Relapse Prevention for Substance Abuse Disorders of Women - Research Paper Example

? Using Cognitive Behavior and Self-management in Treatment in Middle Aged Women for Substance Abuse and Preventing Relapse Title> Using Cognitive Behavior and Self-management in Treatment in Middle Aged Women for Substance Abuse and Preventing Relapse. Substance abuse is prevalent throughout the United States, with one in ten American adults suffering from alcohol abuse and one in four addicted to nicotine. Abuse of more serious substances is lower, but still prevalent at an estimated level of 1 in 35 in 1990 (Beck et al., 2001), likely to be much higher in the present day. The effects of this substance abuse are widespread, affecting people’s lives, jobs, family and can frequently result in death from an overdose or from actions taken while under the influence. There are many clinical programs that help people overcome substance abuse and one particular challenge these programs come across is dealing with relapses. In relation to substance abuse, a relapse has two separate definitions and these definitions are relevant to the way substance abuse is understood and treated. The first definition considers a relapse as part of a dichotomy. An individual is either sick or well, he either shows symptoms or he doesn’t, either he relapses or he doesn’t, there is no intermediate. This definition considers a relapse as an outcome, and as such, does not perceive any difference between an individual who has relapsed and one that has never undergone treatment. The second definition that a relapse is where backsliding, subsiding or worsening occurs. This view of a relapse, perceives it as part of the process of recovery, and not as a critical juncture (Brownell et al., 1986). This definition allows for more flexibility when treating patients who have relapsed, and less of an emotional strain that is put on them. Generally speaking, a relapse refers to reverting back to a course of behavior following a period of abstinence, while a lapse may be a single time mistake. For example, a lapse could be a recovering alcoholic having a drink for the first time in several months, while a relapse could be the same individual having drinks for the next few nights. Relapsing has the potential to bring the patient right back to where they were before treatment, and teaching the patient to understand and expect a relapse ahead of time, helps them better prepare and know what to do to prevent them never returning to treatment. The rates for relapse are generally assumed to range between 50% and 90% for the first year in generic treatments. These numbers are based of clinical studies, although the rates can vary extremely across different types of substance abuse, different levels of addiction as well as across individuals (Brownell et al., 1986). When dealing with substance abuse and addictive behavior, one of the biggest challenges is reducing how often relapse occurs, and helping individuals recover from relapse and continue their progress away from substance abuse (Breslin et al., 2002; Brownell et al., 1986). Relapse prevention is designed around preventing or managing the occurrence of relapses through the generation of various techniques, particularly working with patients on predicted outcomes and on assumptions (Marlatt & Witkiewitz, 2005). This is referred to as a cognitive-behavioral approach for relapse prevention (Witkiewitz & Marlatt, 2004). Relapse prevention has specific aims; firstly it aims to prevent lapses happening and secondly it aims to provide assistance if a lapse does occur and prevent any relapses (Marlatt & Witkiewitz, 2005). The Cognitive Behavior Model The cognitive-behavioral model for relapse was first described 27 years ago and derived from clinical data that was obtained from 70 chronic male alcoholics. The model centers on how an individual responds to a situation of high risk following completed substance abuse treatment. The model includes the interactions within the person (such as the ability to cope) and interactions between the person and environmental factors (such as social influences or stress). If the individual has a low coping ability, or lacks confidence with the situation, there is a higher tendency for them to relapse. This can lead to abstinence violation effect (AVE), which is blame, guilt and a perceived loss of control following a relapse (Marlatt & Witkiewitz, 2005). This can cause a spiraling effect, where the AVE emotions can stress the patient, causing further relapses. The model suggests immediate and distant determinants that can result in the relapse. Immediate determinants may be things like stress, coping ability and the outcome that is expected, while distant determinants are things such as cravings, urges and lifestyle factors (Larimer, Palmer, & Marlatt, 1999). An important factor is that, even after completing successful