Addiction Relapse Prevention

All counselors need to be prepared to appropriately address client setbacks in with engagement in view. The following is a guide for counselors when addressing setbacks with challenging clients, with a view toward maintaining rapport and positive engagement in treatment

For some who have done previous Taking the Escalator worksheets focused on “Setbacks”, this may be a review. The Taking the Escalator methodology is a harm reduction-based, motivational and self- awareness focused philosophy. In the process of learning to recover and change from substance use disorders and other co-existing issues, it is not uncommon that there are many challenges along the way. Abstinence based models, such as the 12 Step Model, usually refer to these challenging periods in recovery as “Relapse”. By contrast, Taking the Escalator prefers the term “Setbacks”.

This activity is designed for active preparation for an upcoming event that may be challenging to deal with as related to substance use and co-occurring mental health issues. Often events can bring with them various triggers and other obstacles that can make it challenging to maintain a course of progress. It makes sense to plan ahead when a challenging event is on the horizon so as to prevent setbacks.

This tool has been edited to correct some formatting errors

This tool is free for download and use. If you or your agency is going to use this tool, please email takingtheescalator@gmail.com just to notify

In spite of the extent of the substance use problem in many parts of the world, the number of available comprehensive substance use assessment tools is limited. Some of the tools that are available are extremely outdated. The E13 Comprehensive Integrated Substance Use Assessment is modern and inclusive as it considers aspects of motivation, insight,  MAT and Harm Reduction as well as including ASAM criteria and DSM 5 diagnosis components. In addition the assessment fully integrates coexisting mental health, medical and behavioral issues as well as multiple other relevant life area assessments.

Free for download and use.  If you plan on using the E13 Assessment in your clinical practice or agency, please simply email takingtheescalator@gmail.com to inform. Modifications can be made in the assessment tool for your specialized needs

The problem of retention and relapse was born with the science of orthodontics and continues to persistently disturb Orthodontic researchers and clinicians. In spite of all the advances in the active treatment procedures, retention and relapse remains a problem for many practitioners. Several studies have been carried out to determine the changes taking place several years after orthodontic treatment and the influencing factors. Factors including growth, periodontium, age, third molars, tooth dimensions etc., have been held responsible for post treatment relapse. Several procedures have been devised to ensure stability and prevent or at least avoid post treatment changes so as to reduce relapse. To achieve this purpose, a proper understanding of the changes occurring, various factors affecting relapse and retention procedures is important. Thus problems of retention and the continued trend, which owes to the biological and mechanical limitations, demands to go through the state of art of this perennial problem "Retention and Relapse".

Boredom is quite often cited as one of the more challenging aspects when dealing with recovery from substance use issues. It is safe to say that no one likes boredom, and we all have to face boredom at one time or another. Therefore, it makes sense to be prepared for boredom when making life changes as we move away from a life of addictive behaviors. One way to do this is to adjust our viewpoint on boredom. We can learn and practice mastering boredom instead of allowing feelings of boredom to derail our progress.

Fear of Missing Out - FOMO -  can at times be associated with substance use disorders especially when an individual is trying to change their lifestyle to avoid situations that can trigger relapse. An individual who is trying to live without drugs/alcohol may experience a sense of fear or worry about what may be missed out on when making a change to a more stable and safer lifestyle without substances.  To put this in perspective here are some examples of FOMO types of statements associated with substance use recovery:

In the article, the authors deal with how addiction can be related to autonomy. First, they will provide a definition of substance addiction and the way various theories have interpreted this phenomenon. Further, they will give a general description of the concept of autonomy and relate this to the phenomenon of addiction. Subsequently, the authors will deal with the way some explanatory models of addiction (the disease model, disorder of choice model, and existential disorder model) see the relationship of autonomy and addiction and focus on the following questions: How does addiction relate to autonomy? Does addiction make volitional choice impossible, i.e. are addicts out of control? Is addictive behavior a rational activity?

Key words: Addiction, autonomy, disease model, disorder of choice model, existential disorder model, spirituality.

