conceived, Relapse Prevention (RP) is a
cognitive-behavioural treatment (CBT) with a focus
on the maintenance stage of addictive behaviour
change that has two main goals:
 To prevent the occurrence of initial lapses
after a commitment to change has been made
and
 To prevent any lapse that does occur from
escalating into a full-blow relapse

The 5 Ws (functional analysis)
The 5 Ws of a person‘s drug use (also called a
functional analysis)
 When?
 Where?
 Why?
 With / from whom?
 What happened?

The 5 Ws (functional analysis)
People addicted to drugs do not use them at
random. It is important to know:
 The time periods when the client uses drugs
 The places where the client uses and buys drugs
 The external cues and internal emotional states that can
trigger drug craving (why)
 The people with whom the client uses drugs or the
people from whom she or he buys drugs
 The effects the client receives from the drugs ─ the
psychological and physical benefits (what happened)

Questions clinicians can use to learn the 5
Ws
 What was going on before you used?
 How were you feeling before you used?
 How / where did you obtain and use drugs?
 With whom did you use drugs?
 What happened after you used?
 Where were you when you began to think about
using?

Triggers & Cravings

Trigger Thought Craving Use

Triggers & Cravings

Trigger

Thought

Craving

Use

Cravings
Craving:
 To have an intense desire for
 To need urgently; require
Many people describe craving as similar to a hunger for
food or thirst for water. It is a combination of thoughts and
feelings. There is a powerful physiological component to
craving that makes it a very powerful event and very difficult
to resist.
Cravings or urges are experienced in a variety of ways by
different clients.
For some, the experience is primarily somatic. For example,
―I just get a feeling in my stomach,‖ or ―My heart races,‖ or
―I start smelling it.‖
For others, craving is experienced more cognitively. For

Coping Strategies to Cravings
Coping with Craving:
1. Engage in non-drug-related activity
2. Talk about craving
3. ―Surf‖ the craving
4. Thought stopping
5. Contact a drug-free friend or counsellor
6. Pray

Levels of Prevention
 Levels of prevention refer to where in the issue‘s
development the focus is: Before it starts, as it develops, or
after it has developed as a problem. They are typically
categorized as being primary, secondary, or tertiary.
 Primary prevention refers to activities undertaken prior to an
individual using. Most educational programs fit under this, but
so do programs designed to reduce drug availability (e.g., law
enforcement).
 Secondary prevention refers to activities applied during the
early stages of drug use and would encompass attempts to
prevent the transition from use to abuse. Early diagnosis,
crisis intervention, and economic changes such as increasing
alcohol taxes can decrease use and interrupt problematic
patterns of use.
 Tertiary prevention takes place at later (advanced) stages of
drug abuse and refers to actions to avoid relapse and maintain

Relapse Prevention Strategies
 Learn to willingly accept your mind – The first step to preventing
relapse is to understand and accept your mind. The presence of
whatever your mind produces such as
thoughts, beliefs, images, memories, feelings, or sensations is
temporary. Even if you don‘t like them, if you understand that the ideas
your mind creates will change, you do not need to act on what your
mind is thinking. This goes for urges and cravings. Note how they
simply come and go. They may seem like a problem, but avoiding them
through addictive behavior appears as the real problem in the long run.
Consider learning and practicing ―Mindfulness‖ to increase your ability to
―sit with‖ or ―ride out‖ urges without acting on them.
 Get psychological and medical help when needed – When
needed, seek and get psychological and medical help for psychiatric
illnesses and to learn better ways of coping with life events. Treatment
options for addiction are not limited to psychotherapy or support groups.
Consider using medications like Disulfiram (Antabuse®), Naltrexone
(ReVia®), Acamprosate (Campral®), etc., as a sign of positive action
and never as a mark of failure or inadequacy. Take your medications as

 Stimulus control – Begin to understand and practice stimulus
control. Change the ―activating events,‖ cues or ―triggers‖ which
can be changed. Accept those which can‘t be changed. They can
cue you, but they don‘t rule you.
 PIG Awareness – Live with awareness of the PIG (Problem of
Immediate Gratification). Learn about the PIG concept and of
natural penalties for slips, lapses and relapses. Carry, review and
update a Cost-Benefit Analysis or list of reasons for sticking to
your change plan.
 AID’s Awareness – Beware of Apparently Irrelevant Decisions
(AID‘s) that lead to high risk situations and using. Recovery
requires living with greater awareness or mindfulness.
 Beware of the “Abstinence Violation Effect” (the use of a
small slip as an excuse for a major relapse). Carry your how-to-
cope reminder instructions. Remember: ―One ‗swallow‘ does not
make a summer, nor a relapse.‖