treatment, patients are still vulnerable to the demands of stimuli and environmental stressors, and may relapse as a consequence (Breslin et al., 2002). However, a high risk situation in itself isn’t enough to cause a relapse; it is also dependant on what expectations the individual has (Breslin et al., 2002; Marlatt, 1979). If the individual sees a relapse as a loss of control, or a failure on their part, while in fact the risks are environmental and uncontrollable, then they are more likely to relapse. However, if the individual sees a relapse as an inevitable part of the process or as a learning experience, then their response is less predictable and they may experiment with alternative methods of coping that they may not have otherwise (Marlatt & Witkiewitz, 2005). The relapse rates that are known are collected from clinical treatment, and because of these are all patients that have undergone professional treatment. As a consequence, these numbers may not be fully indicative of the entire population. For example, it is often considered that relapse rates may be lower in those that change by their own means. This is because people who decide to change, and do so under their own strength often have higher willpower than individuals in the programs, and as a consequence may relapse less frequently (Brownell et al., 1986). Preventing relapse using cognitive behavior and self-management People recovering from substance abuse are prone to relapses (Breslin et al., 2002), and as a consequence relapse prevention is now important in the treatment of some behavioral disorders, and combines training in behavioral skills with cognitive intervention to prevent or limit future relapses (Marlatt & Witkiewitz, 2005). There is a large component of educational teaching involved in relapse prevention. This is because the way an individual perceives relapses, as well as misconceptions about substance abuse, and negative thoughts are all important to the relapse process, and thus to relapse prevention. For example, if the substance abuse is perceived as being the fault of the situation, rather than caused by the individual, then their focus may be to change the situation rather than the substance abuse. If the situation is unchangeable, or if it is not the cause, then this is counterproductive and can prevent the patient from completing the program. Preparing individuals for relapses is an important part of this, helping them to restructure their thought process to see a lapse as part of the process (Marlatt & Witkiewitz, 2005). This allows the relapse to be seen as a stepping stone, or a point to recover from, rather than the perception that prior work in recovery had been wasted. Changing from negative to positive thinking as a coping strategy has been reported as a good strategy during treatment, and indicative of the trend continuing after treatment (Breslin et al., 2002). The second part of relapse prevention is self-management strategies. For relapse prevention to be effective, and goals to be maintained following treatment, lifestyle balance is important. Therapists often work with individuals to help them deal with daily stresses, learn stress management techniques or time management, and work towards developing a ‘road map’ of the different outcomes of potential choices (Marlatt & Witkiewitz, 2005). This allows them to develop an idea of what is a good decision, and what is a bad one, as well as situations that they may want to avoid as they will be vulnerable. Treatments following the cognitive behavior model often involve targeted interventions. These are on an individual level, and are a form of relapse prevention. A therapist will talk with the client about many of the steps that may cause a relapse, looking at what situations are high-risk for that individual, and eliminating many of the myths and assumptions surrounding substance abuse. The therapist assesses characteristics of high risk situations, and helps determine the client’s weaknesses in these areas, and thus can work to address these with them, reducing chance of relapse (Larimer et al., 1999). What is the effect of this in the treatment of middle aged women? Treatment types and the effect of substance abuse are not constant across age groups and genders. This is particularly true for women. Many studies have found that women have heightened vulnerability to many of the negative consequences of substance abuse, advancing more rapidly from occasional to regular use than males in the same situation. On entering treatment, they often show similar levels of symptoms as males, despite most of the time having used smaller quantities and for a shorter time period (Greenfield et al., 2007). Substance abuse in adult women often does not occur on its own. It is commonly linked to a number of different psychiatric disorders, with co-occurrence of multiple being common. Such disorders include low