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1 6-2 Short Paper: Relapse Prevention Planning Jolene Whittom PSY-624 Intersection of Law and Psychology Professor Holtgrave August 12, 2023
2 Relapse Prevention Plans Importance of Relapse Prevention Plans Drug and alcohol addiction is a daedal disorder, which is distinguished by intense and, sometimes, unmanageable drug and/or alcohol cravings, in conjunction with compulsively seeking the substance of choice and repeatedly using the substance even with the knowledge of the devastating repercussions of said use (1999). Alcohol and drug addictions, or substance use disorders (SUD), are empirically proven to be sustained disorders of the brain. Many addicts have a legitimate desire to stop using, however, they may not be able to due to psychological and corporal dependency; this populace may think they have control over their addiction and then be triggered leading them to start using their substance(s) of choice again, which is considered having a relapse. These relapses are a common and somewhat expected part of recovery. The National Institute on Drug Abuse (NIDA), reports that approximately 60% of the individuals who have a SUD relapse (2022). To prevent this, it’s imperative for clients in a dependence treatment facility to have a relapse prevention plan (RPP). The RPP was first conceptualized within the relapse prevention model (RPM) that was established in the 1970s, RPM has become one the central treatments in many psychotherapeutic sub-disciplines (Thakker & Ward, 2010). RPM also states that there are usually three parts to RAs relapse progression, which include emotional relapse, this involves the RA not disclosing feelings, not wanting to join sobriety meetings, evading familial units and close relationships, shirking self-upkeep; mental relapse, this involves the RA imagining consuming the substances they abuse, experiencing longings to use, emboldening previous substance use, finding reasons to relapse, and developing a plan for relapsing; and physical relapse, which is consuming the substance of choice one or more times (Thakker & Ward, 2010). With a relapse prevention plan, it affords the recovering addict (RA) the capacity to recognize and utilize acquired sobriety
3 coping skills towards triggering emotions and situations, which allow the RA to avoid a corporeal relapse (Thakker & Ward, 2010). Components of a Relapse Prevention Plan An RPP characteristically consists of ways in which the recovering addict can sanguinely react and handle triggering circumstances in which the individual could surrender to the urge of use drugs and/or alcohol. Creating a RPP is a tool the RA can employ when facing the dilemma of using or not using their substance of choice. For instance, if the RA is enduring a separation from their significant other, it can be a trigger for the RA and result in a relapse, However, having a RPP in place can support the RA in thinking of supplementary channels for their hurt and disappointment. The RPP can consist of attending an AA/NA meeting or multiple meetings daily, calling someone in your support network immediately, going to church or to see your spiritual advisor, redirecting the RAs energy in a hobby or physical activity. If the RA has already relapsed it is important for them to know who they will contact first, the role of that support person, and potentially, dependent on the relapse duration and intensity whether the RA should go to a meeting or go back to rehab (Thakker & Ward, 2010). The more comprehensive the RPP is, the more probable the RA can get themselves back on the road of sobriety. Typically, the RPP is devised with the addict’s recovery specialist who assists them in creating the most effectual support, this includes instructions for the RA on what actions to take should they relapse. The RPP employs a basic outline, which can be added to as the plan is individualized. The RPP includes identifying triggers, learning how to address hungering and compulsions, listing coping skills and practices, joining a sobriety consortium, putting in writing the motivations to refrain from using, and to read them to aid in resisting the craving until it passes (Thakker & Ward, 2010). The tools are not in a specific sequence; however, it can be
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4 beneficial to reread the list throughout the relapse prevention planning. Having the RA and the recovery specialist working together to make the RPP is vital because it facilitates identifying more triggers since distinguishing what causes a RA to consider relapsing is exactly how they can prevent it. It is also important to remember that if the recovering individual relapses, it does not indicate the treatment failed but it does indicate that the RPP needs to be modified (Thakker & Ward, 2010). These modifications could consist of entering an outpatient SUD treatment program, increasing their attendance at AA/NA meetings, and reminding the RA of their support network. A good support network is imperative for the RA because it acts as a safeguard, because the persons identified as part of the support network can include members of the RA sobriety consortium, like a sponsor, their church or spiritual support, or their friends and familial units. Oftentimes it helps the RA from relapsing when they can talk to someone in their support network to grasp that they are deserving of being loved and that they are not abandoned. SUD’s are continual, indicating they are psychological and health conditions that the RA must govern the entirety of their lives. Nonetheless, that does not suggest that addiction is untreatable or that any previous treatments failed. A relapse generally occurs owing to a sequence of circumstances and it does not occur immediately and usually involves more than one trigger; specified triggers can be the impetus to the RA using illicit substances or drinking again (Thakker & Ward, 2010). That is why the RPP is so important for the RA, because having a standing RPP can facilitate the RA’s coping skills that were developed to adders the specific trigger, which can help overt the RA from relapsing (Thakker & Ward, 2010). Also, it can be adjusted as time goes on and an individual identifies more triggers that they weren’t aware of when they created the plan.
