Relapse Prevention Techniques Research Articles

Addictive Disorders: An Integrated Approach: Part Two-An Integrated Treatment

ABSTRACT In Part One of this two-part paper, a framework for understanding addictive disorders was presented that centered on the underlying addictive process: compulsive dependence on external actions as a means of regulating one's internal states. In Part Two, an integrated system for treatment of addictive disorders is outlined. This treatment system was designed to address both addictive behavior and the addictive process. Addictive behavior is addressed through behavioral symptom management, which includes relapse prevention and other cognitive-behavioral techniques. The addictive process is addressed through treatments that promote self-regulation and development of meaningful interpersonal connections. These include psychoanalytic (exploratory-expressive) psychotherapy and therapeutic group experience. The role of pharmacotherapy (medication treatment) also is discussed. The proposed treatment system brings together these therapeutic methods in one theoretically coherent, clinically unified approac...

Diagnosis and treatment of sexual addiction.

Following a brief introduction to the concept of addiction, the definition of and diagnostic criteria for sexual addiction are presented. A theoretical framework for treatment of sexual addiction is then outlined, based on an understanding of the underlying addictive process: the compulsive dependence on external actions as a means of regulating one's internal states. Effective treatment addresses both addictive behavior and the addictive process. Addictive sexual behavior is addressed through behavioral symptom management, which includes relapse prevention and other cognitive-behavioral techniques. The addictive process is addressed by enhancing self-regulatory functions through individual psychotherapy, therapeutic group experience, and pharmacotherapy (medication treatment, when indicated). An integrated system for treatment of sexual addiction, which brings together these therapeutic methods in one theoretically coherent, clinically unified approach, is outlined.

Relapse prevention strategies and techniques in sex therapy.

Research and clinical reports have documented the effectiveness of sex therapy interventions, but surprisingly little work has been done on how to maintain therapeutic gains and prevent relapse. This clinically oriented paper describes successful use of techniques, including keeping couple dates after the termination of formal sessions, use of six-month follow-ups for two years, continual utilization of nonintercourse pleasuring sessions, making sure lapses do not become relapses, setting realistic couple goals, initiating intimacy dates, and designing a generalization program. The clinician's goal is not simply to restore sexual functioning, but to help the couple build a satisfying sexual style which will continue to reinforce and energize the marital bond.

Nicotine Dependence—treatment for the 1990s

Physicians must recognize that nicotine is a powerfully addictive drug, and patients with nicotine dependence will have all the hallmarks of an addictive disorder. To successfully treat such patients will require compassion and patience on the part of the physician along with the realization that successful treatment will not be easy for most. As with other drugs, there is a very high relapse rate after initial abstinence and this can be discouraging for physicians and patients alike. Applying the principles outlined above in a stepped-care fashion will lead to greater success in dealing with this difficult problem. In the future, more effective treatment interventions will be developed and tested but it is unlikely that there will be a simple cure for this complex behaviour which is complicated by a powerfully addictive drug. Though not a cure-all, adjunctive pharmacologic therapy will play an increasingly important role as we learn how to better use existing agents and as others are shown to be effective. The key to the future is in the development of better relapse prevention techniques to enhance the rather remarkable short-term success rates that can be achieved with counselling and adjunctive pharmacologic therapy.

Treatment issues: towards a stepped-care model

The winds of change in health care in the US place us on the edge of a decade of opportunity to make a difference in prevention of chronic diseases related to lifestyle. The philosophy that prevention be fully integrated into mainstream health care practice is central to these winds of change. We must ensure the optimisation of health care practice in terms of quality of life, quality of services, access, and cost for all citizens. This presentation focuses on the essential elements to be considered in making wise choices about comprehensive treatment of tobacco dependence. My goals for this presentation are threefold: First, I will highlight general conceptual principles. Second, I will provide specific recommendations for optimal treatment of tobacco dependence using a stepped-care approach. Third, I conclude with an exploration of selected concerns about barriers to treatment implementation, service delivery, and to standards of care and cost- effectiveness. Even in this age of high technology communications, there’s a natural insularity among disciplines. Insularity in three broad domains has slowed progress toward a comprehensive approach to the treatment of all smokers in the population. The domains are the biological, clinical, and public health sciences. In the biological domain, genetic, biobehavioural science, and neurochemistry research is conducted. Concepts include genetic vulnerability and the key neuroregulatory adaptive mechanisms in tobacco dependence.1,2 In the clinical domain, many treatment programmes and relapse prevention techniques are researched.3,4 They range from nicotine replacement to behaviour modification to hypnosis.5,6 In the public health arena are the more macrodomains of public policy, organisational systems, epidemiology, economics, and health communications/education.7,8 We have to integrate key concepts from all three areas to do justice to a comprehensive treatment approach.9,10 Otherwise, important factors for optimal treatments …

Alcohol & drug abuse. The myth of the typical dual diagnosis patient.

