Therapist's Guide to Evidence-Based Relapse Prevention (eBook)

Front cover 1
Therapist’s Guide to Evidence-Based Relapse Prevention 4
Copyright page 5
Table of contents 6
Contributors 10
Preface 14
SECTION I: Introduction andOverview 18
Chapter 1: Overview of Relapse Prevention 20
COGNITIVE-BEHAVIORAL MODEL OF RELAPSE 20
RELAPSE PREVENTION INTERVENTIONS 26
SUMMARY AND CONCLUSIONS 31
REFERENCES 31
Chapter 2: High-Risk Situations: Relapse as a Dynamic Process 36
COGNITIVE BEHAVIORAL MODEL OF RELAPSE, REVISED 37
TONIC PROCESSES 39
PHASIC PROCESSES 40
DYNAMICAL SYSTEMS PROCESSES 42
EMPIRICAL BASIS FOR DYNAMIC MODEL 43
CLINICAL CASE ILLUSTRATION 46
SUMMARY OF CLINICAL IMPLICATIONS 47
DYNAMIC RELAPSE MODEL AND NONSUBSTANCE USE BEHAVIOR 47
REFERENCES 48
SECTION II: Application of Relapse Prevention to Specific Problem Areas 52
Chapter 3: Relapse Prevention: Clinical Strategies for Substance Use Disorders 54
INTRODUCTION 54
OVERVIEW OF LAPSE, RELAPSE, AND RECOVERY 55
TREATMENT OUTCOMES AND RELAPSE RATES 57
EFFECTIVENESS AND EFFICACY OF RP 58
RELAPSE REPLICATION AND EXTENSION PROJECT 62
MODELS OF RELAPSE PREVENTION 63
RELAPSE-RELATED DOMAINS OF ASSESSMENT 65
RP INTERVENTIONS TO MINIMIZE LAPSE AND RELAPSE RISK 66
CLINICAL STRATEGIES TO REDUCE RELAPSE RISK 67
RP IN THE CONTEXT OF SUDs WITH COMORBID PSYCHIATRIC DISORDERS 72
FUTURE RESEARCH DIRECTIONS 74
CLINICAL CASE ILLUSTRATIONS 74
CONCLUSIONS 77
ACKNOWLEDGEMENTS 77
REFERENCES 78
INTERNET RESOURCES 88
Chapter 4: Mindfulness-based Cognitive Therapy as a Relapse Prevention Approach to Depression 90
INTRODUCTION TO MINDFULNESS-BASED COGNITIVE THERAPY (MBCT) 90
DEFINITION OF MINDFULNESS 91
EMPIRICAL SUPPORT FOR MBCT IN PREVENTING DEPRESSIVE RELAPSE 92
OVERVIEW OF MBCT 93
KEY PRINCIPLES 96
HOW MBCT IS SIMILAR AND DIFFERENT WITH CT AND MBSR 98
ASSESSMENT 99
CLINICAL CASE ILLUSTRATION 101
SPECIAL TOPICS 103
CONCLUSIONS AND FUTURE DIRECTIONS 104
REFERENCES 104
INTERNET RESOURCES 106
Chapter 5: Relapse Prevention for Return of Pathological Worry in CBT-Treated GAD 108
INTRODUCTION TO GAD AND CLIENT POPULATION 108
ASSESSMENT OF GAD 109
GAD TREATMENT AND THE INCORPORATION OF RELAPSE PREVENTION 110
CASE EXAMPLE 114
WHAT IS PATHOLOGICAL WORRY? 117
WHY IS PATHOLOGICAL WORRY SO DIFFICULT TO STOP? 118
MINDFULNESS AND CBT FOR WORRY: HOPE FOR IMPROVED RESPONSE AND REDUCED RELAPSE 119
STRATEGIES FOR IMPLEMENTING MINDFULNESS INTO GAD CBT TREATMENT 121
POTENTIAL WAYS MINDFULNESS WORKS IN GAD TREATMENT 125
SPECIAL TOPICS 126
SUMMARY AND CONCLUSIONS 127
ACKNOWLEDGEMENTS 128
REFERENCES 128
RESOURCE BIBLIOGRAPHY AND A LIST OF INTERNET LINKS 132
Chapter 6: Relapse Prevention for Schizophrenia 134
INTRODUCTION 134
OVERVIEW OF PSYCHOSOCIAL TREATMENT 137
CORE FEATURES OF CBT FOR SCHIZOPHRENIA 138
INTERVENTIONS TAILORED TO PREVENT RELAPSE 140
