Although the RP model considers the high-risk situation the immediate relapse trigger, it is actually the person’s response to the situation that determines whether he or she will experience a lapse (i.e., begin using alcohol). A person’s coping behavior in a high-risk situation is a particularly critical determinant of the likely outcome. Thus, a person who can execute effective coping strategies (e.g., a behavioral strategy, such as leaving the situation, or a cognitive strategy, such as positive self-talk) is less likely to relapse compared with a person lacking those skills. Moreover, people who have coped successfully with high-risk situations are assumed to experience a heightened sense of self-efficacy (i.e., a personal perception of mastery over the specific risky situation) (Bandura 1977; Marlatt et al. 1995, 1999; Marlatt and Gordon 1985). Conversely, people with low self-efficacy perceive themselves as lacking the motivation or ability to resist drinking in high-risk situations.
Therapeutic effects of antidepressant medications in bulimia nervosa are thought to be related to their capacity to restore more normal signaling patterns in serotonergic pathways. Family studies have shown that there is an increased rate of eating disorders in first-degree relatives of individuals with anorexia nervosa and bulimia nervosa. Similarly, twin studies have shown a higher concordance for the eating disorders in monozygotic twins in comparison to dizygotic twins. These studies suggest that heritable biological characteristics contribute to the onset of the eating disorders, although the potential role of familial environmental factors must also be considered. In order to understand AVE, it is important to realize the difference between a lapse and relapse. Again, many experts agree that a one-time lapse into using drugs or alcohol does not equally relapse.
Cognitive Factors in Addictive Processes
In extreme cases and in many cases of opioid addiction, this method has proven unreliable, as drugs such as Buprenorphine may be prescribed to help people abstain from the drug they misuse, allowing them to maintain a functional lifestyle. Our analyses also shed light on the role played by NRT assignment, demonstrating the extent to which nicotine patch treatment prevents progression across a series of repeated lapses. Shiffman, Scharf, et al (2006) showed that treatment with high-dose abstinence violation effect definition patch impeded overall progression from the first lapse to relapse. The present analysis provides additional detail, demonstrating that active patch slowed progression from each lapse to the next, but that this protective effect was limited to the first 8–10 lapses. This suggests that smokers should be encouraged to remain on treatment even after they have lapsed, at least through the first 8–10 lapses, while persisting in efforts to recover abstinence as soon as possible.
Treatment took a behavioral-psychoeducational approach with strong emphasis on providing a supportive group environment (e.g., Brown, 2003). Relapse prevention initially evolved as a calculated response to the longer-term treatment failures of other therapies. The assumption of RP is that it is problematic to expect that the effects of a treatment that is designed to moderate or eliminate an undesirable behaviour will endure beyond the termination of that treatment. Further, there are reasons to presume a problem will re-emerge on returning to the old environment that elicited and maintained the problem behaviour; for instance, forgetting the skills, techniques, and information taught during therapy; and decreased motivation5. Recent studies have also explored whether abnormalities in metabolic signals related to energy metabolism contribute to symptoms in the eating disorders. Several studies have suggested that patients with bulimia nervosa may have a lower rate of energy utilization (measured as resting metabolic rate) than healthy individuals.
Lapse-activated consumption
The therapist and patient collaboratively review the advantages/disadvantages of engaging in substance use or addictive behaviour. Several behavioural strategies are reported to be effective in the management of factors leading to addiction or substance use, such as anxiety, craving, skill deficits2,7. 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 lapse6.
- Relapse is a process in which a newly abstinent patient experiences a sense of perceived control over his/her behaviour up to a point at which there is a high risk situation and for which the person may not have adequate skills or a sense of self-efficacy.
- In CBT for addictive behaviours cognitive strategies are supported by several behavioural strategies such as coping skills.
- Miller and Hester reviewed more than 500 alcoholism outcome studies and reported that more than 75% of subjects relapsed within 1 year of treatment1.
- AA was established in 1935 as a nonprofessional mutual aid group for people who desire abstinence from alcohol, and its 12 Steps became integrated in SUD treatment programs in the 1940s and 1950s with the emergence of the Minnesota Model of treatment (White & Kurtz, 2008).
- Parametric survival analyses that allowed for recurrent events within-subjects treated each lapse episode as the beginning of an interval during which the participant was at risk for having another lapse, and examined how AVE responses to each lapse affected the likelihood of progression.
- This is an important measure, but it doesn’t do much for relapse prevention if we don’t forge a plan to deal with these disturbances when they arise.
High-risk situations are related to both the client’s general and specific coping abilities. Cognitive behaviour therapy is a structured, time limited, psychological intervention that has is empirically supported across a wide variety of psychological disorders. CBT for addictive behaviours can be traced back to the application of learning theories in understanding addiction and subsequently to social cognitive theories. The focus of CBT is manifold and the focus is on targeting maintaining factors of addictive behaviours and preventing relapse. Relapse prevention programmes are based on social cognitive and cognitive behavioural principles. More recent developments in the area of managing addictions include third wave behaviour therapies.
