Relapse Prevention for Alcohol and Drug Problems

Witkiewitz, K. & Marlatt, G.A. (2004). Relapse Prevention for Alcohol and Drug Problems. American Psychologist, 59, 4, 224-235.

Relapse prevention (RP) is a cognitive-behavioral approach with the goal of identifying and preventing high-risk situations such as substance abuse, obsessive-compulsive behavior, sexual offending, obesity, and depression. Relapse is seen as both an outcome and as a transgression in the process of behavior change. An initial setback (lapse) may either translate into a return to the previous problematic behavior (relapse) or into the individual turning again towards positive change (prolapse). That individuals commonly experience lapses, and even relapses, is not contested. However, an understanding of this phenomenon continues to evolve.

Relapse is thought to be multi-determined, especially by self-efficacy, outcome expectancies, craving, motivation, coping, emotional states, and interpersonal factors. High self-efficacy, negative outcome expectancies, potent availability of coping skills following treatment, positive affect, and functional social support are expected to predict positive outcome. Craving has not historically been shown to serve as a strong predictor.

The article proposes a new reconceptualization of relapse as a multidimensional, complex system. Such a nonlinear dynamical system is believed to be able to best predict the data witnessed, which commonly includes cases where small changes introduced into the equation seem to have large effects. The model also introduces concepts of self-organization, feedback loops, timing/context effects, and interplay between tonic and phasic processes. The effectiveness and efficacy of RP for various goals is also discussed in the article.

(I, Doug Girard, am the author of this article, Relapse Prevention, and I release its content under the terms of the GNU Free Documentation License, Version 1.2 and later.)