Relapse Prevention and Response in Drug Court
Keeping It Moving:
Keeping It Moving:
Relapse Prevention and
Relapse Prevention and
Response in Drug Court
Response in Drug Court
Terrence D Walton, MSW, ICADC
Director of Treatment
Pretrial Services Agency for the District of Columbia
True or False?
True or False?
Research shows that even
Research shows that even
while in treatment, some
while in treatment, some
addicted people can only stay
addicted people can only stay
clean a couple of days before
clean a couple of days before
relapsing.
relapsing.
The 1
The 1
st
st
Big Question
Big Question
Is it “
Is it “
relapse
relapse
” or
” or
“
“
continued use
continued use
”?
”?
Defining Relapse
Defining Relapse
1.
When a person in
When a person in
recovery
recovery
returns to the
returns to the
self-prescribed, non-medical use of any
self-prescribed, non-medical use of any
mood altering chemical (MAC) and the risk
mood altering chemical (MAC) and the risk
of the problems associated with that use
of the problems associated with that use
2.
The return to use after a period of
The return to use after a period of
abstinence that interrupts the addicts
abstinence that interrupts the addicts
ongoing attempts to
ongoing attempts to
recover
recover
3.
A return to drug use that is precipitated by
A return to drug use that is precipitated by
and/or leads to lessening of commitment to
and/or leads to lessening of commitment to
recover
recover
Defining Recovery
Defining Recovery
In 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.
The 2
The 2
nd
nd
Big Question
Big Question
Is it a “
Is it a “
slip
slip
” or
” or
a “
a “
relapse
relapse
”?
”?
A Slip
A Slip
Initial episode of alcohol or other drug
Initial episode of alcohol or other drug
use after a period of recovery/remission
use after a period of recovery/remission
Does not indicate or precipitate a
Does not indicate or precipitate a
lessening in
lessening in
commitment to change
commitment to change
Can end quickly or lead to a relapse of
Can end quickly or lead to a relapse of
varying degrees
varying degrees
Slipping
Slipping
Neither a slip, nor relapse is accidentally
Neither a slip, nor relapse is accidentally
using
using
Both are willful decisions to use
Both are willful decisions to use
Slip
Slip
= Set Back
= Set Back
Relapse
Relapse
= Collapse
= Collapse
Slip
Slip
= Rapidly restored commitment to
= Rapidly restored commitment to
change
change
Relapse
Relapse
= Recycling back through
= Recycling back through
change stages
change stages
Two Secrets
Two Secrets
1.
“No use”
“No use”
doesn’t mean you’re in
doesn’t mean you’re in
recovery
recovery
2.
“Use”
“Use”
__________________________
__________________________
Research
Research
1.
Studies show
Studies show
relapse rates of 40% to 60%
relapse rates of 40% to 60%
at
at
one year follow-up
one year follow-up
2.
Most relapses occur in the first year of
Most relapses occur in the first year of
recovery, with two thirds occurring in the first
recovery, with two thirds occurring in the first
90 days
90 days
3.
Clients who remain in treatment longer
Clients who remain in treatment longer
generally have the better outcomes
generally have the better outcomes
Causes
Causes
Pretreatment Factors
Pretreatment Factors
Degree of substance dependence
Degree of substance dependence
Co-occurring disorders
Co-occurring disorders
Combat related trauma
Combat related trauma
Treatment Factors
Treatment Factors
Type, length and quality of treatment
Type, length and quality of treatment
Post Treatment Factors
Post Treatment Factors
Family/social supports
Family/social supports
Social/coping Skills
Social/coping Skills
Post treatment depression
Post treatment depression
Impact on the Individual
Impact on the Individual
Relapse is a persistent risk in
Relapse is a persistent risk in
recovery
recovery
Consequences may include:
Consequences may include:
Return to active use
Return to active use
Criminal behavior
Criminal behavior
Physical, social, or emotional
Physical, social, or emotional
collapse
collapse
Re-commitment to recovery
Re-commitment to recovery
Relapse
Relapse
An 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
WHAT IS RELAPSE PREVENTION?
WHAT IS RELAPSE PREVENTION?
Therapy designed to teach people to
Therapy designed to teach people to
engage in recovery-supportive
engage in recovery-supportive
activities and to recognize, anticipate,
activities and to recognize, anticipate,
and manage the relapse warning signs
and manage the relapse warning signs
so that they can interrupt the relapse
so that they can interrupt the relapse
process early and return to the process
process early and return to the process
of recovery.
of recovery.
