Relapse Prevention, Recovery Support, and Continuing Care
What to know
Relapse prevention draws on Marlatt's model: high-risk situations, coping skills, outcome expectancies, abstinence violation effect, and lapse vs. relapse. Understand triggers (internal/external), craving management, and relapse prevention plans. Know continuing care: step-down, recovery support services (peer recovery coaches, recovery community centers), mutual-help groups (AA, NA, SMART Recovery - SMART is CBT-based, non-spiritual). Understand recovery capital (social, physical, human, cultural). Recognize that social support and engagement predict outcomes. Know that abstinence violation effect (all-or-nothing thinking after a lapse) increases escalation.
Traps
Questions equate a lapse with full relapse - a lapse is a single event; relapse is a return to prior pattern. Watch for items suggesting AA is the only mutual-help option (SMART Recovery is a secular, CBT-based alternative). Don't confuse relapse prevention with withdrawal management.
Rule of thumb
Plan for high-risk situations in advance. A lapse should trigger re-engagement, not abandonment of the plan - counter the abstinence violation effect with cognitive restructuring.
Worked example
A client in recovery attends a wedding with alcohol. Pre-planning (support person, exit strategy, coping rehearsal) reduces risk; if a lapse occurs, the response is to analyze the trigger and adjust the plan, not to declare failure.