May 2004

What are the basic components of relapse prevention?

Relapse prevention is considered currently an essential phase of most treatment intervention for mental health and substance use disorders. Relapse prevention can take many forms but most simply put, it is any supportive activity that helps maintain positive behavior change.   Professionals, families, and recovered individuals all state that in order to maintain the positive changes needed to sustain a healthier lifestyle, "it takes long-term continued attention and care." This long-term care is most beneficial when different types of support such as medication and self-help groups are combined (i.e., alcoholics anonymous, narcotics anonymous, dual disorder recovery associations, individual or group therapy, after care groups, and drug testing).  

The science of relapse prevention is grounded on a broad theoretical, practical, and research base. The most successful relapse prevention techniques are quite clear and factor relapse into the recovery process.   There are warning signs and lifestyle actions that can signal when a person is in relapse well before the actual behavior occurs, such as drinking alcohol or smoking marijuana. For many problems such as substance use, there are two types of causes that contributeto relapse: immediate determinants and covert antecedents (Marlatt and Gordon, 1985).  

Immediate determinants are the high risk situations (the external or internal triggers that lead to picking up substances), as well as individualcoping skills. Covert antecedents are the urges, cravings, and lifestyle habits already in place that lead to negative behaviors. An example of a covert antecedent is a family fight that leads to anger. The immediate external trigger might be the six pack of beer in the refrigerator, but the actual relapse began when the family fight created anger and a subsequent craving and urge to medicate with alcohol. The model suggests that if the individual or child had developed a healthy way to express anger, maybe even using physical activities and developing some friendships, the anger would not lead to the urge to smoke but rather the use of the healthier stress outlet.