CO-OCCURRING ADDICTION AND MENTAL ILLNESS 141
IMPLEMENTATION OF RELAPSE PREVENTION INTERVENTIONS 147
CLINICAL CASE ILLUSTRATIONS 149
PHARMACOTHERAPY MEDICATION MANAGEMENT OF SCHIZOPHRENIA 152
CONCLUSIONS AND FUTURE DIRECTIONS 153
REFERENCES 154
Chapter 7: Seeking Safety: An Evidence-based Model for Substance Abuse and Trauma/PTSD 158
INTRODUCTION 158
OVERVIEW OF TREATMENT 160
KEY ELEMENTS 161
EMPIRICAL RESULTS 171
IMPLEMENTATION ISSUES 173
CLINICAL CASE ILLUSTRATION 177
RELATION TO RELAPSE PREVENTION 178
CONCLUSIONS AND RECOMMENDATIONS 180
AUTHOR NOTE 181
REFERENCES 181
Chapter 8: Relapse Prevention for Eating Disorders 186
INTRODUCTION 186
EMPIRICALLY SUPPORTED TREATMENTS 187
OVERVIEW OF COGNITIVE BEHAVIOR THERAPY FOR BULIMIA NERVOSA AND BINGE EATING DISORDER 187
RELAPSE PREVENTION FOR EATING DISORDERS 188
EVIDENCE ON RELAPSE PREVENTION FOR EATING DISORDERS 189
INNOVATIONS IN RELAPSE PREVENTION FOR EATING DISORDERS 192
OTHER APPROACHES TO TREATING EATING DISORDERS 196
ASSESSMENT 197
IMPLEMENTING CBT 198
CLINICAL CASE ILLUSTRATIONS 200
SUMMARY AND CONCLUSIONS 203
REFERENCES 203
INTERNET RESOURCES 207
Chapter 9: Stopping Self-Harm Once and for All: Relapse Prevention in Dialectical Behavior Therapy 208
THE PROBLEM OF DELIBERATE SELF-HARM IN BORDERLINE PERSONALITY DISORDER 209
TREATMENT FOR DELIBERATE SELF-HARM: DIALECTICAL BEHAVIOR THERAPY 211
RESEARCH ON TREATMENTS FOR DELIBERATE SELF-HARM 212
CHARACTERISTICS OF BORDERLINE PERSONALITY DISORDER THAT CONTRIBUTE TO DSH RELAPSE 213
CHARACTERISTICS OF TREATMENT THAT CONTRIBUTE TO RELAPSE OF DSH 216
CLINICAL CASE ILLUSTRATION 217
STOPPING SELF-HARM ONCE AND FOR ALL: RELAPSE PREVENTION IN DBT 219
REDUCING VULNERABILITY TO HIGH-RISK SITUATIONS THROUGH EXPOSURE-BASED INTERVENTIONS 219
REDUCING EMOTION VULNERABILITY THROUGH SELF-CARE AND POSITIVE ACTIVITIES 222
PROBLEM SOLVING TO PREVENT AND MODIFY HIGH-RISK SITUATIONS 223
REDUCING CRISIS-GENERATING BEHAVIORS AND SELF-HARM THROUGH EMOTION REGULATION 223
INTERVENTIONS TO PREVENT RELAPSE BY IMPROVING GENERALIZATION 224
SUMMARY AND CONCLUSION 226
REFERENCES 227
INTERNET RESOURCES ON DIALECTICAL BEHAVIOR THERAPY AND BORDERLINE PERSONALITY DISORDER 230
Chapter 10: Treatment of Sexual Offenders: Relapse Prevention and Beyond 232
INTRODUCTION 232
TREATMENT OF SEXUAL OFFENDERS 233
RELAPSE PREVENTION APPLIED TO THE TREATMENT OF SEXUAL OFFENDERS 234
BEYOND RELAPSE PREVENTION: THE SELF-REGULATION MODEL 237
EMPIRICAL SUPPORT FOR THE SELF-REGULATION MODEL OF OFFENDING 241
CLINICAL CASE ILLUSTRATION 244
CONCLUSIONS AND FUTURE DIRECTIONS 247
REFERENCES 248
SECTION III: Specific Populations and Treatment Settings 252
Chapter 11: Focus on Families: Integration of Relapse Prevention and Child Drug Abuse Prevention Training with Parents in Methadone Treatment 254