5 Local Programs As a relatively new CPS social worker, RPP’s are a tool that I commonly discuss with my parents that are receiving SUD treatment. The first aspect that I discuss is if the RA has a sponsor, how many AA/NA meetings they plan on attending, their support network, their recover specialist, and any additional areas of support that they feel can support them in their sobriety. Being that Sacramento County is very large and diverse, they have the capacity and subsidies to offer substance abuse prevention and treatment facilities for SUD’s. The county contracts with an assortment of community-based service providers located throughout the region and these services comprises of prevention amenities, outpatient resources, intensive outpatient programs, medication-aided protocols, settings for managing withdrawal or detoxification, residential treatment, sober living environments, and community sobriety support meetings (2023). These resources are offered to youths, young adults, pregnant women, parents, adult persons, and elders, with the assurance that these services will be offered in a manner that reflects diverse cultures and in different languages at no cost (2023). To access this information people can go to the county website that will direct people to System of Care (SOC) for substance use treatment, who then conducts an over-the-phone evaluation and provides an assessment of their SUD treatment needs, SOC can then refer that person to an appropriate treatment provider. Being that I refer my parents to SOC on a regular basis, I can attest to their quick responses in scheduling over-the-phone evaluations, submittance of referrals, and response in general to people in need of help with their SUD. Limitations to Relapse Prevention Planning The biggest limitation to an RPP is the disease of addiction itself. RAs tend to have an all or nothing mindset and when a RA relapses, it instills this feeling of being a failure, especially if
6 this is not the first time they have relapsed. Whether it is being addicted to illicit substances, gambling, sex, food, shopping, etc., when an addict falls off the wagon, especially more than once, the fear of failing again is a huge barrier to the RA’s ability to regain sobriety from their addiction. In society, many people believe the worst F-word is the word Fuck, however, that is not true because the worst F-word is actually Failure. When a person believes that no matter what they try to accomplish, they will fail at it because that is their history, it gets more difficult to recover from a relapse, but that doesn’t mean it is impossible. It is important to remember in each person’s own journey as they age their progression of learning and maturing changes, with those changes comes a capacity to perceive new and old information differently. So, for an addict, a treatment they received prior may not have worked for them at that point in their life, however, now they may be able to discern it in a manner that does benefit them. Also, new SUD treatments are being researched and implemented on a continuous basis, so an efficacious treatment method may exist now that the RA can truly benefit from. Another limitation with the RPP occurs for RAs who have had longer durations of sobriety, these RAs are susceptible to distinct dangers of relapse that are not frequently observed in RAs in the initial stages of recovery. Clinical practice has proven RAs with longer durations of sobriety experience heightened risk for causes that result in their relapse in the growth stage of recovery, this stage is when the RA starts focusing on moving toward their future instead of being consumed by their past. Clinical understanding has shown that the growth stage typically begins 3 to 5 years after the RA ceased consuming their substance of choice and the RA feels they have squandered a fragment of their lifetime to substance dependence, and they don’t intend to occupy the remaining part of their life fixated on their sobriety; this is when the RA begins to decrease the AA/NA meeting attendance (Melemis, 2015). This is also the stage when the RA
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7 slowly begins to concentrate less on self-maintenance, they acquire further obligations to compensate for their lost time. Essentially, they are seeking to resume their old way of life devoid of utilizing drugs or alcohol and they cease practicing the beneficial coping skills that aided to their sobriety. Melemis (2015) posits that another mindset that can lead to relapse is the RAs perceive themselves as cured, they believe that they have a competent awareness of drugs and alcohol and, thus, believe they can control any potential a relapse or circumvent the adverse repercussions they have experienced before. The key aspect for a RA to remember is that they do not accomplish sobriety simply by not using drugs or drinking alcohol. Sobriety means establishing a new way of living that makes it easier for the RA not to use. If the RA does not transform aspects of their lives, then all the influences that influenced their dependence will still be around them and affecting their ability to remain sober (Melemis, 2015). Having an RPP facilitates the RA in knowing safe, sober, and reliable resources and coping tools for them to mitigate their relapse.
8 References Melemis S. M. (2015). Relapse prevention and the five rules of recovery. The Yale journal of biology and medicine, 88 (3), 325–332. Principles of Drug Addiction Treatment: A research-based guide. (1999). National Institute on Drug Abuse, National Institutes of Health Sacramento County. (2023). Substance Use Prevention and Treatment Services. Department of Health Services . https://dhs.saccounty.gov/BHS/Pages/SUPT/Substance-Use-Prevention- and-Treatment.aspx Thakker, J., & Ward, T. (2010). Relapse prevention: A critique and proposed reconceptualization. Behavior Change, 27 (3), 154–175. https://doi.org/10.1375/bech.27.3.154 U.S. Department of Health and Human Services. (2022, March 3). National institute on drug abuse (NIDA). National Institutes of Health . https://www.nih.gov/about-nih/what-we- do/nih-almanac/national-institute-drug-abuse-nida Yeom, H. (2011). Gender differences in treatment outcomes among participants in a mixed- gender substance abuse aftercare program. Social Work in Public Health, 26 (6), 557–576. https://doi-org.ezproxy.snhu.edu/10.1080/10911359.2011.534681