According to Dharmadhikari(2015), Drug addiction is a severe health issue that expands globally. It impacts an individual personally and socially. When considering a relapse prevention plan for those addicted to alcohol and drugs, the individual cravings, different reasons and expectations for using, as well as the patient’s strengths to support recovery, and the therapist interventions that are effective for the patient need to be addressed within the relapse plan.
One of the most apparent characteristics of addictive behaviors consists of cravings or triggers to use. Cravings are difficult to control and interfere with the addictive individual’s ability to abstain from drug use. (Dharmadhikari 2015). According to Dharmadhikari(2015), there are psychological treatment procedures for the reduction of cravings. The first is called stimulus control. This includes the patient avoiding situations, people, places, or things that could increase a patient’s use.
Dharmadhikari(2015) also noted that before a patient learns effective ways to cope with cravings, they need to avoid these activities. The second psychological treatment procedure Dharmadhikari(2015) identified is Cue Exposure. Thus, with this procedure, the patient has continual exposure to the triggers causing cravings while simultaneously being taught how to use coping mechanisms to reduce the cravings.
An example of this can be deep breathing, using a distraction, etc. This is identified as effective when the patients are taught to use coping skills to deal with daily stressors. A third psychological treatment is called self-monitoring. Thus, with self-monitoring, the patient is encouraged to maintain a diary in which the severity of their cravings is noted, their mood is identified when they are experiencing cravings, and how long the desires last are recorded.
The patient is also encouraged to note coping skills they used during their craving and its effectiveness. Thus, coping skills showing effectiveness are encouraged to be pointed out as a skill in the relapse plan. Furthermore, a third technique Dharmadhikari(2015) identified is the Craving Identification Management(CIM). This model brings the patient’s unconsciousness or unawareness of cravings to the patient’s consciousness, whereby they are able to assess the causes of the cravings, and due to these causes, they can begin using strategies to prevent and manage their cravings.
Dharmadhikari (2015) asserts that there are four causes identified in the CIM :
1: Environmental cues(triggers) are when the patient is exposed to people, places, and things associated with alcohol or drug use that may increase cravings.
2: Stress when the patient may experience stress or stressors
3: Mental illness, a co-occurring mental illness, could be a trigger to use to escape the symptoms of mental illness.
4: Drug withdrawal is when a patient has symptoms related to mental illness and withdrawal from a drug. This may lead to them craving the drug to relieve the symptoms of withdrawal.
Overall, Dharmadkikari (2015) noted a need to address cravings using a holistic approach compared to a pharmacological approach. While identifying cravings and triggers is a vital part of starting the Relapse Plan, the therapist needs to have knowledge of different cultures reasons/expectations for using as well as interventions to integrate into the relapse plan utilizing strengths that the different cultures bring to the therapeutic session.
First, according to Witkiewitz and Walker(2005), it is noted that expectancies or reasons to use drugs or alcohol vary across cultures. Witkiewitz and Walker (2005) found that Americans’ motives for drinking alcohol, for instance, were to cope with stressors; however, Nigerian culture noted that their motive for drinking alcohol was a way to socialize. Similarly, a study that was done with Puerto Ricans in the United States pointed out that their reasons for drinking alcohol were due to sociability.
Integrating a patient’s strength in their relapse plan can be an effective intervention and beneficial to some groups of patients. Hence, Marlatt(2005) identified the relapse prevention model that offers intervention to address interpersonal and environmental determinants. Thus, interpersonal interventions used with some cultures that rely on family ties, community, leadership institutions, and structure could benefit from interventions that address these areas and can be implemented in the relapse plan.
In another study, Marlatt(2005) noted that Afro-American patients diagnosed with Schizophrenia were more likely to relapse on cocaine if they did not have a case manager assigned to them. Therefore, this case management entity can be utilized as a strength and advantageous for recovery when put into the relapse plan. Thus, this could be done by a case manager following the patient once discharged from the hospital and providing weekly or as-needed home visits with the patient.
Marlatt (2005) noted another study including American Indian adolescents in which a successful relapse plan program utilizing a mentorship that provided social support for maintaining sobriety. According to Marlatt(2005), this mentorship culturally enhanced traditional relapse prevention by integrating the traditional cultural values of eldership into the scientific lapse prevention model.
Finally, Marlatt(2005) found that using Harm Reduction strategies in the Relapse Prevention plan can be effective for some cultures. Hence, some cultures have a belief in moderation in which there is no support for abstinence because, in some cultures, the use of some substances is for religious or spiritual purposes. The final step of a relapse prevention plan includes a therapist offering different interventions.
According to Kadden and Cooney(2005), Motivational interviewing is an intervention in which the therapist examines the patient’s ambivalence about changing their drug or alcohol use. The therapist works with the patient by helping the patient identify strategies to move toward change. In addition, the therapist discusses problems related to the patient’s use of drugs and alcohol while accepting the patient’s perception of the problem.
Hence, this can be integrated into the patient’s relapse plan as the patient starts to move toward change. A final intervention the therapist could address in the relapse plan is what Kodden and Cooney(2005) describe as Pleasant Activities. When the patient is no longer using drugs or alcohol, they may identify having a void in their lives or an unbalanced life. Therefore, Kodden and Cooney(2005) noted that the therapist can have a session with the patient and help the patient develop and agree on new positive activities in which to engage. These activities will take the place of their use of drugs and alcohol and can be written in their relapse plan.
In conclusion, addressing cravings, identifying reasons to use drugs and alcohol as well as identifying the individual patient’s strengths that can be used in their recovery are all factors that can be included in the relapse plan to increase their recovery. It is also important to note that this plan can be changed or added to any time as the patient progresses.
References
Dharmadhikari, A. S., & Sinha, V. K. (2015a). Psychological management of craving. J Addict Res Ther, 6(230), 2.
Kadden, R. M., & Cooney, N. L. (2005). Treating alcohol problems. Relapse Prevention, 65, 91.
Marlatt, G. A., & Witkiewitz, K. (2005). Relapse prevention for alcohol and drug problems. Relapse Prevention: Maintenance Strategies in the Treatment of Addictive Behaviors, 2, 1-44.
Witkiewitz, K., Marlatt, G. A., & Walker, D. (2005). Mindfulness-based relapse prevention for alcohol and substance use disorders. Journal of Cognitive Psychotherapy, 19(3), 211-228.
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