Recovery is as a “process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.” (SAMHSA 2012) This is a direction for those who are ready to recover, or to help others live a life worth meaning.  This is an outline for those who seek to regain or maintain sanity and wellness in a context of holistic wellness.  Let us examine recovery by the numbers, and form a solution information base for the sick, and struggling who may become inspired toward recovery based living.  If human and social capital can be leveraged to help others recover let us provide support for our peers and share with them.  It is part of the human condition that we need the support and encouragement of others to become content with life, and to feel connected.

Coping with craving is an essential part of the change process when dealing with substance use issues or when coping with any potentially behavioral addictions as well (such as compulsive gambling, sex, shopping, etc.) Having a plan for managing cravings is critical to making positive progress. For this activity, you will develop your own cravings plan.

By now almost everyone is familiar with the concept of co-occurring disorders in substance abuse treatment. The expanded idea of integrating coexisting issues looks beyond just mental health with a view toward treating the whole person, not just the "disorder"

This activity is easy and can be done in person or through telehealth. It is good for both adolescents and adults and for people with any type of presenting problem as the directions are clear and simple: Just take turns reading out loud each of the "fill in the blank" discussion points and let group members give their answers.

In the plethora of international research on smoking relapse there are findings that suggest distinct ethnocultural differences in relapse predictors. This study aimed to uncover cognitive and affective factors that contribute to relapse in a sample of Filipino adult smokers (N = 115). Using discriminant function analysis, results suggest that self-efficacy, outcome expectancy, craving and the subdomains of motivation to change contemplation and action are accurate relapse predictors, whereas negative emotional states are not. An integrative framework was used in the discussion to account for inconsistencies in the results. Implications for understanding the relapse cycle, the connection between smoking relapse and substance use, as well as suggestions for future studies on smoking relapse, are also discussed.

Recent research suggests that romantic love may be literally addictive. Although the exact nature of the relationship between love and addiction has been described in inconsistent terms throughout the literature, we offer a framework that distinguishes between a narrow view and a broad view of love addiction. The narrow view counts only the most extreme, harmful forms of love or love-related behaviors as being potentially addictive in nature. The broad view, by contrast, counts even basic social attachment as being on a spectrum of addictive motivations, underwritten by similar neurochemical processes as more conventional addictions. We argue that on either understanding of love-as-addiction, treatment decisions should hinge on considerations of harm and well-being rather than on definitions of disease. Implications for the ethical use of anti-love biotechnology are considered.

People regress back toward negative behaviors for a variety of reasons, many of which do not directly correspond with the concept of relapse in the traditional sense. Using the term setback is often more practical and expansive when it comes to describing the wide variety of situations that may constitute a challenge or diversion in one’s overall path toward progress.

Drug addiction has become a worldwide problem and the leading cause of death. The global problem of addiction and drug abuse is responsible for millions of deaths and millions of new cases of HIV every year. In recent years, India is seeing a rising trend in drug addiction. The most common use of drug in India is alcohol, followed by cannabis and opiates. Drug use, whether licit or illicit, causes serious health problems in individuals. The National level survey conducted on drug use in India indicated that prevalence of drug abuse among males in the general population is significant. Drug abuse among women exists. Despite the fact that more men use drugs than women, the impact of drug use tends to be greater on women, because women lack access to care for drug dependence. Economic burden, disturbed family environment, violence, and psychological problems are other consequences of drug abuse in the family. Adolescent drug abuse is another major area of concern because more than half of the person's with substance use disorder are introduced to drugs before the age of 15 years. At present, there exists a significant gap in service delivery. The current paper highlights the causes of drug abuse, and describes the treatment and prevention of drug abuse and addiction for proper management of the problem.

Psychedelic drugs are some of the most powerful tools in the world for personal healing and psychological growth. Research at major medical centers over the past few years have shown remarkable results in the treatment of conditions such as depression, post-traumatic stress disorder (PTSD), and anxiety. Psychedelic drugs provide a path of treatment that is often more effective and rapid than other methods, and with many fewer side effects than pharmaceutical options. This paper will be focusing on hallucinogens such as lysergic acid diethylamide (LSD), and psilocybin and entheogens such as ayahuasca and ibogaine.

