Relapse Prevention, Second Edition: Maintenance Strategies in the Treatment of Addictive Behaviors PDF
Preview Relapse Prevention, Second Edition: Maintenance Strategies in the Treatment of Addictive Behaviors
RELAPSE PREVENTION RELAPSE PREVENTION Maintenance Strategies in the Treatment of Addictive Behaviors Second Edition Edited by G. ALAN MARLATT DENNIS M. DONOVAN THE GUILFORD PRESS New York London ©2005TheGuilfordPress ADivisionofGuilfordPublications,Inc. 72SpringStreet,NewYork,NY10012 www.guilford.com Allrightsreserved Nopartofthisbookmaybereproduced,translated,storedina retrievalsystem,ortransmitted,inanyformorbyanymeans, electronic,mechanical,photocopying,microfilming,recording,or otherwise,withoutwrittenpermissionfromthePublisher. PrintedintheUnitedStatesofAmerica Thisbookisprintedonacid-freepaper. Lastdigitisprintnumber: 9 8 7 6 5 4 3 2 1 LibraryofCongressCataloging-in-PublicationData Relapseprevention:maintenancestrategiesinthetreatmentofaddictive behaviors/editedbyG.AlanMarlattandDennisM.Donovan.—2nded. p.cm. Includesbibliographicalreferencesandindex. ISBN1-59385-176-6(alk.paper) 1. Substanceabuse—Relapse—Prevention. 2. Substanceabuse—Treatment. 3. Behaviortherapy. I. Marlatt,G.Alan. II. Donovan,DennisM.(Dennis Michael) RC564.R452005 616.86′06—dc22 2005000834 AAbboouutt tthhee EEddiittoorrss About the Editors G. Alan Marlatt, PhD, Director of the Addictive Behaviors Research Cen- ter and Professor of Psychology at the University of Washington, is re- nowned for his innovative theoretical and clinical work in the addictions field. Over the past two decades, he has made significant advances in de- veloping programs for both relapse prevention and harm reduction for a range of addictive behaviors. In addition to coediting the first editions of Relapse Prevention: Maintenance Strategies in the Treatment of Addictive Behaviors (1985) and Assessment of Addictive Behaviors (1988), Dr. Marlatt is the editor of Harm Reduction: Pragmatic Strategies for Man- agingHigh-RiskBehaviors(1998),coeditorofChangingAddictiveBehav- ior:BridgingClinicalandPublicHealthStrategies(1999),andcoauthorof BriefAlcoholScreeningandInterventionforCollegeStudents(BASICS):A Harm Reduction Approach (1999), all published by The Guilford Press. He is a Fellow of both the American Psychological Association and the American Psychological Society, and is a former president of the Associa- tionforAdvancementofBehaviorTherapy. Heservedasamemberofthe National Advisory Council on Drug Abuse at the National Institute on Drug Abuse from 1996 to 2002, and served on the National Advisory Council on Alcohol Abuse and Alcoholism Subcommittee on College Drinking from 1998 to 2001. Dr. Marlatt currently holds a Senior Re- search Scientist Award from the National Institute on Alcohol Abuse and Alcoholism, and received the Innovators Combating Substance Abuse AwardfromtheRobertWoodJohnsonFoundationin2001. Previously,he was presented with the Jellinek Memorial Award for Alcohol Studies (1990), the Distinguished Scientist Award from the American Psychologi- cal Association’s Society of Clinical Psychology (2000), the Visionary Award by the Network of Colleges and Universities Committed to the EliminationofDrugandAlcoholAbuse(2002),andtheDistinguishedRe- searcher Award from the Research Society on Alcoholism (2004). v vi About the Editors Dennis M. Donovan, PhD, was affiliated with the Addictions Treatment Center at the Seattle Department of Veterans Affairs Medical Center for over 20 years, while engaging in clinical, administrative, training, and re- searchactivities.Duringthattimehewasalsoinstrumentalinthedevelop- ment of, and served as the Associate Director of, the first Center of Excel- lence in Substance Abuse Treatment and Education (CESATE) within the nationalDepartmentofVeteransAffairs. HecurrentlyservesastheDirec- tor of the University of Washington’s Alcohol and Drug Abuse Institute and holds the faculty ranks of Professor in the Department of Psychiatry and Behavioral Sciences, and Adjunct Professor in the Department of Psy- chology at the University of Washington in Seattle. He has written over 120journalarticles,30bookchapters,and3booksintheareaofalcohol- ism and addictive behaviors, with emphases on social learning theory and biopsychosocialapproachestotheetiology,maintenance,andtreatmentof addictions; the clinical assessment process and assessment measures; treat- ment of entrance and engagement; evaluation of treatment process and outcome; relapse prevention; and patient–treatment matching. Dr. Dono- van’sresearchhasbeenfundedbytheNationalInstituteonAlcoholAbuse