Relapse Prevention Planning
1.
Written, specific, and rehearsed plans
2.
Reiterates commitment to and rationale
for recovery
3.
Outlines and schedules recovery
supportive activities
4.
Identifies warning signs, cues, and high
risk situations (triggers)
5.
Details preventive and progressive
responses to all triggers
A Big Resource
A Big Resource
National Registry of Evidenced-based
National Registry of Evidenced-based
Programs and Practices:
Programs and Practices:
w
w
w
w
w
w
.
.
n
n
r
r
e
e
p
p
p
p
.
.
s
s
a
a
m
m
h
h
s
s
a
a
.
.
g
g
o
o
v
v
“Relapse Prevention
“Relapse Prevention
Therapy”
Therapy”
Traffic Signal Approach
Traffic Signal Approach
Green Light Problems
–
Failing to engage fully in
recovery-supportive activities
1.
Skipping or coming late to meetings
2.
Neglecting spiritual activities and
readings
3.
Skipping work or cutting class
4.
Failing to plan and participate in leisure
activities
5.
Neglecting physical exercise, adequate
sleep, or healthy diet
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 recall
3.
Holidays, celebrations; vacations, and other
“
down-time
”
; Sleeping (using dreams)
4.
Dishonesty, greed, or having extra money
5.
Feeling depleted, deprived, entitled or exhausted
6.
Sobriety milestones
7.
Re-entering from institutions
Red Light Problems
–
Situations to avoid,
persistently resist, and/or requiring urgent
external support
1.
Offers to use or drink
2.
Persistent cravings, urges, or euphoric recall
3.
Feeling hopeless, like giving up, or not caring
4.
Euphoric recall
5.
Sudden, unexpected external triggers
(sound, sight, smell, taste, sensation)
6.
Trauma reactions
7.
A slip
Relapse Response Planning
1.
Written & specific plans
Written & specific plans
2.
Detailing immediate post-use actions
Detailing immediate post-use actions
3.
Full disclosure
Full disclosure
Who is to be informed immediately
Who is to be informed immediately
Program to be informed at first
Program to be informed at first
opportunity
opportunity
4.
Expected & accepted consequences
Expected & accepted consequences
5.
Plan for re-evaluation and intervention
Plan for re-evaluation and intervention
Responses to Relapse
Responses to Relapse
1.
Reassess Continued Use Potential and Change
Reassess Continued Use Potential and Change
Readiness
Readiness
2.
Conduct Functional Analysis of Relapse
Conduct Functional Analysis of Relapse
3.
Determine Whether “Continued Use”, “Slip”,
Determine Whether “Continued Use”, “Slip”,
“Relapse”
“Relapse”
4.
Apply Planned Court-related or Supervision-
Apply Planned Court-related or Supervision-
Related Responses (e.g. sanction, phase freeze,
Related Responses (e.g. sanction, phase freeze,
staffing)
staffing)
5.
Apply Planned Clinical Responses (e.g., enhancing
Apply Planned Clinical Responses (e.g., enhancing
treatment, increase drug/alcohol testing)
treatment, increase drug/alcohol testing)
6.
Re-stabilize and Re-engage (e.g. detoxification,
Re-stabilize and Re-engage (e.g. detoxification,
treatment readiness); Re-instill hope
treatment readiness); Re-instill hope
Honesty Matters
1.
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 admits thoughts of using
before doing so
.
Program Response Tips
Program Response Tips
1.
“Continued use” or dishonesty usually
“Continued use” or dishonesty usually
sanctioned more severely than a readily
sanctioned more severely than a readily
acknowledged “relapse/slip”
acknowledged “relapse/slip”
2.
Relapse prevention and response planning
Relapse prevention and response planning
should be implemented early in the
should be implemented early in the
treatment process
treatment process
3.
Prepare to respond to repeated “continuing
Prepare to respond to repeated “continuing
use” or relapses/slips in some participants,
use” or relapses/slips in some participants,
especially early in treatment
especially early in treatment
Relapse Prevention and
Relapse Prevention and
Response in Drug Court:
Response in Drug Court:
Terrencewalton@aol.com
Exploring the concepts of relapse prevention, response, and defining terms like relapse and recovery in the context of drug court programs. It discusses the difference between a slip and a relapse and emphasizes the importance of ongoing commitment to change in achieving total abstinence from substances.