Clinicians who treat patients with comorbid substance abuse and psychiatric disorders need both the expertise involved in treating each of the patient's individual disorders and the specialized knowledge required to help the patient cope with having more than one illness. Programs treating dually diagnosed patients should include sophisticated psychopharmacologic and psychotherapeutic treatment, offer the capability of safely detoxifying patients from a variety of different agents, include relapse prevention and 12-step techniques, and provide long-term treatment to help patients work through the difficulties they will experience at various stages of the recovery process. By combining excellent psychiatric and chemical dependence treatment, such specialized programs may be able to substantially improve the prognosis of a patient population that has traditionally been very difficult to reach.

Treating Cigarette Smoking in Methadone Maintenance Clients

Substance abusers in treatment have cigarette-smoking rates about three times that found in the general adult population, yet there is a paucity of published studies examining smoking-cessation programs for these clients. Accordingly, a behaviorally based smoking-cessation program for methadone maintenance clients was developed, and the efficacy of a methadone dose increase as a pharmacological adjunct was tested in a double-blind placebo-controlled study. While no significant difference between experimental and control subjects in reported abstinence rates was found, subjects receiving a methadone increase reported significantly more nicotine craving and other withdrawal symptoms during the first week of abstinence than did controls. Measures of smoking rates indicated that experimental subjects smoked significantly more than controls throughout the 10-week study period. Although the initial smoking abstinence rate of 65% was encouraging, most subjects returned to smoking by the end of the study period. These findings indicate that the development of smoking-cessation programs for methadone clients merits further study and that such programs should stress relapse prevention techniques tailored to the specific needs of this population. Also, while the use of a methadone dose increase as a pharmacological adjunct has not been found to be efficacious, other pharmacological strategies involving the use of nicotine should not be ruled out.

Relapse Prevention Strategies for the Treatment of Cocaine Abuse

A variety of promising pharmacotherapies, psychotherapies, and other treatments for cocaine abuse have recently been developed, many of which may facilitate the initiation of abstinence in cocaine abusers. This paper describes specific interventions and therapeutic strategies used in the treatment of cocaine abuse, adapted from Marlatt's theory of relapse prevention. These strategies extend Marlatt's primarily psychoeducational approach to address the unique difficulties presented in the treatment of cocaine abuse, which may include wide variations in patients' severity of abuse, available psychosocial resources, and coexistent psychopathology. This approach attempts to integrate relapse prevention techniques into a psychotherapeutic, rather than a purely psychoeducational approach, in order to enhance its effectiveness with cocaine abusers.

Neurobehavioral Treatment for Cocaine Dependency

Relapse prevention techniques have recently been incorporated into some nonpharmacologic models of chemical dependency treatment. The neurobehavioral model of cocaine dependency treatment establishes a clear timetable for recovery from cocaine dependency and focuses on four distinct areas of functioning. Strategies for addressing these areas of functioning include the use of relapse prevention methods and individual therapy procedures, family systems materials, 12-Step involvement, and urine testing. The model constructs a comprehensive framework for facilitating involvement in recovery activities that promote positive behavior change. The relapse prevention group component of the model is described, the use of a systematic relapse analysis procedure is presented, and an outline of plans for evaluating the model is discussed. The development of a comprehensive outpatient treatment model for treating cocaine dependency provides a standardized structure within which other treatment interventions (e.g., medication, acupuncture) could be evaluated.

An Eight-Week Group Treatment Program for Bulimia

The following paper outlines an eight-week group treatment program for bulimia that is within the scope of counseling services offered by most universities and colleges. It includes interventions that have been deemed necessary for recovery from the disorder such as cognitive restructuring, relapse prevention techniques, and family-of-origin work. Brief commentary is given to common themes and processes that emerge during the couse of this type of group.

Current status of the field: contrasting perspectives. The behavioral therapist's view.

Over the past decade, behavioral research and treatment approaches to alcohol problems have become an integral part of the alcohol field. Particularly valuable contributions have included the provision of alternative treatment methods and goals for nonaddicted problem drinkers, the development of relapse management and prevention techniques, the refinement of assessment and treatment outcome evaluation methodologies, and an overall enhancement of our understanding of the nature of alcohol problems. Viewing the progression of research studies over the last 10 years, it is evident that the behavioral perspective on alcohol problems has matured beyond ideological boundaries. The greatest strength of behavioral approaches relates to a reliance on the scientific method. Most likely, behavioral approaches will continue to contribute meaningfully to the field of alcohol studies.