keeping it moving: relapse prevention and response in drug court terrence d walton, msw, icadc...

Keeping It Moving: Relapse Prevention and Response in Drug Court

Terrence D Walton, MSW, ICADCDirector 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 1st Big Question

Is it “relapse” or “continued use”?

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

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.

The 2nd Big 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 Secrets1. “No use” doesn’t mean you’re

in recovery2. “Use”

__________________________

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

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

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

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

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

A Big ResourceNational Registry of Evidenced-based

Programs and Practices:

www.nrepp.samhsa.gov

“Relapse Prevention Therapy”

Traffic Signal Approach

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

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

Red Light Problems– Situations to avoid, persistently resist, and/or requiring urgent

external support1. 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

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

opportunity4. Expected & accepted consequences5. Plan for re-evaluation and

intervention

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

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 admits thoughts of

using before doing so.

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

Relapse Prevention and Response in Drug

Court:

Terrencewalton@aol.com