Addiction A-Z

Relapse prevention therapy

If there’s one thing almost everyone who’s ever battled an addiction will tell you, it’s that overcoming it is usually an uphill battle.  Getting clean and sober isn’t easy, but the real challenge is maintaining their newfound sobriety once rehab ends and they’re back in the real world.

Millions of people go through alcohol and drug rehab programs every year.  Some are new to the process, often the result of either reaching rock bottom and realizing they can’t do it alone or finally succumbing to the relentless pressure of loved ones who fear the worst will happen if something doesn’t change – and soon.  Others are going through rehab for the second, third, or fourth time – mad at themselves for their inability to stay clean and sober despite all the treatment they’ve received.

It’s a well-known (and well-documented) fact that relapse rates following drug and alcohol treatment are disappointingly high.  However, one of the things that can significantly reduce a recovering individual’s chances of relapse is Relapse Prevention Therapy (RPT).

Relapse prevention therapy is a form of cognitive behavior therapy designed to help individuals successfully maintain their sobriety after they’ve completed their addiction treatment.  It’s designed to help them understand, anticipate, and manage their potential for relapse.  Although it was originally created to be an aftercare maintenance program, RPT can also be effectively used as a stand-alone treatment intervention.

History of RPT

Relapse prevention therapy was developed over 40 years ago by G. Alan Marlatt, PhD, and his colleague Judith Gordon, PhD, to treat alcohol abuse and addiction.  Dr. Marlatt taught psychology at the University of Washington and also directed the school’s Addictive Behaviors Research Center.  Their cognitive-behavioral model was the primary influence for Terence Gorski, an internationally recognized expert on addressing alcohol and drug use.  He has developed his own version of relapse prevention therapy, known as the CENAPS® Model of Relapse Prevention Therapy (CMRPT). Marlatt and Gordon’s treatment approach was later adapted to treat cocaine users by Yale psychiatry professors Bruce Rounsaville, MD, and Kathleen Carroll, PhD., and their colleague, Daniel Keller, PhD.

Numerous studies have been done on the effectiveness of RPT.  While much of the research has been conducted in the U.S., studies have also been done in Canada as well as Scotland.

Understanding Relapse

In their research on the process of relapse Marlatt and Gordon discovered the following:

  • The longer recovering clients are able to remain abstinence, the more confident they are in their ability to continue doing so
  • Their sense of competence continues to grow until they’re confronted with a “high-risk situation” that taps into their vulnerability
  • When this occurs, their sense of being competent and in control starts to wane, increasing their risk of relapse
  • The most common high-risk situations involved:
    • Negative emotional states
    • Pressure from others to drink or use
    • Relationship conflicts
  • If they haven’t established good coping skills to handle high-risk situations, their likeliness of relapsing greatly increased

These discoveries helped form the basis of RPT.

Primary Ares of Focus in RPT

There are three primary areas of focus in RPT:

  • Coping skills training
  • Cognitive therapy interventions
  • Behavioral techniques / lifestyle changes

Emphasis on Coping Skills Training

Relapse prevention therapy places a strong emphasis on helping recovering clients develop effective coping skills.  These skills equip them to handle high-risk situations and avoid a relapse.

High-risk situations like the ones listed above often appear to be the trigger for a client’s relapse. However, Marlatt and Gordon found that, in most cases, there was more to the story.  The high-risk situation was usually the proverbial straw that broke the camel’s back.  In other words, there were almost always earlier warning signs that, had the client known how to recognize them, should have been heeded – and could be in the future with proper training.  

This is why RPT emphasizes coping skills training.  This training helps clients:

  • Understand how a relapse is a process rather than an isolated event that occurs in response to an apparent trigger (i.e. a high-risk situation)
  • Develop effective ways to cope with cravings and urges when they appear
  • Identify potential high-risk situations (e.g. relationship conflicts, social pressure to drink or use, and painful or unpleasant emotions such as frustration, sadness, or anger)
  • Find effective ways to manage these situations
  • Learn to employ strategies to prevent a lapse from turning into a full-blown relapse
  • Learn how to minimize the negative consequences when a lapse occurs
  • Learn to make healthy lifestyle changes that support abstinence
  • Continue with their treatment following a relapse

CMRPT (Gorski’s relapse prevention therapy program) helps clients in similar, but slightly different ways [2].  It teaches them to:

  • Identify their current problems and consider the role those problems have contributed to their pattern of relapse
  • Consider the likely consequences that will occur down the road if they continue to relapse
  • Commit to making the necessary changes in their lifestyle and personality to prevent future relapse
  • Complete a detailed history of their substance use and their life, starting with childhood events
  • Identify things that may have triggered past relapses (using a relapse calendar)
  • Identify and understand their personal warning signs
  • Identify hidden warning signs that preceded prior relapses
  • Identify negative or distorted thoughts and feelings that hindered their resistance to relapsing
  • Identify the maladaptive and self-defeated feelings or behaviors, overwhelming urges, and irrational thoughts that underlie those warning signs
  • Consider anything (e.g. .thoughts, feelings, etc.) that may be interfering with their ability to manage the critical warning signs when they appear
  • Make necessary changes that will enable them to more effectively handle critical warning signs
  • Create a plan for recovery that supports and reinforces what they’ve learned and the changes they’ve made in therapy

As you can see, Gorski’s approach focuses a lot on learning to identify and effectively manage warning signs.

