Transcript Retaining Sobriety

CHAPTER 10:
Retaining Sobriety
Substance Abuse Counseling: Theory and Practice
Fifth Edition
Patricia Stevens
Robert L. Smith
Prepared by:
Dr. Susan Rose, University of the Cumberlands
Overview of Chapter
●
Introduction
●
Determinants of Relapse
●
Models of Relapse Planning and
Management
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Self-Help Recovery Organizations:
Adjuncts to Professional Intervention
Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e
© 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved
10-2
Introduction
●
Definitions
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Recovery: not only abstinence from mind-altering
chemicals or nonproductive compulsive behaviors but
also as changes in physical, psychological, social,
familial, and spiritual areas of functioning.
Relapse has many definitions.
1. A breakdown or setback in a person’s attempt to
change or modify a target behavior.
2. The act or an instance of backsliding, worsening, or
subsiding.
3. A recurrence of symptoms of a disease after a period
of improvement.
4. The continuous return to ATOD use or to the
dysfunctional patterns of compulsive behavior.
Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e
© 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved
10-3
Introduction
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Relapse can be seen in two dimensions:
 The “event”
 The “process”
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Definitions
 Lapse: the initial return to use after a period of
sobriety.
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Concept Change
 Most now view relapse as a normal part of the
recovery process and as a learning experience
for the recovering individual.
Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e
© 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved
10-4
Determinants of Relapse
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Environmental
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High-risk situations threaten the client’s control and
increase the likelihood of return to use:
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Negative emotional states
Interpersonal conflict
Social pressure
Environmental stimuli
Craving
Behavioral
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Clients who have few or no coping skills to respond
to these high-risk situations are more likely to
return to substance use.
Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e
© 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved
10-5
Determinants of Relapse
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Cognitive Variables that affect relapse
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Individual’s attitude toward sobriety (motivation to quit or
not)
Individual’s perception of his/her ability to cope (selfefficacy)
Expectation of relapse
Affective
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Research identifies negative affect as the major cause of
relapse.
Two very strong emotions that must be dealt with in
recovery are shame and guilt.
Recognizing that positive emotional states also create stress
is imperative when working with this population.
Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e
© 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved
10-6
Determinants of Relapse
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Interpersonal Determinants
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The lack of a supportive family or social network has been
highly correlated with a return to substance use.
The family is usually the primary relationship and, therefore,
the relationship that is most harmed in the process of abuse
and dependency.
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If family is not involved in recovery process, results
can be devastating.
Other components that may create a problem in recovery:
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Work
Leisure Time
Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e
© 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved
10-7
Models of Relapse Planning and
Management
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The Disease Model
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Developed by Jellinek in the 1940’s
Alcoholics Anonymous (AA) adopted this model of
addiction recovery
Developmental Models
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Gorski views addiction as a chronic and progressive
disease The Gorski Model’s Six steps:
1.
2.
3.
4.
5.
6.
Transition
Stabilization
Early recovery
Middle recovery
Late recovery
Maintenance
Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e
© 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved
10-8
Models of Relapse Planning and
Management
●
Developmental Models
The model assumes that change is intentional on
the part of the individual.
 The Stage Model’s Stages of Change
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1.
2.
3.
4.
5.

Precontemplation
Contemplation
Determination
Action – When client becomes abstinent for first time
Maintenance
This transtheoretical model assumes that change is
cyclical and dynamic.
Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e
© 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved
10-9
Models of Relapse Planning and
Management
●
Cognitive-Behavioral/Social Learning Model
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Social Learning Theories
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Primary learning principle is operant conditioning.
Another social theory perspective examines the effect
of psychological stress on substance use.
Important of self-efficacy in social learning theory
Cognitive Behavioral Model
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Premise of Relapse Prevention (RP) model is that
individuals attempt to stop or reduce substance use
will face risks of relapse.
o Relapse is seen as a learning tool.
Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e
© 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved
10-10
Models of Relapse Planning and Management:
Cognitive Behavioral Model cont.
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Cognitive Behavioral Model
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Ward and Stewart’s Good Lives Model recognizes 10
primary good that every individual needs to pursue:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Healthy living
Knowledge
Excellence in play and work
Excellence in agency
Inner peace
Friendship
Community
Spirituality
Happiness
Creativity
Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e
© 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved
10-11
Models of Relapse Planning and
Management: Cognitive Behavioral
Model cont.
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Cognitive Behavioral Model
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Abstinence Violation Effect (AVE)
create cognitive dissonance
o
Involves self-attribution effect
Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e
© 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved
10-12
Self-Help Recovery Organizations:
Adjuncts to Professional Intervention
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Alcoholics Anonymous Model
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Giving up control to gain control
Making Amends
Group Participation
AA Outcome Studies
Spirituality as a Resource
 Spirituality can be a helpful resource for understanding
a past lifestyle of substance abuse and for making
decisions about a future free from addiction.
Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e
© 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved
10-13
Self-Help Recovery Organizations:
Adjuncts to Professional Intervention

AA-Associated 12-Step Programs
 All are based on the AA philosophy and use a variation
of the 12 steps of AA.
 The difference is their scope.

Moderation Management (MM)
 Based on the cognitive behavioral model
 Views moderate use as success
 Specific Guidelines for participation in the program
(Table 10.2, page 279)
 Harm Reduction Model
Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e
© 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved
10-14
Self-Help Recovery Organizations:
Adjuncts to Professional Intervention
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Rational Recovery
 Developed as an alternative for individuals who had
difficulty with the spiritual aspect of AA
 Based in cognitive-behavioral theory on the work of
Albert Ellis
 Used framework of Rational Emotive Therapy

Secular Organizations for Sobriety/Save Our
Selves (SOS)
 Claims to be a self-empowerment approach based on the
belief that sobriety is an issue apart from any other
issues in the person’s life.
Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e
© 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved
10-15
Self-Help Recovery Organizations:
Adjuncts to Professional Intervention

Women for Sobriety (WFS)
 A group founded by women for women
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Self-help for Dually Diagnosed Persons
 Nearly 50% of persons diagnosed with a mental illness
have a co-existing substance abuse or dependence
disorder.
 Self-help groups that have been started to help dually
diagnosed individuals:
 Double Trouble in Recovery
 Dual Recovery Anonymous
 Special AA meetings for alcohol-dependent individuals
with a mental disorder
 SMART
Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e
© 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved
10-16
Self-Help Recovery Organizations:
Adjuncts to Professional Intervention

A Well-Rounded Life with Joy
 Addicts must learn to manage their
“pleasure threshold”
 Ward and Stewart’s “Good Lives Model”
Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e
© 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved
10-17