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Relapse Prevention Therapy

A. Tom Horvath, Ph.D., ABPP, Kaushik Misra, Ph.D., Amy K. Epner, Ph.D., and Galen Morgan Cooper, Ph.D. , edited by C. E. Zupanick, Psy.D.

In addiction treatment, a "relapse" refers to a reoccurrence of the addictive behavior, following an attempt at recovery. It is helpful to specifically address relapse during recovery efforts. Statistically speaking, most individuals making a recovery effort will experience relapse at some point. Without advance preparation, cravings will inevitably lead to relapse. When a relapse occurs, feelings of guilt and self-blame may only worsen the situation.

hand saying no to alcoholRelapse Prevention Therapy (RPT, Marlatt & Donovan, 2005) is a type of cognitive-behavioral therapy. RPT aims to limit or prevent relapses by helping the therapy participant to anticipate circumstances that are likely to provoke a relapse. You can develop strategy to cope with these high-risk situations in advance. This is termed a relapse prevention plan. For instance, therapy participants learn that certain feelings are common triggers for relapse. We summarize these feelings with the acronym BHALT: bored, hungry, angry, lonely, and tired. Relapse prevention therapy teaches therapy participants to be alert for these types of feelings and to have a plan of action for coping with them.

Other circumstances that trigger relapse are environmental cues that prompt cravings. This might include people, places, or things that are associated with the pleasurable feelings of addictive behavior. For instance, some people who inject drugs find the sight of blood can trigger powerful cravings. So can a flu inoculation, or routine blood test. Relapse prevention therapy helps therapy participants to identify possible environmental cues that might prompt craving. Then, they develop a strategy for coping with these cues.

RPT also teaches participants to place relapse into the proper perspective. When a recovering person has a relapse, they frequently interpret this as a failure. A person can believe that such a "failure" is evidence of their inability to recover. Of course, if someone believes they are unable to recover there really is no point in trying. Based on this (false) conclusion, the recovering person sees no option but to return to their addiction in earnest.

RPT seeks to prevent this misinterpretation by representing relapses as prolapses. In other words, relapses are reinterpreted as opportunities for learning and improving coping skills. This perspective serves to keep relapses as time-limited and harmless as possible. Viewed in this manner, they might be also termed "slips" or "lapses" rather than relapses.