 Find valued directions for your life – Develop a balanced
life with healthy indulgences and activities that can
substitute for unhealthy and undesirable addictive behaviors
is a good start. But in the long run we each need to decide
what is really important to be doing and commit ourselves to
acting on those values, taking us in our own valued life
directions.
 Take better care of yourself – TLC stands for Therapeutic
Lifestyle Change. Staying clean from drugs and alcohol or
abstaining from unwanted behaviors is part of living a
balanced life. Ample evidence exists that you can improve
your mental health through exercise, better diet and
nutrition (including Omega-3 found in fish oils), getting out
in nature, developing and maintaining good human
relationships, engaging in recreation and vital absorbing

 Learn and apply the SMART Recovery® Four Point
Program™ and Recovery Tools – Read, study, learn
and apply what you learn. If you don‘t help yourself,
who is going to help you? Self-help requires
determination and work on your part. That‘s why it‘s
called self-help.
 Reward yourself - Be sure to celebrate successes and
reward yourself for successful abstinence, compliance
with treatment and follow up.

Levels of Intervention
 Levels of Intervention are categorized as Universal,
Selective, or Indicated.
 Universal Intervention refer to efforts focused on every eligible
member of a community. These are programs aimed at an entire
group (rather than individuals) and include media campaigns,
policies that affect all members of a community equally, such as
taxes and laws, and educational programs provided to all
students regardless their risk level. Potential benefits are
expected to outweigh costs for everyone.
 Selective Intervention are more focused at a more systems
domain where higher-risk subgroups are targeted (e.g., children
from homes where family members have a history of drug use or
college students in general).
 Indicated intervention is individual-focused interventions and
represents the most time and financially-intensive programs.
These include prevention efforts targeted at individuals, for
example those who show signs of developing problems, e.g.,

Early Intervention
 When a problem has been identified, early intervention is
needed to prevent it from getting worse. A key issue is
motivating change. Motivation is not just the responsibility of
the problem drinker. Motivation is the result of an interaction
between the drinker and others. A therapist can increase
motivation for change through his or her interactions with the
person experiencing or at risk for substance usage and its
abuse.
 Understanding the reasons people stop using drug can help
in motivating change.

RELAPSE, RELAPSE
PREVENTION & EARLY
INTERVENTION IN
MENTALLY ILL
PATIENTS

Relapse, Relapse Prevention
 In the course of illness, relapse is a return of symptoms after
a period of time when no symptoms are present. Any
strategies or treatments applied in advance to prevent future
symptoms are known as relapse prevention.
 When people seek help for mental disorders, they receive
treatment that, hopefully, reduces or eliminates symptoms.
However, once they leave treatment, they may gradually
revert to old habits and ways of living. This results in a return
of symptoms known as relapse. Relapse prevention aims to
teach people strategies that will maintain the wellness skills
they learned while in treatment.
 Prevention of relapse in mental disorders is crucial—not only
because symptoms are detrimental to quality of life but also
because the occurrence of relapse increases chances for
future relapses. In addition, with each relapse, symptoms

Pathogenesis
 Relapse is a concern with any disorder, whether
physical or psychological.
 Psychological disorders can follow a similar
pattern, and certain psychological disorders tend to
have a higher rate of relapse than others.
 Addictive disorders, such as alcohol and drug
abuse, smoking, overeating, and pathological
gambling , are well known for high levels of relapse.
Many addictions involve a lifestyle centered around
the addictive behavior. In such cases, individuals must
not only discontinue the addictive habit, they must
also restructure their entire lives in order for changes
to last. Such vast changes are difficult at
best, approaching impossible in the worst scenarios.
For example, an individual with a drug addiction may
live in a neighborhood where drugs are prevalent but
may lack the resources to move.

Relapse Prevention
 For many types of disorders, initial treatment is often
effective at eliminating the unwanted behavior.
However, these effects are rarely maintained long-
term without some type of preventive planning.
Results of medications are similar; symptoms are
alleviated, but once the medication is
discontinued, symptoms return unless the individual
has had some type of training in coping with his or her
disorder and that training has been effective. There
are various forms of relapse prevention training. Most
follow a similar pattern with and employ the following
common elements:

Relapse Prevention
 Identifying high-risk situations: Symptoms are often initiated
by particular times, places, people, or events. For example, a
person with agoraphobia is more likely to experience
symptoms of panic in a crowded building. An essential key to
preventing relapse is to be aware of the specific situations
where one feels vulnerable. These situations are called
"triggers," because they trigger the onset of symptoms. While
people with the same mental disorder may share similar
triggers, triggers can also be highly individual. People tend to
react—sometimes unknowingly—to negative experiences in
their past. For example, a woman who was sexually abused as
a child may have negative emotions when in the presence of
men who resemble her abuser. Because some triggers occur
without conscious awareness, individuals may not know all
their triggers. Many prevention programs encourage
individuals to monitor their behavior closely, reflecting on
situations where symptoms occurred and determining what

