Relapse prevention is aimed at building the capacity of a young person and others involved in their care to maintain change. Daley and Marlatt (1997) identify that this begins with making lifestyle changes to reduce the need for alcohol or drugs and undertaking healthy activities. They specify the need for clients (and those involved in their care) to develop coping skills for handling high-risk situations and relapse warning signs. Relapse prevention also involves preparing young people for managing a lapse or a slip to prevent progression to a relapse. Where relapse occurs it is treated as a natural part of the change process.
Relapse prevention provides a framework for a young person to understand their individual circumstances that may hinder the recovery process and put them at risk of relapse. It is a process of identifying and developing strategies and skills to minimize the risk of this happening and enabling the young person to cope if lapse or relapse occurs. This involves empowering the young person to develop greater insight into situations in which managing recovery may be more difficult and develop other ways to cope in these situations.
An important focus of relapse prevention is to assist the young person in viewing lapse and relapse as a mistake they can learn from rather than a behaviour for which they need to be judged or punished (Miller 2010). Relapse prevention work is usually a combination of education, skills development and therapeutic confrontation.
Relapse is very common, however not inevitable. Relapse does not mean treatment isn’t working. Nor does it mean that the young person isn’t trying or will never be able to live without the presence of substances in their life. Predominantly, substance use has worked for a young person at some point in time and on some level, usually for short-term gain, and this makes ceasing (or reducing) use difficult.
At its most simple, relapse prevention training is contingency planning. It has been likened to the development of fire prevention strategies or the practicing of fire drills. Clear, carefully thought out plans that are relevant to a young person’s life, are put in place, and rehearsed such that they become easy to implement when risky situations arise (YSAS 2002).
The underlying assumptions of relapse prevention are:
- From time to time, young people use substances to cope with a range of factors in their lives
- Young people are able to exercise control and make choices
- Young people require the necessary skills and support in order to exercise control and make choices.
The role of the practitioner is to help the young person understand their potential individual risk factors for relapse while simultaneously empowering them to believe they can manage these difficult situations effectively. The practitioner can work with the young person to develop insight and identify alternative skills and strategies that can be implemented during difficult situations that may lead to unwanted substance use.
Lapse and Relapse
Lapse (or slips) and relapse are commonly used terms in relapse prevention.
Relapse involves regression from action or maintenance to an earlier stage and is evidenced by a return to previous problematic patterns of behaviour. Relpase is both an outcome and a process that at some stage involved an initial setback or ‘lapse’ (Witkiewitz & Marlett, 2004).
A lapse is a brief or limited incident of substance use. This brief return to substance use does not constitute a relapse. Further, lapse does not automatically lead to relapse but is a step in that direction.
Why is relapse prevention important in youth AOD work?
Relapse prevention work is very important during recovery because:
- Relapse is extremely common;
- Behaviour change takes time and occurs via learning from mistakes, and
- It is not to be assumed that just because a behaviour change has occurred that it will be continuously maintained.
The goals of relapse prevention are to:
- Understand that relapses don’t happen by accident. There is a process. If the young person understands how this individually applies to them they are able to learn skills and practice contingencies to reduce the likelihood and impact of relapse;
- Identify personal high risk situations for using and to learn new coping strategies, and increase awareness of protective behaviours;
- Understand that having a balanced lifestyle is a key to making and maintaining changes;
- Learn that relapse doesn’t mean the end of the world but that one can do something different, cope in another way and learn for the experience. Therefore, empowering the young person to have more control over their life and substance use, and
- Develop insight into how one may unwittingly sabotage their desire to change (for example, seemingly irrelevant decisions or the abstinence violation effect) and that with awareness, vigilance and other strategies the risk of relapse can be minimised.
There are some key factors that will influence a young person’s susceptibility to lapse or relapse. These will be referenced several times during this module as they can inform treatment planning and identification of coping strategies that will assist in relapse prevention. Key factors include:
- The strength of the original resolution;
- The degree of attachment to the substance using lifestyle;
- The young person’s capacity to cope and exercise control in high-risk situations, and
- The strength of support and resources the young person has.