mood, anxiety, post-traumatic stress and eating disorders. One particularly strong pairing is posttraumatic stress disorder (PTSD), which is also linked to childhood abuse (Cohen & Hien, 2006; Greenfield et al., 2007) As a consequence women frequently find seeking help difficult, as they see the substance abuse as a result of their mental disorder, and look for the solution to that, ignoring the substance abuse. The role that women play in child carrying and raising is also a factor that limits their enrollment in programs. Women who are pregnant, or have custody of children often do not want to admit the problem, as they fear prosecution or losing custody (Greenfield et al., 2007). Within programs, the differences between males and females were not as distinct as the differences in numbers of each gender entering the programs. Five studies found that women were more likely to leave part way through the program and not finish the substance abuse treatment. However, two studies showed that women were less likely than men to drop out (Greenfield et al., 2007). This may indicate causes of individuals staying in programs are not linked directly to gender, but to another fact which can be linked to gender and may differ across locations. Alternatively, the manner in which they studies were conducted may hide the true nature of what is occurring. Up to 80 percent of women looking for treatment for substance abuse have histories of sexual abuse, physical abuse or both (Cohen & Hien, 2006). Cognitive behavior treatments have been found to be important for women for this reason. Psychosocial assessments following cognitive behavior treatments found that women treated in this way showed decreased depression, decreased suicidal thoughts and increased substance abstinence (Greenfield et al., 2007). Conclusion Women are a particularly vulnerable when they enter programs that look at managing substance abuse. They often have been abused either physically or sexually, and may have fears about entering treatment. Many women who are mothers or soon-to-be mothers find entering treatment programs especially difficult, as they fear prosecution or losing custody of children. Once they are in treatment, there are still strong indications that females are more likely to drop out than males (five studies found females dropped out more; two found they dropped out less). Cognitive behavior treatment is especially important for women, and it has been shown to lead to improvements in mood and increases in the ability to maintain abstinence from the substance. This, accompanied with self-management, allows women to understand the potential weak spots they have, areas in which they may be vulnerable to relapsing, and work towards avoiding those situations. This method of treatment also considers the idea that relapses occur as part of the process of recovery and teaches individuals how to cope with the concept that relapses may occur. Self-management focuses on creating plans and goals, working out what to expect and how to behave in situations that may turn dangerous, or may be likely to cause a relapse. Cognitive behavior therapy and self-management have become important in the treatment of women suffering from substance abuse, and their use is becoming effective at increasing mental well-being as well as decreasing the chance of relapse either during or following treatment. References Beck, A. T., Wright, F. D., Newman, C. F., & Liese, B. S. (2001). Cognitive therapy of substance abuse. Breslin, F. C., Zack, M., & McMain, S. (2002). An information-processing analysis of mindfulness: Implications for relapse prevention in the treatment of substance abuse. Clinical Psychology: Science and Practice, 9(3), 275–299. Brownell, K. D., Marlatt, G. A., Lichtenstein, E., & Wilson, G. T. (1986). Understanding and preventing relapse. American Psychologist, 41(7), 765. Cohen, L. R., & Hien, D. A. (2006). Treatment Outcomes for Women With Substance Abuse and PTSD Who Have Experienced Complex Trauma. Psychiatric Services, 57(1), 100. Greenfield, S. F., Brooks, A. J., Gordon, S. M., Green, C. A., Kropp, F., McHugh, R. K., Lincoln, M., et al. (2007). Substance abuse treatment entry, retention, and outcome in women: A review of the literature. Drug and Alcohol Dependence, 86(1), 1–21. Larimer, M. E., Palmer, R. S., & Marlatt, G. A. (1999). Relapse prevention. An overview of Marlatt’s cognitive-behavioral model. Alcohol research & health: the journal of the National Institute on Alcohol Abuse and Alcoholism, 23(2), 151. Marlatt, G. A., & Witkiewitz, K. (2005). Relapse Prevention for Alcohol and Drug Problems. Relapse prevention: Maintenance strategies in the treatment of addictive behaviors (pp. 1-45). New York: Guilford Press. Witkiewitz, K., & Marlatt, G. A. (2004). Relapse prevention for alcohol and drug problems: that was zen, this is tao. American Psychologist, 59(4), 224.  Read More