Relapse Prevention
 Learning alternate ways to respond to high-risk situations: Once
triggers have been identified, one must find new ways of coping with
those situations. The easiest coping mechanism for high-risk
situations is to avoid them altogether. This may include avoiding
certain people who have a negative influence or avoiding locations where
the symptom is likely to occur. In some instances, avoidance is a good
strategy. For example, individuals who abuse alcohol may successfully
reduce their risk by avoiding bars or parties. In other instances,
avoidance is not possible or advisable. For example, individuals
attempting to lose weight may notice that they are more likely to binge at
certain times during the day. One cannot avoid a time of day. Rather, by
being aware of this trigger, one can purposely engage in alternate
activities during that time. Strategies for coping with unavoidable triggers
are generally skills that need to be learned and practiced in order to be
effective. Strategies include—but are not limited to—discussion of
feelings, whether with a friend, counselor, or via a hotline; distraction,
such as music, exercise, or engaging in a hobby; refocusing techniques,
such as meditation , deep-breathing exercises, progressive muscle
relaxation (focusing on each muscle group separately, and routinely
tensing then relaxing that muscle), prayer, or journaling; and cognitive
restructuring, such as positive affirmation statements (such as, "I am
worthwhile"), active problem solving (defining the problem, generating

Relapse Prevention
 Creating a plan for healthy living: Besides being prepared
for high-risk situations, relapse prevention also focuses on
general principles of mental health that, if followed, greatly
reduce the likelihood of symptoms. These include factors
such as balanced nutrition, regular exercise, sufficient sleep,
health education, reciprocally caring relationships, productive
and recreational interests, and spiritual development.
 Developing a support system: Many research studies have
demonstrated the importance of social support in maintaining
a healthy lifestyle. Individuals who are socially isolated tend
to display more symptoms of mental disorders. Conversely,
individuals with mental disorders tend to have more difficultly
initiating and maintaining relationships due to inappropriate
social behavior.

Relapse Prevention
 Preparing for possible relapse: Although the ultimate goal of
relapse prevention is to avoid relapse altogether, statistics
demonstrate that relapse potential is very real. Individuals need
to be aware that, even when exerting their best efforts, they
may occasionally experience lapses (one occurrence of a
symptom or behavior) or relapses (return to a previous,
undesirable level of symptoms or behavior). Acknowledging the
potential for relapse is important, because many people
consider a lapse or relapse as evidence of personal failure and
give up completely. In their widely acclaimed book for
professionals, Motivational Interviewing , William R. Miller and
Stephen Rollnick cite a study by Prochaska and DiClemente
that found that smokers typically relapse between three and
seven times before quitting for good. From the perspective of
Miller and Rollnick, each relapse can be a step closer to full
recovery if relapse is used as a learning experience to improve
prevention strategies. Although some argue that such a tolerant
attitude invites relapse, general consensus is that individuals
need to forgive themselves if relapse occurs and then move on.

Treatment
 As with any type of therapeutic treatment, success
of relapse prevention programs depend heavily on
motivation. If an individual is not interested in
making life changes, he or she is not likely to
follow a prevention plan. Individuals low in
motivation may need to participate in group or
individual psychotherapy before deciding
whether to enter a relapse prevention program.

PROCHASKA AND
DICLEMENTE’S STAGES
OF CHANGE MODEL

Prochaska and DiClemente’s Stages
of Change Model
 The stages of change are:
 Precontemplation (Not yet acknowledging that there is a
problem behavior that needs to be changed)
 Contemplation (Acknowledging that there is a problem
but not yet ready or sure of wanting to make a change)
 Preparation/Determination (Getting ready to change)
 Action/Willpower (Changing behavior)
 Maintenance (Maintaining the behavior change) and
 Relapse (Returning to older behaviors and abandoning
the new changes)

General Idea of the Model of
Change
 Behavioural change doesn‘t just happen in one step –
instead people tend to progress through a series of
steps. Cessation is a dynamic process.
 The pace is individual. Some stay at one step for the
rest of their lives.
 The decision to change and to move through the
steps must come from within the individual himself –
to force people to change is naive and can be
counterproductive.

