RPM is a continuous perspective on relapse. The journey toward sustained abstinence may consist of progressively shortening returns to use, followed by progressively lengthening periods of abstinence. From this viewpoint, a single return to use is conceptualized as a lapse, in which the individual has several options leading to a return to abstinence (referred to as a prolapse) or a full-scale relapse, meaning a return to baseline substance use. The RPM consists of global and situational interventions, thereby preparing clients to make lifestyle changes to avoid lapses, and develop the cognitive and behavioral tools to respond to a lapse in a way that decreases the probability of a full-scale relapse. In terms of global lifestyle changes, the RPM poses that clients with substance use

Question

disorders must work to achieve a balance between perceived obligations (shoulds) and pleasurable activities (wants) in her or his life. Too many demands without compensatory enjoyment can position an individual for relapse. Essentially, individuals must find joy and satisfaction in their sobriety in order to maintain it. RPM describes situational factors that can increase or decrease the probability of relapse. These factors include high risk situations, coping strategies, self-efficacy, outcome expectancies, and the Abstinence Violation Effect (Larimer et al., 1999; Marlatt & George, 1984; Marlatt & Gordon, 1985). Individuals with substance use disorders may be at-risk for relapse when faced with high risk situations falling into three categories: (1) negative emotional states, (2) interpersonal conflict, or (3) social pressure. These situations call for the implementation of a coping strategy, which the client previously fulfilled by using drugs or alcohol. Therefore, when faced with a high risk situation, the client must utilize a new coping response as a way to manage the high risk situation such as distraction, imagery, refusal techniques, escaping the situation, meditation, positive self-talk, calling a sponsor from a twelve-step program, etc. If the coping strategy is implemented well and proves effective, the client’s self-efficacy will increase. If a client employs a coping strategy other than substance use in response to a high-risk situation and the results are positive, her belief in her ability to utilize her skills will strengthen. This increase of self-efficacy serves to decrease the probability of relapse. If a coping strategy proves ineffective, it could lead to decreased self-efficacy. At this point, the client may believe that she is unable to perform the desired task and experience positive outcome expectancies regarding the drug or alcohol. In light of a failed coping strategy, the client may begin to reminisce about the ways in which the drug was able to help her cope with life’s adversities, albeit temporarily and with negative consequences. She may focus solely on the predictable euphoria and pleasure that occurred when she ingested the drug. These positive outcome expectancies of using the drug, coupled with decreased self-efficacy, puts the client at risk for a lapse, or a first return to use. Once she takes the first drink or drug, she often experiences the Abstinence Violation Effect (AVE).The RPM provides a framework by which counselors and clients can understand lapse and relapse experiences. At each point in the progression toward full-scale relapse, there exists an opportunity for clinical intervention. Additionally, if a client lapses, there are several places where clinical interventions would be effective.

What will be an ideal response?

Answer 1

Counselors employing MBRP seek to help clients become fully present in their immediate experience and accept their experience without judgment. In this way, mindfulness approaches to relapse prevention foster greater levels of personal choice and self-compassion in the pursuit of abstinence. Additionally, clients learn to utilize mindfulness-based strategies when faced with high risk situations as an effective coping strategy. As MBRP is an integration of traditional CBT relapse prevention strategies and mindfulness approaches, counselors continue to help clients identify triggers and high-risk situations as well as develop effective coping strategies. In MBRP, cravings are conceptualized as physiological messages used to alert the client that the substance is desired. Thus, cravings are natural responses to the absence of a substance to which the body has become accustomed. Clients can utilize mindfulness skills to engage in urge surfing, in which they visualize riding the urge like a wave as it crests and falls. By increasing their awareness of cravings, breathing through them, and remaining non-evaluative, clients can endure the urge to use until it subsides. Strategies can consist of mindfulness meditation (in session and out of session), body scans, and mindful eating. According to the manual, MBRP sessions ideally last for two hours over the course of eight weeks. The primary focus of the session is on group members’ immediate experience in the moment, rather than previous or future experiences.