Relapse prevention therapy breaks down the chemical dependency recovery process into specific tasks and skills, which patients must learn in order to recover; it also shows patients how to recognize when they are beginning to relapse, and how to change before they start using alcohol or drugs again (Gorski and Kelley, 2003).
In order to understand the process of relapse prevention, we will first look at the phenomena of chemical dependence, and its associated behaviors, and the phenomena of relapse, in order to be able to then look at the various ways of tackling these behaviors to induce relapse prevention in the patients.
What is Chemical Dependency/Chemical Addiction?
Chemical dependency is a disease caused by the use of alcohol and/or drugs, causing changes in a person's body, mind, and behavior: as a result of the disease of chemical dependency, people are unable to control the use of alcohol and/or drugs, despite the bad things that happen when they use (Gorski and Kelley, 2003). Chemical dependency occurs most frequently in people who have a family history of the disease, and as the disease process progresses, recovery becomes more difficult; chemical dependency may cause death if the person does not completely abstain from using alcohol and other mood-altering drugs (Gorski and Kelley, 2003).
Effects of Chemical Dependency
The problems of chemical dependency that affect people when they use alcohol or drugs, and even after they have stopped using, include the following: Malnutrition and metabolic dysfunction; Liver disease and other medical complications; Brain dysfunction; Addictive preoccupation; Adverse Social consequences and Criminal behaviors (Gorski and Kelley, 2003).
The conditions just described combine and interfere with the ability to think clearly, control feelings, and regulate behaviors, especially under stress, as alcohol and drug dependency damages the basic personality traits that are formed before the addictive use of alcohol or drugs (Gorski and Kelley, 2003). Dependency on alcohol or other drugs systemically destroys meaning and purpose in life as the addiction gets worse and worse (Gorski and Kelley, 2003).
Treatment for Chemical Dependency
As dependency on alcohol or other drugs creates problems in a person's physical, psychological, and social functioning, treatment must be designed to work in all three areas (Gorski and Kelley, 2003). The worse the damage in each area, the greater the chance of relapse and the greater the chance of return to old behaviors, for instance, criminal actions and/or the use of alcohol or drugs (Gorski and Kelley, 2003). Total abstinence (not using any alcohol and drugs) plus personality and lifestyle changes are essential for full recovery (Gorski and Kelley, 2003).
Essentially, the type and intensity of treatment depend on the patient's: current physical, psychological and social problems; stage and type of addiction(s); stage of recovery; personality traits and social skills before the onset of addiction, and other factors in life that cause stress (Gorski and Kelley, 2003).
Chemical dependency is a chronic condition that has a tendency toward relapse, hence abstinence from alcohol and other mood-altering drugs is essential in the treatment of chemical dependency (Gorski and Kelley, 2003).
It is a fact that many chemically dependent people who exhibit criminal behaviors were raised in families that did not provide proper support, guidance, and values, which caused them to develop self-defeating personality styles that interfere with their ability to recover, where personality is the habitual way of thinking, feeling, acting, and relating to others that develops in childhood and continues in adult life which develops as a result of an interaction between genetically inherited traits and family environment (Gorski and Kelley, 2003).
Growing up in a dysfunctional family causes a person to have a distorted view of the world: he or she learns coping methods that may be unacceptable in society (Gorski and Kelley, 2003). In addition, the family may not have been able to provide guidance or foster the development of social and occupational skills that allow the person to fully participate in society (Gorski and Kelley, 2003). This lack of skills and distorted personality functioning may cause addictive behaviors to occur, and these problems may also contribute to a more rapid progression of the addiction, make it difficult to recognize and seek treatment during the early stages of the addiction, and make it hard to benefit from treatment (Gorski and Kelley, 2003).
There are four goals in the primary treatment of dependency on alcohol and other drugs, as defined by Gorski and Kelley, 2003: recognition that chemical dependency is a bio/psycho/social disease; recognition of the need for life-long abstinence from all mind-altering drugs; development and use of an ongoing recovery program to maintain abstinence; diagnosis and treatment of other problems or conditions that can interfere with recovery.