and Alcoholism (NIAAA), the National Institute on Drug Abuse (NIDA), and the Center for Substance Abuse Treatment (CSAT). He has served as AssociateEditorandasamemberoftheeditorialboardsfortheJournalof StudiesonAlcohol,PsychologyofAddictiveBehaviors,andAddiction.He has also been a member of the Clinical and Treatment Research Review CommitteeofNIAAAandtheBehavioralAIDSResearchReviewCommit- tee of NIDA. Dr. Donovan is a member of a number of national profes- sionalorganizationsandservedasPresidentoftheSocietyofPsychologists in Addictive Behaviors. He has also been elected a Fellow of Division 50 (Division on Addictions) of the American Psychological Association. CCoonnttrriibbuuttoorrss Contributors Arthur W. Blume, PhD, Department of Psychology, University of Texas at El Paso, El Paso, Texas Kathleen M. Carroll, PhD, Department of Psychiatry, Division of Substance Abuse, Yale University School of Medicine, New Haven, Connecticut, and VA Connecticut Healthcare Center, West Haven, Connecticut R. Lorraine Collins, PhD, Research Institute on Addictions, University at Buffalo, State University of New York, Buffalo, New York Ned L. Cooney, PhD, Yale University School of Medicine, New Haven, Connecticut, and VA Connecticut Healthcare Center, West Haven, Connecticut Jessica M. Cronce, BS, Department of Psychology, Yale University, New Haven, Connecticut Berenice García de la Cruz, MA, Department of Special Education, University of Texas at Austin, Austin, Texas Dennis M. Donovan, PhD, Department of Psychiatry and Behavioral Sciences and the Alcohol and Drug Abuse Institute, University of Washington School of Medicine, Seattle, Washington William H. George, PhD, Department of Psychology, University of Washington, Seattle, Washington Valerie A. Gruber, PhD, MPH, Department of Psychiatry, University of California, San Francisco, San Francisco, California Chad Gwaltney, PhD, Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island Nancy A. Haug, PhD, Department of Psychiatry, University of California, San Francisco, San Francisco, California Ronald M. Kadden, PhD, Department of Psychiatry, University of Connecticut School of Medicine, Farmington, Connecticut vii viii Contributors Jon Kassel, PhD, Department of Psychology, University of Illinois at Chicago, Chicago, Illinois Jason R. Kilmer, PhD, Addictive Behaviors Specialist, Evergreen State College, Olympia, Washington, and Saint Martin’s College, Lacey, Washington Debi A. LaPlante, PhD, Division on Addictions, Harvard Medical School, Boston, Massachusetts G. Alan Marlatt, PhD, Department of Psychology and Addictive Behaviors Research Center, University of Washington, Seattle, Washington Dennis McChargue, PhD, Department of Psychology, University of Illinois at Chicago, Chicago, Illinois Rebekka S. Palmer, PhD, Department of Psychiatry, Division of Substance Abuse, Yale University School of Medicine, New Haven, Connecticut Richard A. Rawson, PhD, UCLA Integrated Substance Abuse Programs, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Los Angeles, California Roger A. Roffman, DSW, School of Social Work, University of Washington, Seattle, Washington Howard J. Shaffer, PhD, CAS, Division on Addictions, Harvard Medical School, Boston, Massachusetts Saul Shiffman, PhD, Smoking Research Group, University of Pittsburgh, Pittsburgh, Pennsylvania Yong S. Song, PhD, Department of Psychiatry, University of California, San Francisco, at San Francisco Veterans Affairs Medical Center, San Francisco, California James L. Sorensen, PhD, Department of Psychiatry, University of California, San Francisco, San Francisco, California Robert S. Stephens, PhD, Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, Virginia Susan A. Stoner, PhD, Department of Psychology and the Alcohol and Drug Abuse Institute, University of Washington, Seattle, Washington Jennifer G. Wheeler, PhD, Sex Offender Treatment Program, Department of Corrections, Office of Correctional Operations, Monroe, Washington Katie Witkiewitz, PhD, Department of Psychology and Addictive Behaviors Research Center, University of Washington, Seattle, Washington Tina M. Zawacki, PhD, Department of Psychology, University of Texas at San Antonio, San Antonio, Texas PPrreeffaaccee Preface In the two decades since the first edition of this book was published in 1985, much has happened in the relapse prevention field. Many of these new developments and areas of application are described in this new edi- tion.Intheopeningparagraphofthefirstedition,westatedthat“Relapse Prevention (RP) is a self-management program