This exercise is focused on building insight and self-awareness by first identifying where you often find yourself nowadays in certain situations. Then to follow, the second part of this activity involves some deeper questions about the process of "finding yourself"

This activity features questions for group discussion with a focused on opening up about childhood and family issues. Questions are arranged in a timeline format starting with birth then continuing chronologically to the present. Because some issues can be sensitive, group members are encouraged to be open and try to share what they can but to also make sure not to share more than they are comfortable with at this time in their recovery. The group activity ends with a discussion on coping in the present and the future, as well as some discussion about involving family members in treatment if possible.

Motivational interviewing (MI) is a novel psychotherapeutic approach that involves patient-centred and goal oriented counselling to resolve the patient’s ambivalence towards behaviour change (Miller & Moyers, 2006).

The transtheoritical model (TTM) of change emerged as an integrated model of behaviour change that incorporated the Freudian, Skinnerian and Rogerian theories of psychology to classify the process and stages of behaviour change (Glanz, Rimer, & Viswanath, 2008). TTM classifies behaviour change in to six distinct stages namely pre-contemplation, contemplation, preparation, action, maintenance and termination (Prochaska & DiClemente, 1983) (Glanz et al., 2008).

Stability Self-Awareness Checklist Being self-aware is key when it comes to staying on the right track in order to prevent relapse and setbacks when coping with substance use and coexisting mental health issues. To be truly self-aware, we need to be able to honestly ask and answer questions of ourselves and to objectively assess our true progress, insight and motivation. When we are honest and open our minds, we can learn where we need to make the improvements and adjustments needed to stay on a positive course and avoid going down the wrong path.

The United States is in the midst of a public health crisis: Every year, well over 24,000 Americans die from opioid overdose. This staggering death toll is equivalent to a weekly jumbo jet crash. After a decade of rapid growth, overdose caused by prescription opioids and heroin now tops the accidental death rankings, beating out automobile accidents, AIDS, and other high-profile killers. Overdose does not discriminate, cutting across all geographic, economic, and racial divides. But some groups are especially vulnerable. This article is dedicated to one such group: individuals re-entering the community from correctional settings. In the immediate two weeks after release, people in this group are almost 130 times more likely to die of an overdose than the general population.

It is easy to cast post-incarceration substance use — and consequent overdose — as the re-entering individual’s character weakness or a propensity towards reckless behavior. Nevertheless, modern addiction science reframes such relapse as a foreseeable consequence of the chronic nature of substance use disorders. This scientific evidence also provides clear guidance on how most of the resulting fatalities can be prevented. This article considers the creation of fatal overdose risk among formerly incarcerated individuals as an unacceptable collateral harm emanating from criminal justice involvement.

In order to address this largely overlooked public health problem, we explore a range of legal channels that can help persuade the state (broadly construed) to address a risk to which it substantially contributes. We consider a number of doctrinal approaches, guided by the belief that spending time behind bars must not translate to a death sentence for so many Americans. Whether as a part of possible legal actions or an action agenda on its own right, we present a number of programmatic interventions and policy reforms that may alleviate this crisis. Our analysis also highlights the potential role of the Affordable Care Act (ACA) in facilitating overdose prevention before, during and post-incarceration. This agenda is especially timely given the current move by federal and state governments towards releasing large numbers of individuals incarcerated on drug-related charges to ease prison over-crowding or as a result of legal reforms, pardons, or exonerations.

In Section I, we provide an overview of the opioid overdose epidemic and the special vulnerability among criminal justice-involved individuals. In Section II, we examine the scientific evidence on prevention measures that should be, but are currently rarely deployed to address this vulnerability. In Section III, we explore various legal theories that could be invoked in efforts to motivate government actors to take a greater responsibility for preventing post-incarceration overdose deaths. In Section IV, we cover additional mechanisms to motivate institutional change. We conclude by outlining a policy and programmatic agenda for reducing the vulnerability of criminal justice-involved individuals to opioid overdose.

