road rules: relapse prevention and response in drug court terrence d walton, msw, icadc director of...
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Road Rules: Relapse Prevention and
Response in Drug Court
Terrence D Walton, MSW, ICADC
Director of Treatment
Pretrial Services Agency for the District of Columbia
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True or False?Research shows that even while in treatment, some addicted people can only
stay clean a couple of days before relapsing.
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The 1st Big Question
Is it “relapse” or “continued use”?
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Defining Relapse1. When a person in recovery returns to the
self-prescribed, non-medical use of any mood altering chemical (MAC) and the risk of the problems associated with that use
2. The return to use after a period of abstinence that interrupts the addicts ongoing attempts to recover
3. A return to drug use that is precipitated by and/or leads to lessening of commitment to recover
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Defining RecoveryIn conjunction with a day-by-day commitment to remain abstinent,
the ongoing process of overcoming physical and
psychological dependence on mood altering chemicals and
learning to live in a state of total abstinence, without the need for those substances. In recovery, the individual relies on healthy,
constructive activities and experiences for happiness and
fulfillment.
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The 2nd Big Question
Is it a “slip” or a
“relapse”?
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A Slip Initial episode of alcohol or other drug
use after a period of recovery/remission Does not indicate or precipitate a
lessening in commitment to change Can end quickly or lead to a relapse
of varying degrees
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Slipping
Neither a slip, nor relapse is accidentally using
Both are willful decisions to use Slip = Set Back Relapse = Collapse Slip = Rapidly restored commitment to
change Relapse = Recycling back through
change stages
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Two Secrets
1. “No use” doesn’t mean you’re in recovery
2. “Use” __________________________
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Research1. Studies show relapse rates of 40% to 60% at
one year follow-up2. Most relapses occur in the first year of
recovery, with two thirds occurring in the first 90 days
3. Clients who remain in treatment longer generally have the better outcomes
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Causes Pretreatment Factors
Degree of substance dependence Co-occurring disorders Combat related trauma
Treatment Factors Type, length and quality of treatment
Post Treatment Factors Family/social supports Social/coping Skills Post treatment depression
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Impact on the Individual
Relapse is a persistent risk in recovery
Consequences may include: Return to active use Criminal behavior Physical, social, or emotional
collapse Re-commitment to recovery
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RelapseAn unfolding process in which the resumption of substance abuse is the last event in a long series of
maladaptive responses to internal or external stressors or stimuli
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WHAT IS RELAPSE PREVENTION?
Therapy designed to teach people to engage in recovery-supportive activities and to recognize, anticipate, and manage the relapse warning signs so that they can interrupt the relapse process early and return to the process of recovery.
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Relapse Prevention Planning
1. Written, specific, and rehearsed plans2. Reiterates commitment to and
rationale for recovery3. Outlines and schedules recovery
supportive activities4. Identifies warning signs, cues, and
high risk situations (triggers)5. Details preventive and progressive
responses to all triggers
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A Big Resource
National Registry of Evidenced-based Programs and Practices:
www.nrepp.samhsa.gov
“Relapse Prevention Therapy”
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Traffic Signal Approach
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Green Light Problems– Failing to engage fully in recovery-supportive activities
1. Skipping or coming late to meetings2. Neglecting spiritual activities and
readings3. Skipping work or cutting class4. Failing to plan and participate in leisure
activities5. Neglecting physical exercise, adequate
sleep, or healthy diet
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Yellow Light Problems– Situations requiring caution, extra support, and/or prompt resolution
1. Negative moods & attitudes (angry, afraid, sad, lonely, hurt, guilty, bored, anxious, embarrassed, frustrated, rebellion, resentful, stubborn)
2. Fleeting cravings, urges, or euphoric recall3. Holidays, celebrations; vacations, and other
“down-time”; Sleeping (using dreams)4. Dishonesty, greed, or having extra money5. Feeling depleted, deprived, entitled or
exhausted6. Sobriety milestones7. Re-entering from institutions
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Red Light Problems– Situations to avoid, persistently resist, and/or requiring urgent
external support
1. Offers to use or drink2. Persistent cravings, urges, or euphoric
recall3. Feeling hopeless, like giving up, or not
caring4. Euphoric recall5. Sudden, unexpected external triggers
(sound, sight, smell, taste, sensation)6. Trauma reactions7. A slip
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Relapse Response Planning
1. Written & specific plans2. Detailing immediate post-use
actions3. Full disclosure
Who is to be informed immediately Program to be informed at first
opportunity
4. Expected & accepted consequences5. Plan for re-evaluation and
intervention
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Responses to Relapse
1. Reassess Continued Use Potential and Change Readiness
2. Conduct Functional Analysis of Relapse3. Determine Whether “Continued Use”, “Slip”,
“Relapse”4. Apply Planned Court-related or Supervision-
Related Responses (e.g. sanction, phase freeze, staffing)
5. Apply Planned Clinical Responses (e.g., enhancing treatment, increase drug/alcohol testing)
6. Re-stabilize and Re-engage (e.g. detoxification, treatment readiness); Re-instill hope
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Honesty Matters1. Participant lies about using even
after testing positive.2. Participant readily admits using
after testing positive.3. Participant admits using before
testing positive.4. Participant…
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Program Response Tips1. “Continued use” or dishonesty usually
sanctioned more severely than a readily acknowledged “relapse/slip”
2. Relapse prevention and response planning should be implemented early in the treatment process
3. Prepare to respond to repeated “continuing use” or relapses/slips in some participants, especially early in treatment
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SPONSOR’S NOTE
This project was supported by Grant No. 2012-DC-BX-K004 awarded by the Bureau of Justice Assistance. The Bureau of Justice Assistance is a component of the Office of Justice Programs, which also includes the Bureau of Justice Statistics, the National Institute of Justice, the Office of Juvenile Justice and Delinquency Prevention, the SMART Office, and the Office for Victims of Crime. Points of view or opinions in this document are those of the author and do not represent the official position or policies of the United States Department of Justice.