Efficacy of relapse prevention: A meta-analytic review (original) (raw)
Related papers
Relapse Prevention: An Overview of Marlatt’s Cognitive-Behavioral Model
Alcohol Research & Health, 1999
Relapse prevention (RP) is an important component of alcoholism treatment. The RP model proposed by Marlatt and Gordon suggests that both immediate determinants (e.g., high-risk situations, coping skills, outcome expectancies, and the abstinence violation effect) and covert antecedents (e.g., lifestyle factors and urges and cravings) can contribute to relapse. The RP model also incorporates numerous specific and global intervention strategies that allow therapist and client to address each step of the relapse process. Specific interventions include identifying specific high-risk situations for each client and enhancing the client's skills for coping with those situations, increasing the client's self-efficacy, eliminating myths regarding alcohol's effects, managing lapses, and restructuring the client's perceptions of the relapse process. Global strategies comprise balancing the client's lifestyle and helping him or her develop positive addictions, employing stimulus control techniques and urgemanagement techniques, and developing relapse road maps. Several studies have provided theoretical and practical support for the RP model.
Relapse Prevention in Alcohol Use Disorder
Our therapeutic group infuses the psychoeducational group and relapse prevention group to address the theme "Relapse Prevention in Alcohol Use Disorder". Alcohol use disorder is characterised by uncontrolled use of alcohol to the point where it results in "adverse social, occupational, or health consequences" (National Institute on Alcohol Abuse and Alcoholis, 2020). When people that are faced with alcohol use disorder come into contact with treatment, for the recovery process to be effective, there is a need to incorporate relapse prevention as part of the recovery process. Relapse prevention for persons with alcohol use disorder will require consideration for the identification of emotional, mental, and physical factors that will help the person to uncover self-behaviours that could help identify future relapse while ensuring that target behaviour change is kept on track. Population Overview Our therapeutic group intervention is designed to provide psychoeducational activities and also to prevent relapse among adults aged 19 years and above with alcohol use disorder. The group is designed to be a heterogeneous mix of clients with all genders included. Eligibility into this group requires that members must have completed some outpatient or inpatient addictions Event Description Learning Assessment and Activities Minutes
Relapse Prevention Therapy: A Cognitive-Behavioral Approach
Relapse Prevention Therapy (RPT) was originally designed as a maintenance program for use following the treatment of addictive behaviors although it is also used as a stand-alone treatment program (Marlatt & Gordon, 1985; Parks & Marlatt, 1999). In the most general sense, RPT is a behavioral self-control program designed to teach individuals who are trying to maintain changes in their behavior how to anticipate and cope with the problem of relapse. Relapse refers to a breakdown or failure in a person's attempt maintain change in any set of behaviors. Like other cognitive-behavioral therapies, RPT combines behavioral and cognitive interventions in an overall approach that emphasizes self-management and rejects labeling clients with traits like "alcoholic" or "drug addict." The Relapse Process Relapse rates, usually measured as any use of a substance after a period of abstinence, are notoriously high. Research has demonstrated that the temporal patterning of th...
Addictive Behaviors, 2005
A pragmatic randomised trial examined the effects of Early Warning Signs Relapse Prevention Training (EWSRPT) on drinking in alcohol dependent persons with history of relapse. Participants were 124 abstinent alcohol dependent patients with a history of relapse (median five relapses) who entered the trial as they completed a 6-week day treatment programme. They were randomly allocated to receive either (1) Aftercare as Usual (AU) or (2) AU plus 15 individual sessions of EWSRPT using Gorski's protocol. Assessment carried out at entry to the trial, and 4, 8, and 12 months later, included self-report of drinking, blood tests (gamma glutamyl transferase, GGT; serum alanine aminotransferase, ALT) and measures of functioning (Alcohol Problems Questionnaire, APQ; SF36, Brief Symptom Inventory, BSI; Assessment of Warning-signs of Relapse, AWARE). Intention to treat analysis found no significant differences in continuous abstinence during the follow-up year (17% of 58 AU, 31% of 58 EWSRPT, p=0.08). The EWSRPT participants had a significantly lower probability of drinking heavily (74% of AU, 55% of EWSRPT, p=0.04), and significantly fewer days drinking 0306-4603/$ -see front matter D ( p=0.05) and heavy drinking ( p=0.04). These clinically worthwhile effects for a relapse-prone group justify further research into EWSRPT. D
What follows is the second of two chapters devoted to a cognitive-behavioral approach to the treatment of alcohol abuse and dependence. The goal of this chapter is to present an overview of a cognitive-behavioral approach to the problem of relapse, relapse prevention therapy (RPT).
Relapse prevention for addictive behaviors
Substance Abuse Treatment, Prevention, and Policy, 2011
The Relapse Prevention (RP) model has been a mainstay of addictions theory and treatment since its introduction three decades ago. This paper provides an overview and update of RP for addictive behaviors with a focus on developments over the last decade (2000-2010). Major treatment outcome studies and meta-analyses are summarized, as are selected empirical findings relevant to the tenets of the RP model. Notable advances in RP in the last decade include the introduction of a reformulated cognitive-behavioral model of relapse, the application of advanced statistical methods to model relapse in large randomized trials, and the development of mindfulnessbased relapse prevention. We also review the emergent literature on genetic correlates of relapse following pharmacological and behavioral treatments. The continued influence of RP is evidenced by its integration in most cognitive-behavioral substance use interventions. However, the tendency to subsume RP within other treatment modalities has posed a barrier to systematic evaluation of the RP model. Overall, RP remains an influential cognitive-behavioral framework that can inform both theoretical and clinical approaches to understanding and facilitating behavior change.