INTRODUCTION 254
THE PROGRAM 257
PARENT AND CHILD SKILL TRAINING 257
HOME-BASED CASE MANAGEMENT 260
FOCUS ON FAMILIES EVALUATION 264
COMPARISON WITH OTHER APPROACHES INTEGRATING FAMILY-FOCUSED RELAPSE PREVENTION 267
CHALLENGES 269
CONCLUSIONS 270
ACKNOWLEDGEMENTS 270
REFERENCES 271
Chapter 12: Relapse Prevention with Hispanic and Other Racial/Ethnic Populations: Can Cultural Resilience Promote Relapse Prevention? 276
INTRODUCTION: ISSUES IN RELAPSE PREVENTION WITH HISPANIC AND OTHER RACIAL/ETHNIC POPULATIONS 276
DEFINITIONS OF CONSTRUCTS SPECIFIC FOR EXPLORING GROUP DIFFERENCES 282
ASSESSMENT, TREATMENT, AND RELAPSE PREVENTION 287
CLINICAL CASE ILLUSTRATION 298
CONCLUSIONS AND FUTURE DIRECTIONS 302
ACKNOWLEDGEMENTS 303
REFERENCES 303
INTERNET RESOURCES 309
Chapter 13: Relapse Prevention for Adolescent Substance Abuse: Overview and Case Examples 310
ABSTRACT 310
INTRODUCTION 311
REVIEW OF THE LITERATURE 312
OVERVIEW OF RP TREATMENT 313
CASE EXAMPLES 320
SUMMARY AND CONCLUSIONS 325
REFERENCES 326
Chapter 14: Relapse Prevention with Older Adults 330
INTRODUCTION 330
PREVALENCE AND IMPACT OF SUBSTANCE ABUSE AMONG OLDER ADULTS 330
PROJECTED DEMOGRAPHIC TRENDS 332
LIFETIME PATTERNS OF DRINKING 333
IDENTIFYING SUBSTANCE USE PROBLEMS IN OLDER ADULTS 333
INTERVENTIONS AND TREATMENTS FOR OLDER ADULTS 334
CLINICAL CASE ILLUSTRATION #1 334
SUBSTANCE ABUSE TREATMENT OUTCOMES FOR OLDER ADULTS 336
CURRENT RESEARCH ON RELAPSE AMONG OLDER ADULTS 337
RELAPSE PREVENTION STRATEGIES AND RECOMMENDATIONS 338
A GROUP TREATMENT APPROACH TO SUBSTANCE ABUSE RELAPSE PREVENTION 339
TREATMENT MODULES 340
USE OF BRIEF INTERVENTIONS IN RELAPSE PREVENTION 340
BRIEF ALCOHOL INTERVENTION COMPONENTS WITH OLDER ADULTS 341
CO-OCCURRING DISORDERS IN OLDER ADULTS 342
COMORBID DEPRESSION 343
RELAPSE PREVENTION FOR LATE-LIFE DEPRESSION 343
ALZHEIMER’S DISEASE (AD) 344
ALCOHOL-ASSOCIATED COGNITIVE IMPAIRMENT 345
SLEEP DISORDERS 345
CLINICAL CASE ILLUSTRATION #2 346
CONCLUSIONS AND FUTURE DIRECTIONS 347
REFERENCES 348
INTERNET RESOURCES 354
Chapter 15: Utilizing Relapse Prevention with Offender Populations: What Works 356
INTRODUCTION 356
EXPLORING THE QUESTION OF “WHAT WORKS” WITHIN RP: THE ROLE OF META-ANALYSIS 358
WHAT WORKS WITHIN RP PROGRAMS: GENERAL TRENDS 359
RISK, NEED, AND RESPONSIVITY: MISSING PIECES IN THE RP PUZZLE? 361
OVERALL THOUGHTS AND DIRECTIONS FOR THE FUTURE OF RP WITHIN CORRECTIONAL TREATMENT 362
ACKNOWLEDGEMENTS 367
REFERENCES 367
Chapter 16: Drinking as an Epidemic—A Simple Mathematical Model with Recovery and Relapse 370
INTRODUCTION 371
MATHEMATICAL MODEL OF DRINKING LAPSE 372
UNCERTAINTY AND SENSITIVITY ANALYSIS 374
NUMERICAL SIMULATIONS 377
DISCUSSION 379
ACKNOWLEDGEMENTS 381
REFERENCES 381
APPENDIX 383
REFERENCE 385
Index 386