Stage One: Pre-contemplation
 In the pre-contemplation stage, people are not
thinking seriously about changing and are not
interested in any kind of help. People in this stage
tend to defend their current bad habit(s) and do not
feel it is a problem. They may be defensive in the face
of other people‘s efforts to pressure them to quit. They
do not focus their attention on quitting and tend not to
discuss their bad habit with others. In AA, this stage is
called ―denial,‖ but at Addiction Alternatives, we do not
like to use that term. Rather, we like to think that in
this stage people just do not yet see themselves as
having a problem.

Stage Two – Contemplation
 In the contemplation stage people are more aware of the
personal consequences of their bad habit and they spend time
thinking about their problem. Although they are able to consider
the possibility of changing, they tend to be ambivalent about it.
In this stage, people are on a teeter-totter, weighing the pros
and cons of quitting or modifying their behavior. Although they
think about the negative aspects of their bad habit and the
positives associated with giving it up (or reducing), they may
doubt that the long-term benefits associated with quitting will
outweigh the short-term costs. It might take as little as a couple
weeks or as long as a lifetime to get through the contemplation
stage. (In fact, some people think and think and think about
giving up their bad habit and may die never having gotten
beyond this stage)
 On the plus side, people are more open to receiving information
about their bad habit, and more likely to actually use educational
interventions and reflect on their own feelings and thoughts

Stage Three -
Preparation/Determination
 In the preparation/determination stage, people have made
a commitment to make a change. Their motivation for
changing is reflected by statements such as: ―I‘ve got to do
something about this — this is serious. Something has to
change. What can I do?‖
 This is sort of a research phase: people are now taking
small steps toward cessation. They are trying to gather
information (sometimes by reading things like this) about
what they will need to do to change their behavior. Or they
will call a lot of clinics, trying to find out what strategies and
resources are available to help them in their attempt. Too
often, people skip this stage: they try to move directly from
contemplation into action and fall flat on their faces
because they haven‘t adequately researched or accepted
what it is going to take to make this major lifestyle change.

Stage Four: Action/Willpower
 This is the stage where people believe they have the ability to
change their behavior and are actively involved in taking steps
to change their bad behavior by using a variety of different
techniques. This is the shortest of all the stages. The amount of
time people spend in action varies. It generally lasts about 6
months, but it can literally be as short as one hour! This is a
stage when people most depend on their own willpower. They
are making overt efforts to quit or change the behavior and are
at greatest risk for relapse.
 Mentally, they review their commitment to themselves and
develop plans to deal with both personal and external pressures
that may lead to slips. They may use short-term rewards to
sustain their motivation, and analyze their behavior change
efforts in a way that enhances their self-confidence. People in
this stage also tend to be open to receiving help and are also
likely to seek support from others (a very important element).
 Hopefully, people will then move to the fifth stage.

Stage Five: Maintenance
 Maintenance involves being able to successfully avoid any
temptations to return to the bad habit. The goal of the
maintenance stage is to maintain the new status quo.
People in this stage tend to remind themselves of how
much progress they have made. People in maintenance
constantly reformulate the rules of their lives and are
acquiring new skills to deal with life and avoid relapse.
They are able to anticipate the situations in which a
relapse could occur and prepare coping strategies in
advance.
 They remain aware that what they are striving for is
personally worthwhile and meaningful. They are patient
with themselves and recognize that it often takes a while to
let go of old behavior patterns and practice new ones until
they are second nature to them. Even though they may
have thoughts of returning to their old bad habits, they

References
 http://www.recoverymonth.gov/~/media/Images/Files/Webcas
t%20Transcript/2011_April_DiscussionGuide-508.ashx
 www.AddictionsAndRecovery.org
 http://facultypages.morris.umn.edu/~ratliffj/psy1081/Sec5_pr
evention.htm
 http://alcohol.addictionblog.org/relapse-prevention-strategies/
 Freese CBT DMH Psychiatry 2009-04-09. Treatnet Training
Volume B, Module 3: Updated 10 September 2007
 http://pathwayscourses.samhsa.gov/aaap/aaap_6_pg3.htm
 http://www.minddisorders.com/Py-Z/Relapse-and-relapse-
prevention.html
 http://addictioninfamily.com/addiction_types/healthy-vs-
addicted-pathway/
 http://www.cpe.vt.edu/gttc/presentations/8eStagesofChange.pdf

RELAPSE PREVENTION & EARLY INTERVENTION STRATEGIES

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Viewers also liked

Viewers also liked (20)

Similar to RELAPSE PREVENTION & EARLY INTERVENTION STRATEGIES

Similar to RELAPSE PREVENTION & EARLY INTERVENTION STRATEGIES (20)

More from Оладапо Олувабукола

More from Оладапо Олувабукола (6)

RELAPSE PREVENTION & EARLY INTERVENTION STRATEGIES