Withdrawal Management and Relapse Prevention
An-Pyng Sun in Treating Addictions, 2018
This chapter focuses on two major sequential phases: detoxification or withdrawal management during patients' initial phase of treatment; second, their rehabilitation and aftercare with a goal of relapse prevention. Although the withdrawal management phase occurs prior to the relapse prevention phase, addicted people may relapse during the relapse prevention phase and return to the withdrawal management phase. The chapter highlights Alcohol and opioid addictions because many patients seek treatment, especially withdrawal, for one of the two addictions. Pharmacotherapy is better developed for alcohol and opioid addiction than many other addictive drugs such as cocaine, amphetamines, and marijuana. Methadone, an opioid agonist, has been traditionally the typical medication for treatment of opioid withdrawal symptoms. Detoxification can be as long as six months in an outpatient methadone clinic; it can also be just several says in an inpatient setting. There are three major medications for relapse prevention of opioid use: methadone, buprenorphine and naltrexone.
Relapse Prevention and the Completion of Treatment
Amy Wenzel in Cognitive Behavioral Therapy for Beginners, 2019
This chapter provides some guidelines for the major activity that occurs in the late phase of Cognitive Behavioral Therapy (CBT)—relapse prevention—as well as approaches to tapering sessions and ending treatment. It deals with space for therapist to reflect on their own learning and decide upon the next steps they will take to refine their skills as a cognitive behavioral therapist. Relapse prevention is a strategy in which clients think ahead to signs that they are experiencing another episode of their mental health disorder and ways to, proactively, apply the CBT principles and strategies that they have learned. In addition to the focus on relapse prevention, in the last sessions before the completion of treatment, cognitive behavioral therapists typically discuss clients’ reflections on the course of treatment and their reactions to the end of treatment. CBT is an example of a “living” approach to psychotherapy that continually is honed while, at the same time, retaining its fundamental principles.
Phase 5 – Relapse prevention
Glenn Waller, Hannah M. Turner, Madeleine Tatham, Victoria A. Mountford, Tracey D. Wade in Brief Cognitive Behavioural Therapy for Non-Underweight Patients, 2019
This chapter outlines relapse prevention methods, designed to ensure that cognitive behaviour therapy-ten (CBT-T) continues to have its effects into the follow-up period and beyond. The stress is on reinforcing the patient’s sense of having made the changes themselves, rather than being dependent on the clinician’s contribution. The aim of the self-directed therapy sessions is to ensure that the patient maintains practice and develops problem-solving skills following the ten sessions of CBT-T, to reduce the risk of relapse. Relapse prevention usually takes place over Sessions 9–10, although it can be delivered earlier if the patient has made rapid progress through the other phases. The chapter considers the viability of self-help approaches, as this seems to be valued by the patients who we have worked with. It suggests that patients should use self-help materials to enhance their skills in any relevant domain.
Lymphopenia predicts preclinical relapse in the routine follow-up of patients with diffuse large B-cell lymphoma
Published in Leukemia & Lymphoma, 2015
Xiaolei Wei, Yongqiang Wei, Fen Huang, Hui Jing, Muchen Xie, Xiaoxiao Hao, Ru Feng
The absolute lymphocyte count (ALC) has been reported to predict relapse in diffuse large B-cell lymphoma (DLBCL). We performed the present study to determine whether the ALC could identify preclinical relapse during routine follow-up. Among all 148 patients analyzed, 39 patients exhibited relapse. Patients without relapse had a higher ALC compared with those with proven relapse at the time of relapse as well as 1 and 3 months before relapse. Low ALC (< 950/μL) at 1 and 3 months before relapse had a positive predictive value of 74.2% and 69.0% and a negative predictive value of 86.3% and 84.0%, respectively, to predict relapse. Low ALC at both 1 and 3 months before relapse was significantly associated with relapse by univariate and multivariate analysis. Our data suggest the potential of lymphopenia to detect preclinical relapse in DLBCL. This may help to identify patients requiring salvage chemotherapy at the time of minimal disease rather than clinically overt relapse.
“It’s About Us, You Know?” Relapse in Emotionally Focused Couples Therapy for Addictions
Published in Journal of Social Work Practice in the Addictions, 2018
Kara Fletcher, Heather Macintosh
Addiction treatment unavoidably entails working with relapse. In the context of couple therapy, discussion of relapse can become an integral part of the treatment process, as each partner is affected and interprets relapse differently. Drawing on data from a case study that used a theoretical extension of emotionally focused therapy for couples dealing with substance addictions, this article analyzes the experiences of slips and relapse across 4 couples. Using a thematic analysis to explore the findings, 4 primary themes are identified related to slips and relapse within the context of couple therapy and additions. These themes include guilt, shame, and depression; relapse as an attachment injury; confusion about relapse; and relapse as part of the process. Recommendations are offered for treating and working with relapse in the context of couple therapy.
Time to Relapse Questionnaire (TRQ): A Measure of Sudden Relapse in Substance Dependence
Published in The American Journal of Drug and Alcohol Abuse, 2010
Bryon Adinoff, Chelsea Talmadge, Mark J. Williams, Erica Schreffler, Patricia K. Jackley, Steven R. Krebaum
Background: Relapse may occur suddenly, following a short period of craving, or after extended consideration. The time to relapse may reveal underlying mechanisms of relapse and have important implications for treatment. Objective: The Time to Relapse Questionnaire (TRQ), a self-administered questionnaire, was designed to assess the time from the initial thought of drug use to actual use. Methods: Psychometric properties of the TRQ were evaluated in two distinct populations (n = 183 and 194) with DSM-IV primary substance use disorders. Results: Factor analysis and item refinement led to a 9-item TRQ with a three-factor solution accounting for 63% of the total variance. Three discrete types of relapse style were identified: Sudden Relapse, Short Delay Relapse, and Long Delay Relapse. The TRQ demonstrated good construct validity and adequate internal consistency for the total (α = .61) and individual factor (α = .64–.75) scores. Measures to assess convergent validity of the TRQ suggest that Sudden Relapse may not reflect more generalized deficits of inhibitory control. Conclusions and Significance: The TRQ may provide a useful self-report measure to discriminate between addicted patients who relapse without forewarning compared to those with a period of delay. Clinical interventions may be targeted towards different relapse styles.
Related Knowledge Centers
- Substance Abuse
- Substance Dependence