Relapse prevention: From radical idea to common practice
Addiction Research & Theory, 2012
The term ''relapse prevention'' drew great criticism and was not generally accepted when it was initially introduced in the early 1980s. The idea of talking with clients about the possibility of relapse was an incredibly radical idea until the pioneering work on relapse prevention by Alan Marlatt and his colleagues challenged the prevailing disease conceptualization of addictions and provided a revolutionary perspective that focused on understanding the factors contributing to and maintaining addiction. Today, relapse prevention is both a manualized treatment and a general treatment strategy that has been implemented in addiction treatment centers around the world. The theory and practice of relapse prevention has emerged as one of the most prominent and pervasive approaches in the treatment of addictive behaviors and stands as one of Alan Marlatt's most notable and longest-lasting contributions to the field. This article provides a review of the development, adaptation, and dissemination of relapse prevention over the past 30 years and also provides some ideas for the future of relapse prevention in research and treatment.
Alcohol and Alcoholism, 2008
The aim of this study was to compare the effectiveness of the sequential combined treatment (SCT) and treatment as usual (TU) in relapse prevention in a sample of alcohol-dependent patients, during 180 days of outpatient treatment. Method: 209 alcohol-dependent patients who could attend with an informant adult were randomized to either TU or SCT. The primary outcome measure was time to first relapse, defined as the consumption of any amount of alcohol during the 180 days of follow-up. Secondary outcome measures included maximum duration of continuous abstinence (MDCA), cumulative abstinence duration (CAD), quality of life (ARPQ) and blood test markers of alcohol consumption. Results: The SCT approach was more effective than TU. The Kaplan-Meier abstinent proportion at the end of the 180 days was 78% for the SCT group and 59% for the TU group (P < 0.01). The mean time to first relapse was 150 days for SCT and 123 days for TU (P < 0.01). The relative risk reduction of relapse was 62% for SCT after adjustment in multiple Cox regression (P < 0.01). SCT had more MDCA (P < 0.05) and more CAD (P < 0.05). Therapy sessions lasted slightly longer for SCT than TU (mean 13 min versus 10 min). Conclusions: SCT can result in better outcomes than TU in the outpatient treatment of alcohol dependence.
Mindfulness-Based Relapse Prevention for Substance Use Disorders: A Systematic Review
2015
This systematic review aims to synthesize evidence from trials of Mindfulness-Based Relapse Prevention (MBRP) to provide estimates of its efficacy and safety for substance use disorders (PROSPERO record CRD42015016380). In December 2014, we searched PubMed, PsycINFO, AMED, CINAHL, CENTRAL, Web of Science, and bibliographies of existing systematic reviews and included studies to identify English-language randomized controlled trials (RCTs) evaluating the efficacy and safety of MBRP—used adjunctively or as monotherapy—to treat substance use disorders in adults diagnosed with alcohol, opioid, stimulant, and/or cannabis use disorder. Two independent reviewers screened identified literature using predetermined eligibility criteria, abstracted prespecified study-level information and outcome data, and assessed the quality of included studies. Outcomes of interest included relapse, frequency and quantity of substance use, withdrawal/craving symptoms, treatment dropout, functional status, health-related quality of life, recovery outcomes, and adverse events. When possible, meta-analyses were conducted using the Hartung-Knapp-Sidik-Jonkman method for random-effects models. Strength of evidence was assessed using the GRADE approach. Six studies (reported in 20 publications) with 685 participants were included. Evidence was insufficient to determine whether MBRP effects differ by type of substance use targeted. There were no significant effects for MBRP as an adjunctive therapy or a standalone monotherapy for most outcomes; we did find some evidence in support of MBRP evaluated as an adjunctive therapy based on one RCT with regard to quality of life (SMD −0.65; CI −1.20 to −0.10; 1 RCT; very low quality evidence) and legal problems (SMD −1.20; CI −1.78 to −0.62; 1 RCT, very low quality evidence), yet these outcomes were not measured in any RCTs of MBRP as a monotherapy to serve as a comparison with effects for MBRP as an adjunctive therapy. Effects did not appear to systematically differ by identified comparison group. Across studies, we did not find differences between MBRP and any comparator (standard relapse prevention, cognitive behavioral therapy, or treatment as usual) for relapse (OR 0.49; CI 0.17 to 1.44; 4 RCTs) or other outcomes except for quality of life (as above). Three RCTs reported on adverse events: Two RCTs reported no adverse events, while the third reported that one participant receiving standard relapse prevention died, and another participant receiving MBRP was admitted to inpatient care. There were no statistically significant differences between MBRP and any of the comparators for substance use outcomes. The available evidence on MBRP effects is very limited, both in terms of the quantity of existing studies and the quality of the body of evidence. To provide firmer conclusions about the efficacy and safety of MBRP, future RCTs on this intervention are needed.