SUBSTANCE RELAPSE PREVENTION 1

Substance Relapse Prevention

Elizabeth Simmons

Wake Forest University

CNS 765 Addictions Counseling

Dr. Jennifer Rogers

July 7, 2023
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Substance Relapse Prevention

Relapse is defined by the Merriam-Webster Dictionary as a verb “to become ill again

after a period of improvement in health” and as a noun “a return of illness or a return to a former

and undesirable condition” (Maisto & et al., 2016). Relapse can also be defined as “a return to a

previous level of substance use after a period of considerable reduction or abstinence from

substance use” (Moe & et al., 2021). Some professionals distinguish between lapse and relapse

as lapse being “a single instance of use, a slip, or as a discrete outcome of any use” and relapse

as “a behavioral change” or a “goal change” (Maisto & et al., 2016). Addiction can be defined as

a “chronic disorder with relapses” (Hser & et al., 2015). Studies suggest that 80% of addicts will

relapse within the first six months after quitting their addiction of choice (Haghighi & et al.,

2018). In 2018 the Substance Abuse and Mental Health Services Administration estimated 20.3

million Americans met the DSM criteria for substance use disorder (Mahoney & et al., 2020). It

has been estimated that 20% of all deaths globally are related to substance use disorders (Kang &

et al., 2022). Understanding the prevalence of substance use disorders, their mortality rate,

underlying reasons for use, causes of relapse, and the relapse rates connected to treatments is

important in discovering a way to overcome this global public health crisis.

Causes

There is no single cause that leads people to substance use disorders. It is believed that

there is complex interplay between genetics, social, and environmental factors that result in drug

use behaviors (Lai, Lee., & Huang, 2023). A study in 2022 resulted in poor coping skills to a

variety of issues including mental health diagnosis, the desire to relax or unwind, feelings of

boredom, grief, guilt, loneliness, stress, low self-esteem, and work or relationship issues as the
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leading cause of why people turned to substances (Coelho & et al., 2022). The leading reinforcer

to addictive behavior in this same study was social influence of family or friends and social

environmental use (Coelho & et al., 2022).

Just as there is no singular cause for addiction there is no singular cause for relapse.

People that have social support, housing, employment, healthy lifestyle, and lower stress levels

tend to have a lower risk of relapse (Moe & et al., 2021). A study on relapse smoking showed

that positive affect situations such as feeling relaxed, consuming alcohol at a party, or happiness

was the number one reason given by study participants for relapse (Rodríguez-Cano & et al.,

2021). The second cause in this study was negative affect situations with depression being

named as the top reason for a relapse in smoking (Rodríguez-Cano & et al., 2021). The third

leading cause for smoking relapse was dependance related situations, the longer the participant

had been using cigarettes the more likely they would have a relapse (Rodríguez-Cano & et al.,

2021). A brain scan study of cocaine users showed that participants that had lower connectivity

between multiple regions of the brain were more likely to relapse by day 30 post residential

treatment (McHugh & et al., 2017).

Treatments

There are multiple treatment models used by addiction counselors. The Relapse

Prevention model focuses on cravings. This model suggests that cravings are the largest indicator

of relapse (Lai, Lee, & Huang, 2023). By targeting compulsion, longing, yearning, and

physiological need the possibility for sobriety increases (Lai, Lee, & Huang, 2023). It is a

cognitive-behavioral approach that identifies high risk situations so that behavior modifications

can be implemented (Lai, Lee, & Huang, 2023). Mindfulness-based relapse prevention uses
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situational awareness, meditation, living in the moment, and a nonjudgmental attitude as a way

to bring awareness to impulsivity related to cravings (Bowen et al., 2021).

The use of medications to prevent addiction relapse has shown promising results in

alcohol, opioid, and nicotine addicted participants. The medications work in a variety of ways by

blocking the substance, reducing the effects, being a replacement, or acting in a way that reduces

cravings (Kampman, 2009). Lai, Lee, & Huang report that Methadone Maintenance Treatment is

among the most effective relapse prevention treatments for opioid use. There is currently no

medication therapy for stimulant drugs such as cocaine and methamphetamine (Kampman,

2009).

Results

Multiple studies have shown that a combination of counseling and medication

management have the lowest rates of relapse.

Outcomes of Relapse Prevention

A 20 week study comparing the alcohol use rate between Cognitive Processing Therapy,

Relapse Prevention, and Assessment Only groups showed that the Relapse Prevention group had

lower levels of alcohol use during and after the study (Simpson & et al., 2022). This study was

simultaneously looking at the impact of Cognitive Processing Therapy, Relapse Prevention, and

Assessment Only on Post Traumatic Stress Disorder. Those results differed from the drinking,

showing that Cognitive Processing Therapy was more helpful for PTSD than Relapse Prevention

or Assessment Only (Simpson & et al., 2022). The 101 participants were a mix of male and

female that were randomly placed in groups. The results were measured using scaling

questionnaires.
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Outcomes of Mindfulness

Using Mindfulness Based Relapse Prevention (MBRP) in a residential setting showed

that participants reported lower levels of cravings, stress, and a 96% risk decrease in relapse

versus the Relapse Prevention, treatment as usual, group (Davis & et al., 2018). Immediately

following discharge from the residential program, the MBRP group had slower levels of relapse

(Davis & et al., 2018). At 6 months the MBRP group continued to have slower rates of relapse

(Davis & et al., 2018). The 79 participants were a mix of male and female that were randomly

placed into groups. The results were measured using self reported assessments.

Outcome of Running

A study using a 14 week walk/run group to reduce relapse in substance use showed that

participants reported fewer cravings, an increase in personal health, gained a sense of

accomplishment, and had feelings of belonging (Dai & et al., 2020). The feelings of belonging

were divided between fitting into the walk/run group and making connections with the

volunteers facilitating the group (Dai & et al., 2020). The focus of the study was to improve

recovery through physical activity as a coping skill, behavior modification, and goal setting. The

finding showed a “majority” of participants reported no lapses or relapses during the program

(Dai & et al., 2020). It should be noted that participants in this program were also participating in

other recovery modes such as counseling and medication management (Dai & et al., 2020). The

109 participants were a mix of male, female, ethnicities, and ages ranging from 20 years old to

69 years old that were living in a substance use residential center.

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Outcome of Medications

Lai, Lee, & Huang report that Methadone Maintenance Treatment is among the most

effective relapse prevention treatments. There is currently no medication therapy for stimulant

drugs such as cocaine and methamphetamine (Kampman, 2009).

Discussion

The research points to there being a variety of reasons why people lapse or relapse. There

were positive outcomes over several studies using multiple modalities of treatment. No one

treatment was repeatedly proven to be better than others. The takeaway would be to tailor the

treatment style to the person for the best outcome. Much of the research pointed to relapses being

commonplace in addictions, so encouraging people to try new or different treatment options if

their current one is not working is the best course of action. Another theme throughout the

research was assessing the participants' level of change. The lapse and relapse frequency went

down as the level of change increased. With the amount of people globally impacted by

addictions, continued research is needed per the research reviewed. The research should focus on

the reasons for substance use, the causes for relapse, and discovering effective modes of

treatment.
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References

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