Cognitive Techniques

The cognitive aspect of RPT helps clients identify and change cognitive distortions that increase their vulnerability.  Denial is one of the most common cognitive distortions that addiction clients struggle with.  For example, they often deny their vulnerability to relapse – “I worked very hard in treatment and there’s no way on earth I’ll ever drink (or use) again!”  Once they succumb to temptation, the denial makes it very difficult – if not impossible – to take ownership of their actions.  In addition, they also tend to minimize and rationalize their use once they do relapse.

Cognitive therapy techniques also help clients reframe how they look at the process of change.  It’s common to perceive a relapse as a failure. RPT helps clients reframe this perspective by looking at each slip as a learning experience.  As with all learning in life, mistakes and setbacks are bound to occur before developing a sense of mastery over anything.   The same is true in relapse prevention.  Reframing things in a positive way helps thwart negative thoughts and feelings that increase the risk for relapse. For example, when a relapse does occur, it is reframed as a learning opportunity rather than a failure or an indication of a deep personal flaw.

Behavioral Techniques

Lifestyle changes that support and enhance recovery (and help prevent relapse) are part of the behavioral aspect of RPT.  Lifestyle changes include things like establishing a regular sleep schedule, exercising regularly to boost mood, reduce anxiety, and increase self-confidence, or practicing yoga or meditation regularly in order to calm the body and mind while promoting overall wellbeing and a sense of being grounded.

As you can see, cognitive skills training includes implementing cognitive and behavioral techniques (even though they’re discussed separately).

RPT and Other Treatment Programs

Relapse prevention therapy can be used in conjunction with other treatment interventions and programs, including:

  • Family therapy
  • Other types of psychotherapy, such as cue exposure therapy
  • Motivational interviewing
  • 12-step programs such as AA and NA
  • Employee assistance programs
  • Community reinforcement programs
  • Court diversion programs

Benefits of RPT

There are many benefits to addiction clients who participate in a relapse prevention therapy program.  Following are just some of the potential benefits:

  • Improved self-awareness
  • Decrease in cognitive distortions and negative thought patterns
  • Increased ability to identify the early warning signs that make them vulnerable to relapse
  • Improved coping skills that enable clients to effectively deal with negative emotional states and other potentially high-risk situations
  • Greater understanding of the relapse process
  • Ability to identify and challenge cognitive distortions
  • Ability to reframe negative, self-defeating thoughts and perceptions into ones that are positive, supportive, and empowering
  • Greater self-control
  • Increased ability to manage urges and cravings
  • Improved ability to make ongoing lifestyle adjustments that enhance wellbeing and support sobriety

Who Can Benefit from RPT?

First and foremost, anyone who is considering or being referred to RPT need to complete the detoxification process prior to starting therapy.  This is not usually an issue when RPT is used as an aftercare treatment program, but can be when it’s being used as a stand-alone treatment for drug and alcohol addiction.

Individuals who are able to benefit the most from RPT usually have at least average intellectual abilities.

Unfortunately, RPT isn’t a suitable form of treatment for all potential clients. Individuals who may not be a good fit for RPT include those who:

  • Have significant cognitive limitations
  • Have untreated impulse control problems
  • Have any disorder or condition that would make it difficult for them to work in a group format or handle a structured approach to therapy

Therapist’s Qualifications for RPT

Therapists who are trained in and qualified to provide relapse prevention therapy come from a variety of professional backgrounds.   Some are mental health professionals including psychologists, licensed professional counselors, and clinical social workers.  Other RPT therapists lack the formal training and degree in a mental health-related field, but are certified addiction counselors.  Their experience working specifically in the addiction field can be very helpful in their work as RPT therapists.  Regardless of educational background, the most skilled and effective RPT therapists typically have a significant amount of training and experience with both cognitive behavioral therapy and addiction treatment.

If they’re working with a specific addiction population, such as individuals with an addiction to cocaine, it’s imperative that they understand the challenges and issues specific to that particular form of chemical dependency.  While there are many areas of overlap when it comes to the problems and challenges associated with any substance addiction, there is still some variance from one substance to the next.

Finding a Relapse Prevention Therapy Provider

Relapse prevention therapy is often provided in connection with drug and alcohol treatment programs.  One of the best ways to find a qualified RPT provider is to simply do an online search for relapse prevention therapy [your city].   Once you find one or more options, contact the facility or therapist and let them know you’re interested. They’ll want to know a little about your addiction and treatment history.  If you’re already in treatment or have completed a treatment program, and neither offers RPT, someone from the program may be able to refer you to an RPT therapist or provider in your area.

If you have problems with substance abuse or addiction, have recently completed addiction treatment and want to do everything possible to ensure a lasting recovery, or have been in and out of treatment due to a pattern of relapse, RPT is certainly worth considering.  Regardless of where you’re at in your addiction recovery, you already know or have experienced the often painful consequences a relapse can cause.  You may already know some of your triggers and areas of vulnerability, but without developing effective coping skills and making appropriate changes in the way you think and behave, that knowledge alone is rarely sufficient to keep you from relapsing when faced with challenging situations.

Relapse prevention therapy can help you get on the road to recovery, help you stay on the road once you’re there, and break the pattern of relapse that may have been interfering with your ability to stay clean and sober despite multiple attempts at treatment.  You deserve all the benefits and joys of a successful, lasting recovery!

References:

[1] http://nationalpsychologist.com/2000/09/relapse-prevention-therapy-a-cognitive-behavioral-approach/10491.html

[2] http://www.tgorski.com/clin_mod/rpt/rpt.htm

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