Download Presentation
Please find below an Image/Link to download the presentation.
The content on the website is provided AS IS for your information and personal use only. It may not be sold, licensed, or shared on other websites without obtaining consent from the author.If you encounter any issues during the download, it is possible that the publisher has removed the file from their server.
You are allowed to download the files provided on this website for personal or commercial use, subject to the condition that they are used lawfully. All files are the property of their respective owners.
The content on the website is provided AS IS for your information and personal use only. It may not be sold, licensed, or shared on other websites without obtaining consent from the author.
E N D
Presentation Transcript
Keeping Keeping It Moving: It Moving: Relapse Prevention and Relapse Prevention and Response in Drug Court Response in Drug Court Terrence D Walton, MSW, ICADC Director of Treatment Pretrial Services Agency for the District of Columbia
True or False? Research shows that even while in treatment, some addicted people can only stay clean a couple of days before relapsing.
The 1stBig Question Is it relapse or continued use ?
Defining Relapse 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 The return to use after a period of abstinence that interrupts the addicts ongoing attempts to recover A return to drug use that is precipitated by and/or leads to lessening of commitment to recover 1. 2. 3.
Defining Recovery In 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.
The 2ndBig Question Is it a slip or a relapse ?
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
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
Two Secrets 1. No use doesn t mean you re in recovery 2. Use __________________________
Research Studies show relapse rates of 40% to 60% at one year follow-up Most relapses occur in the first year of recovery, with two thirds occurring in the first 90 days Clients who remain in treatment longer generally have the better outcomes 1. 2. 3.
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
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
Relapse An 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
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.
Relapse Prevention Planning Written, specific, and rehearsed plans Reiterates commitment to and rationale for recovery Outlines and schedules recovery supportive activities Identifies warning signs, cues, and high risk situations (triggers) Details preventive and progressive responses to all triggers 1. 2. 3. 4. 5.
A Big Resource National Registry of Evidenced-based Programs and Practices: www.nrepp.samhsa samhsa.gov Relapse Prevention Therapy
Green Light Problems Failing to engage fully in recovery-supportive activities 1. Skipping or coming late to meetings 2. Neglecting spiritual activities and readings 3. Skipping work or cutting class 4. Failing to plan and participate in leisure activities 5. Neglecting physical exercise, adequate sleep, or healthy diet
Yellow Light Problems Situations requiring caution, extra support, and/or prompt resolution Negative moods & attitudes (angry, afraid, sad, lonely, hurt, guilty, bored, anxious, embarrassed, frustrated, rebellion, resentful, stubborn) Fleeting cravings, urges, or euphoric recall Holidays, celebrations; vacations, and other down-time ; Sleeping (using dreams) Dishonesty, greed, or having extra money Feeling depleted, deprived, entitled or exhausted Sobriety milestones Re-entering from institutions 1. 2. 3. 4. 5. 6. 7.
Red Light Problems Situations to avoid, persistently resist, and/or requiring urgent external support Offers to use or drink Persistent cravings, urges, or euphoric recall Feeling hopeless, like giving up, or not caring Euphoric recall Sudden, unexpected external triggers (sound, sight, smell, taste, sensation) Trauma reactions A slip 1. 2. 3. 4. 5. 6. 7.
Relapse Response Planning 1. Written & specific plans 2. Detailing immediate post-use actions 3. Full disclosure Who is to be informed immediately Program to be informed at first opportunity 4. Expected & accepted consequences 5. Plan for re-evaluation and intervention
Responses to Relapse Reassess Continued Use Potential and Change Readiness Conduct Functional Analysis of Relapse Determine Whether Continued Use , Slip , Relapse Apply Planned Court-related or Supervision- Related Responses (e.g. sanction, phase freeze, staffing) Apply Planned Clinical Responses (e.g., enhancing treatment, increase drug/alcohol testing) Re-stabilize and Re-engage (e.g. detoxification, treatment readiness); Re-instill hope 1. 2. 3. 4. 5. 6.
Honesty Matters 1. 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 admits thoughts of using before doing so.
Program Response Tips 1. 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
Relapse Prevention and Relapse Prevention and Response in Drug Court: Response in Drug Court: Terrencewalton@aol.com
