Module 14: Relapse Prevention

Transcript Module 14: Relapse Prevention

Module 14: Relapse Prevention

Objectives

• To recognise that maintaining change is difficult • To be able to identify things that help maintain change • To be able to identify what things trigger relapse • To be able to help someone develop a contingency plan

Dual Diagnosis Capabilities

Transtheoretical Model

Precontemplation Contemplation Preparation Action Maintenance

Osher Stages and Kofoed’s Four

Engagement/early persuasion Early persuasion Late persuasion Active Treatment Relapse prevention

Relapse Prevention

• Not experienced negative consequences of substances for 6 months • Maintaining abstinence (maintaining change)

Relapse Prevention

• Increased vulnerability as people are trying to cope without substances (or with reduced supply) and, for some people, being drug free means that their mental health problems may escalate. • Building on lifestyle changes that support stability in both mental health and substance use problems. – Housing – Work – Activity – Supportive peer groups • Relapse can’t be prevented, but risks of lapse can be minimised.

• Interventions aim to equip the person with: – an awareness of their own personal triggers to lapse.

– appropriate skills (e.g. assertiveness training – Self help groups.

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– contingency strategies to cope with such triggers.

Interventions For Relapse Prevention Stage

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Supported or independent employment Independent housing Family problem solving Self help Peer support groups Social skills training

Marlatt & Gordon Model of Relapse Prevention

Coping response Increased self-efficacy Decreased probability of relapse High-risk situation No coping response Decreased self-efficacy Positive outcome expectancy of behaviour Slip Rule Violation Effect – dissonance, conflict & self attribution – guilt & perceived loss of control Increased probability of relapse

Marlatt & Gordon Model

“Thanks but I have stopped smoking” Increased self-efficacy Decreased probability of relapse Going to pub, friend offers a cigarette “Oh go on then, I’ve had a bad day” Decreased self-efficacy I am too weak to resist and anyway, I’m in a really bad mood, this will cheer me up Slip smokes Rule Violation Effect – I am hopeless, I promised I would never smoke again. Might as well go an get a packet I’ll never be able to give up!

Increased probability of relapse

Risks for relapse

• • • • • •

Lifestyle Imbalance – “shouldn’t > want to”, “duty vs. Pleasure” Desire for Indulgence/ Feeling of Deprivation Cravings & Urges Rationalisation/ Justification Seemingly Irrelevant Decisions – series of “mini decisions” that take a person into a High-Risk Situation High-Risk Situation – “downers”, “rows” and “join the club”

Exercise 1: Your relapses

Discuss in pairs: (10 minutes) • Think about a behaviour you changed, that you relapsed back into (e.g. stopping smoking, starting regular exercise etc) • What triggered the relapse? • How did you feel about the relapse? • What happened as a result? • How did other people react to your relapse?

Relapse and Dual Diagnosis

• Relapse is highly likely • Change is very hard to maintain due to complexity of problems • Workers need to remain positive when lapses occur (Therapeutic optimism) • Help person to think about why it happened and what could help in the future

Exercise 2: Relapse for people with dual diagnosis

• Make two lists of things that: – trigger relapse in people with dual diagnosis – things that help prevent relapse • What do you and your service offer in terms of relapse prevention work, or who would you refer to for this?

Factors Associated with Recovery

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Positive factors: Social support networks Stable living situation Safe, structured environment Sense of purpose Practical help – job/hobbies Therapeutic discussion Insight & awareness Physical well-being Medication (maximum effectiveness, minimal inconvenience and side-effects Hope

• • • • •

Negative factors: Difficulties with any of the +ve factors Excessive stress Interpersonal conflict Substance use Persistent symptoms

Module 14: Relapse Prevention

Transcript Module 14: Relapse Prevention