Traditional treatment has taken one of two general approaches: The Medical Model which tries to help the patient meet the first three goals listed above; The Social/Behavioral Model which focuses on the fourth goal listed above, i.e., the diagnosis and treatment of other problems that can interfere with recovery (Gorski and Kelley, 2003).
The lack of a model that includes all of the components can lead to high relapse rates, especially in criminal justice populations: relapse prevention therapy is a model that uses an approach that works with all four components (Gorski and Kelley, 2003).
What Is Recovery?
A comprehensive model of chemical dependency treatment effectively combines the best of the medical and social/behavioral treatment models, and is based on the idea that recovery is a process that takes place over time, in specific stages, with each stage having tasks that need to be accomplished and skills to be developed (Gorski and Kelley, 2003). If a recovering person is unaware of this progression, unable to accomplish the tasks and gain the skills, or lacks adequate treatment, he or she will relapse (Gorski and Kelley, 2003).
The following is a description of this comprehensive model, which is called the Developmental Model of Recovery (DMR) (Gorski and Kelley, 2003).
The Developmental Model of Recovery (Gorski and Kelley, 2003)
The DMR has been devised to help recovering people and treatment professionals identify appropriate recovery plans, set treatment goals, and measure progress (Gorski and Kelley, 2003). The DMR describes six stages or periods of recovery (Gorski and Kelley, 2003):
Transition Stage, which begins the first time a person experiences an alcohol or drug-related problem (Gorski and Kelley, 2003). As a person's addiction progresses, he or she tries a series of strategies designed to control use (Gorski and Kelley, 2003). This ends with recognition by the person that safe use of alcohol and/or drugs is no longer possible (Gorski and Kelley, 2003).
The struggle for control is a symptom of a fundamental conflict over personal identity (Gorski and Kelley, 2003). Alcoholics and drug addicts enter this phase of recovery believing they are normal drinkers and drug users capable of controlled use (Gorski and Kelley, 2003). As the progression of addiction causes more severe loss of control, they must face the fact that they are addictive users who are not capable of controlled use (Gorski and Kelley, 2003).
During the transition stage, chemically dependent people typically attempt to control their use or stop using (Gorski and Kelley, 2003). They are usually trying to prove to themselves and others that they can use safely, but this never works for very long (Gorski and Kelley, 2003). Controlled use is especially tough for people who are participating in criminal behavior, because the high level of alcohol and drug use among their peers makes their lifestyle and use seem normal (Gorski and Kelley, 2003).
The major cause of inability to abstain during the transition stage is the belief that there is a way to control use (Gorski and Kelley, 2003).
Stabilization Period: during the stabilization period, chemically dependent people experience physical withdrawal and other medical problems, learn how to break the psychological conditioning causing the urge to use, stabilize the crisis that motivated them to seek treatment, and learn to identify and manage symptoms of brain dysfunction. This prepares them for the long-term processes of rehabilitation (Gorski and Kelley, 2003).
Traditional treatment often underestimates the need for management of these issues, focusing instead on detoxification (Gorski and Kelley, 2003). Patients find themselves unable to cope with the stress and pressure of the symptoms of brain dysfunction and physical cravings that follow detoxification (Gorski and Kelley, 2003). Many have difficulty gaining much from treatment and feel they are incapable of recovery (Gorski and Kelley, 2003). The lack of a supportive environment for recovery that many criminal offenders experience adds stress and undermines their attempts to stabilize these symptoms (Gorski and Kelley, 2003). They often use alcohol and drugs to relieve such distress, and it takes between 6 weeks and 6 months for a patient to learn to master these symptoms with the correct therapy (Gorski and Kelley, 2003).
The major cause of inability to abstain during the stabilization period is the lack of stabilization management skills (Gorski and Kelley, 2003).
Early Recovery Period: early recovery is marked by the need to establish a chemical-free…