designed to enhance the maintenance stage of the habit-change process. The goal of RP is to teach individuals who are trying to change their behavior how to anticipate and copewiththeproblemofrelapse.Inaverygeneralsense,relapsereferstoa breakdownorsetbackinaperson’sattempttochangeormodifyanytarget behavior.” This definition of RP still applies and is consistent with the book’ssubtitle,“MaintenanceStrategiesintheTreatmentofAddictiveBe- haviors.”Ascanbeseeninthecontentsofthisedition,therangeofappli- cation has expanded beyond substance use problems to include disorders associated with eating, gambling, and high-risk sexual behavior. Broadly conceived, RP is a cognitive-behavioral treatment (CBT) with a focus on the maintenance stage of addictive behavior change that has two main goals: to prevent the occurrence of initial lapses after a commitment to changehasbeenmade,andtopreventanylapsethatdoesoccurfromesca- lating into a full-blown relapse (relapse management). This new edition differs from the original 1985 volume in several im- portant ways. The first edition consisted of two main sections: Part I, whichprovidedageneraltheoreticaloverviewoftheRPmodel(Chapters1 to 5), including coverage of high-risk situations for relapse, cognitive and behavioral coping skills, and lifestyle modification; and Part II, which contained four chapters describing application of RP with specific target behaviors (alcoholism, problem drinking, smoking, and weight manage- ment). The current edition contains chapters that extend the coverage of thisapproachtootheraddictivebehaviors.Thefirstchapterisdesignedto ix x Preface provide a summary of the RP approach in the treatment of alcohol and otherdrugproblems,toprovideanoverviewoftreatmentoutcomestudies that have evaluated the effectiveness of RP, and to describe recent updates inthetheoreticalunderpinningsofthemodel.Thesecondchapterprovides an important discussion of issues that need to be considered when using RP programs with diverse client populations. The remaining 10 chapters aredevotedtoapplicationsofRPandrelatedCBTinterventionsforavariety ofhigh-riskbehaviors.Sixchaptersaredevotedtosubstanceuseproblems associated with the use of alcohol, tobacco/nicotine, stimulants, opioids, cannabis, and other substances (club drugs, hallucinogens, inhalants, and steroids).Thefinalfourchapterscovernon-substanceuseproblembehaviors, including eating disorders/obesity, gambling disorders, sexual offending, and sexually risky behaviors. Themostimportantchangeforreaderstonoteisthatthisnewedition of the RP book is designed to be used in conjunction with the second edi- tionofourcompanionvolume,AssessmentofAddictiveBehaviors(Dono- van & Marlatt, 2005). Originally published in 1988, the new edition of Assessmentcontainschaptersthatarematchedwithcontentareascovered intheRPbook.Forexample,readerswhoareseekinginformationonboth assessmentandRPinterventionmethodsforalcoholproblemscanconsult parallel chapters in both books. The same authors were invited to provide boththeassessmentandRPchapters,soastoenhancecongruenceofcov- erage and cross-referenced materials. ThereareadditionalchangesandupdatesinthecurrentRPbookthat are also noteworthy. As described in Chapter 1, the original cognitive- behavioral model of the relapse process has been updated with the recent development of a dynamic model that incorporates both distal and proxi- mal risk factors for relapse. This first chapter also describes the recent addition of mindfulness meditation as a metacognitive coping strategy to enhanceclientawarenessofrelapseriskandtofacilitatecopingwithurges andcravings.Anothernewtopicthatisdiscussedinmanychaptersishow to develop an integrated RP intervention program for the treatment of co- occurring disorders (e.g., working with clients who have problems with bothdepressionandexcessivealcoholuse).Sincerelapseisapotentialrisk for clients with both mental health and substance use problems, therapists whocanprovideanintegratedRPassessmentandtreatmentapproachwill benefit from this material. Many chapters also describe how RP methods can be integrated with other intervention programs to enhance treatment effectiveness. Since the advent and influence of the motivational “stages of change” model, many treatment experts have recommended matching treatment interventions to the client’s current stage of change. Based on this perspective, clients who are unmotivated (precontemplation stage) or ambivalent about changing theirproblembehavior(contemplationstage)maybenefitmostfrommoti-
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