The aims of this pre-test post-test quasi experimental design were to examine the impact on health and well-being and mindfulness scores of an 8 day mindfulness based intervention (MBI) on a group of incarcerated young offenders. The relationship between mental health symptoms and substance dependence is also explored. The Health and Well-Being Tracker and The Five Facet Mindfulness Questionnaires were used as tools in measuring the differences of both the pre-test and post-test conditions. Mental health symptoms and substance dependence were assessed via the DSM-IV-TR and used to measure potential changes in participant scores before and after the MBI. The paper predicted an increase in general health and well-being and higher mindfulness scores on completion of the MBI and a positive correlation between mental health symptoms and substance dependence.  A total of twelve (N=12) participants between the ages of 18 to 21 (M=19.33, SD=1.00) were selected of which nine (N=9) completed the group.  Results indicated a statistically significant positive correlation between mental health symptoms and substance dependence. Although health and well-being scores showed numerical differences in the predicted direction, neither health and well-being or mindfulness scores increased significantly. The limitations of the research are examined in detail.

Since the late 1970s illicit drug use has established itself as a major social problem. The response has largely been dominated by tougher measures to coerce people to accept treatment and become drug free or ultimately face prison. But after decades of tough drug policies our prisons have become crowded silos for drug users and people with multiple personal difficulties. Relatively little progress seems to have been made in reducing the overall size of the drugs problem or the proportion of people taking illicit drugs.

This lecture will reflect upon the way in which a ‘war on drugs’ is played out as a ‘war on drug users’. While most strategies have concentrated upon the physical and psychological aspects of dependence, this paper will highlight the important but often overlooked structural and social context of problem drug use. It will be argued that the stigmatisation of illicit drug use has made it more difficult for problem drug users to recover. Alternative conceptual models that promote a more inclusive approach will be explored.

Successful ‘recovery’ from long-term problem drug use has depended largely upon understanding and tackling the physiological and psychological nature of drug dependence; however, drawing upon research and practice in Liverpool, England, the author questions whether this discourse is sufficient given the changing nature, context and attitudes towards drug consumption in the twenty-first century. This article emphasises the importance of incorporating structural and social factors. Drawing upon qualitative data from three separate studies, the author illustrates how stigmatisation, marginalisation, and social exclusion are significant debilitating components that have tended to be overlooked. This paper contributes new insights into the damaging impact of political rhetoric and structural discrimination that has placed many long-term drug users vulnerable to relapse. In response to these findings the author offers a new conceptual framework for practice that incorporates and pro-motes an understanding of the social nature and context of long-term drug dependence.

On a day to day basis, in addition to formal treatments, therapies and medications, some of the best forms of healing can also take place through the consistent and persistent use of basic coping strategies. These simple strategies used alone may not be the answer with more complex cases of emotional trauma. However, having a handful of basic yet effective coping tools to get through the short term can be a lifesaver when considering emotional survival on a day to day basis.

The present research aimed to study self-reflection, self-importance of moral identity, self-forgiveness, and personal growth initiative as the psychological determinants of relapse prevention among the drug addicts. Study instruments include Self-Reflection and Insight. The whole study is divided into two phases. Phase I underlies translation and validation of the research instrument into Urdu language; such that, translated versions possess significant reliability and possess good construct validity. Phase II studies the relationship between self-reflection, self-importance of moral identity, self-forgiveness, personal growth initiative, and relapse prevention among 240 drug addicts (M = 29.3, SD = 8.2). Sample was approached at different rehabilitation centers of Islamabad and Rawalpindi. Results indicated that all translated instruments are valid for the sample. All the study variables are found to explain about 14% variance (R 2 = .14) in warning of relapse such that personal growth initiative is the most significant predictor. The values of total, direct, and indirect effects demonstrate existence of mediation; such that, self-importance of moral identity, self-forgiveness, and personal growth initiative act as serial mediators in order as mentioned for the relationship of self-reflection and warning of relapse.