Coping

 and  Relapse  Preven1on  

Week  6  
Psychological  Treatment  for  
Substance  Use  Disorders  
 Coping  Skills  
•  CBT  à  Teach  skills  to  handle  challenging  
situa1ons  
•  A  useful  tool  to  complement  other  treatments  
•  Evidence  to  support  skill-­‐enhancing  
approaches  
•  Can  be  offered  in  a  group  format  
•  Menu  of  skill-­‐learning  op1ons  
   
 Coping  Skills  
•  Job  finding  
•  Social  skills  
–  Asser1ve  communica1on  
–  Ability  to  listen  to  others  and  reflect  back  
–  Non-­‐verbal  communica1on  
•  Emo1on  Regula1on  
–  STORC  model  
–  Self-­‐monitoring  
–  Mood  and  anger  management  
 Coping  Skills  (Con’t)  
•  Behavioral  Self-­‐Control  
–  Teaches  common  principles  of  learning  
•  Posi1ve  reinforcement  
•  Self-­‐regula1on  
–  Clear  and  specific  goals  
–  Self-­‐monitoring  
–  Coping  with  craving  and  urges  
 Craving  and  Urges  
•  Craving  à  a  desire  to  experience  the  posi1ve  
effects  of  a  substance  
•  Urge  à  impulse  to  sa1sfy  the  craving  
 Coping  Skills  
•  Urges  and  craving  
–  Urges  are  common  
–  Occur  in  par1cular  circumstances  
–  Temporary  
•  “Urge  surfing”  à  riding  it  out  
–  Giving  in  strengthens  them  while  riding  them  out  
weakens  them  
–  Keep  records  of  urges  
•  Date  and  1me  
•  Situa1on  
•  Strength  (0-­‐100)  
•  Response  
 Developing  Coping  Strategies  
1.  Avoid  à  Reduce  exposure  
2.  Escape  à  Remove  self  from  situa1on  
3.  Distract  à  Enjoyable  distrac1on  to  surf  
through  the  urge  
4.  Endure  à  Talking,  mindfulness,  reminders  of  
sobriety  
 Relapse  Preven1on  
•  60%  or  more  of  individuals  relapse  a^er  
stopping  use  
•  Alan  Marla_  à  first  to  examine  relapse  
process  
•  Relapse  taxonomy  of  high-­‐risk  situa1ons  
–  Intrapersonal  situa1ons  (Nega1ve  emo1ons)  
–  Nega1ve  physiological  states  
–  Substance-­‐related  cues  
–  Interpersonal  situa1ons  
Cogni1ve-­‐Behavioral  Model  of  Relapse  
(Marla_  &  Gordon,  1985)  
 Marla_’s  Model  
•  The  immediate  situa1on  
–  Cogni1ve  expectancies  
–  Abs1nence  viola1on  effect  
•  A^er  effects  of  using  (i.e.,  helplessness,  loss  of  control)  
•  Lapse  becomes  relapse  
•  The  broader  context  
–  Balance  between  “shoulds”  and  “wants”  
–  Seemingly  irrelevant  decisions  
Covert  Antecedents  of  High-­‐Risk  Situa1ons  
 Relapse  Preven1on  
•  Reduce  the  incidence  and  severity  of  relapse  
•  Two  goals:    
–  minimize  the  impact  of  high-­‐risk  situa1ons  by  
increasing  awareness  and  building  coping  skills;  
–  to  limit  relapse  proneness  by  promo1ng  a  healthy  
and  balanced  lifestyle.  
Dynamic  Model  of  Relapse  
 Tonic  Processes  
(who  is  vulnerable)  
•  Distal  risks  
–  Stable,  background  factors  
–  Personality,  gene1c  or  family  history  
–  Drug  sensi1vity,  metabolism,  physical  withdrawal  
–  Cogni1ve  factors:  outcome  expectancies,  global  
self-­‐efficacy,  personal  beliefs  about  abs1nence  or  
relapse  
 Phasic  Responses    
(when  relapse  occurs)  
•  Proximal  or  transient  factors  
•  Cogni1ve  and  affec1ve  processes  
•  Urges/cravings,  mood,  changes  in  outcome  
expectancies,  self-­‐efficacy  or  mo1va1on  
•  Coping  responses  
•  Substance  use  and  consequences  (impaired  
decision-­‐making,  AVE)  
 Class  Exercise  
•  Find  your  group  and  iden1fy  the  group’s  area  of  focus  
1  =  Vulnerability  
2  =  Cogni1ve  and  affec1ve  processes  
3  =  Coping  responses  
4  =  High-­‐risk  situa1ons  
5  =  Decision-­‐making  (e.g.,  AIDs)  
6  =  Lifestyle  imbalance  
•  Apply  the  relapse  preven1on  model  to  the  case  
example.  
•  Use  the  MBS  manual  and  readings  to  come  up  with  a  
treatment  plan  (p.  98-­‐116,  170-­‐187,  195-­‐197).  
 Cultural  Differences  and  Coping  Skills  
•  Limited  research  on  effec1veness  among  
ethnic-­‐minority  clients  for  relapse  preven1on.  
•  One  study  à  African-­‐Americans  had  greater  
coping  skills  and  higher  self-­‐efficacy  to  use  the  
skills  than  whites  (Walton  et  al.,  2001).  
•  Bicultural  competence  may  be  needed  to  
nego1ate  both  cultures.  
–  Level  of  accultura1on  and  encultura1on  
 Cultural  Differences  and  Self-­‐efficacy  
•  May  be  an  important  predictor  for  change  for  
ethnic  minority  popula1ons  
•  May  be  different  for  ethnic  minority  
popula1ons  than  for  whites  
•  Collec1ve  efficacy  may  be  an  important  
construct  à  family,  community  
•  Low  membership  in  AA/12-­‐step  may  be  due  to  
clash  of  cultural  values  
 Cultural  Values  and  Expectancies  
•  Expectancies  vary  across  cultures  and  
genera1ons  (e.g.,  coping  vs.  socializa1on)  
•  Expectancies  may  change  over  1me  among  
different  ethnic-­‐minority  groups  
•  RP  has  flexibility  to  adjust  to  cultural  differences  
–  Model  matches  well  with  collec1vist  worldview  
–  Restora1on  of  lifestyle  balance  
–  Posi1ve  “addic1ons”  as  subs1tute  
–  Alterna1ve  community  ac1vi1es  
 Cultural  Differences  influencing  
Treatment  
•  Collec1vism,  interdependency,  rela1onships  
•  Gender  roles  
•  Birth  order  
•  Value  systems  (honor,  respect,  role  in  
community)  
•  Views  about  1me  (cyclical  and  repe11ve)  
•  Personal  growth  and  oral  tradi1ons  
•  Discrimina1on,  prejudice  and  racism  as  poten1al  
stressors