Presents RELAPSE PREVENTION COUNSELING Internet Based Coursework 4 hours of educational credit Approved by such credentialing bodies as: National Association of Alcoholism and Drug Abuse Counselors National Board of Certified Counselors (All approval bodies are listed at http://www.ceumatrix.com/accreditations.php Formerly CCJP.com RELAPSE PREVENTION COUNSELING Welcome to the growing family of coursework participants at CEU Matrix - The Institute for Addiction and Criminal Justice Studies. This distance learning course package was developed for CEU Matrix by Dennis C. Daley, PhD. It is based on information found in the manual Relapse Prevention Counseling, Daley Publications. This package contains the course materials, along with the post test and evaluation that are required to obtain the certificate of completion for the course. You may submit your answers online to receive the fastest response and access to your online certificate of completion. To take advantage of this option, simply access the Student Center at http://www.ceumatrix.com/studentcenter; login as a Returning Customer by entering your email address, password, and click on 'Take Exam'. For your convenience, we have also enclosed an answer sheet that will allow you to submit your answers by mail or by fax. Copyright Notice The documents and information on this Web site, excluding the Relapse Prevention Counseling manual, are copyrighted materials of CEUMatrix, LLC, and its information providers. Reproduction or storage of materials retrieved from this service is subject to the U.S. Copyright Act of 1976, Title 17 U.S.C. © Copyright 2010 CEUMatrix, LLC. All rights reserved. Do not duplicate or redistribute in any form. Printed in the United States of America. No portion of this publication may be reproduced in any manner without the written permission of the publisher. About the Instructor: Dennis C. Daley, Ph.D., is a Professor of Psychiatry, and Chief of Addiction Medicine Services at Western Psychiatric Institute and Clinic (WPIC) of the University of Pittsburgh Medical Center. He oversees a large continuum of care at Addiction Medicine Services (AMS), which includes over twenty-five treatment, prevention and intervention programs, training programs for psychiatric residents, medical students and graduate students in behavioral health. Dr. Daley has been or is currently an investigator, trainer and/or consultant on numerous research studies at WPIC sponsored by the National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism related to treatment of individuals with substance use disorders and mood disorders. He is currently a trainer and consultant on a NIDA sponsored study of bipolar substance abusers at Harvard Medical School (Roger Weiss, MD, PI). Dr. Daley and colleagues at AMS are currently involved in seven research projects. His research interests are in the areas of addiction, mood disorders and addiction, and adherence to treatment. Using the Homepage for CEU Matrix - The Institute for Addiction and Criminal Justice Studies The CEUMatrix – The Institute for Addiction and Criminal Justice Studies homepage (www.ceumatrix.com) contains many pieces of information and valuable links to a variety of programs, news and research findings, and information about credentialing – both local and national. We update our site on a regular basis to keep you apprised of any changes or developments in the field of addiction counseling and credentialing. Be sure to visit our site regularly, and we do recommend that you bookmark the site for fast and easy return. RELAPSE PREVENTION COUNSELING This course is designed to help clinicians and counselors understand and facilitate the process of recovery among addicted clients and reduce their risk of relapse. The primary focus is reviewing clinical strategies to help clients reduce relapse risk or intervene early in the relapse process, and describe clinical tools that can be incorporated into individual, group or family sessions. Sources of information for this course are studies of treatment of addiction and relapse, clinical literature, the author's experiences as clinicians and researchers, and developing relapse prevention programs and materials for addicted individuals and families. The source material is also a reference on recovery and relapse prevention. Treatment Manuals for professionals Relapse Prevention Counseling Strategies to aid recovery from addiction and reduce relapse risk Dennis C. Daley, PhD Antoine douaihy, md ISBN: 978-0-9835302-0-6 © 2011 by Dennis C. Daley, Ph.D. All rights reserved. No part of this book can be reproduced, stored in a retrieval system, or transmitted by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the first author. Comments about this book or information about clinical workshops on Relapse Prevention can be sent to the first author at [email protected]. Daley Publications Box 161 Murrysville, PA 15668 Phone: 724-727-3640 Fax: 724-325-9515 Email: [email protected] Web: www.drdenniscdaley.com Authors’ Note We thank Cindy Hurney for her help in reformatting and organizing this book. We also wish to thank Janis McDonald for her help with references. Table of Contents: Relapse Prevention Counseling Dedication to G. Alan Marlatt, PhD About This Book 1. Addiction, Treatment and Recovery...............................................................1 Purpose of Book Causes of Addiction Effects of Addiction Treatment of Addiction Recovery from Addiction 2. Causes and Effects of Relapse..........................................................................9 Lapse and Relapse Defined Causes of Relapse in Addiction Effects of Relapse in Addiction 3. Relapse Prevention ......................................................................................13 Treatment Models Incorporating RP Principles Models of Relapse Prevention Limitations of Studies and Reviews of RP Research Support for RP Conclusions 4. Counseling Strategies to Reduce Relapse Risk............................................25 Introduction and Overview of Chapter Treatment Adherence Medication-Assisted Recovery Addiction Management Skills Psychiatric Illness Management Skills Emotional Management Skills Relationship Skills and Support Systems Relapse Recognition and Interruption Skills Lifestyle Changes 5. Counseling Aids for Relapse Prevention.......................................................47 Addict Aftercare Recovery Training and Self-Help Manual Challenging Relapse Thoughts Cognitive Distortions and Relapse Consequences of Using Substances Again Control-O-Log Daily RP Inventory Relapse Autobiography Relapse Debriefing Relapse Fantasy Relapse Prevention Workbook Relapse Prevention Readings (Bibliotherapy) Role Plays (Behavioral Rehearsals) The Road to Relapse Sobriety Journal (written) Sobriety Journal (electronic) 6. Relapse Prevention Groups............................................................................59 Creating RP Groups Group Format for Outpatient Settings Group Format for Residential or Inpatient Settings Orienting Clients to RP Groups Strategies for RP Group Leaders in Covering Group Content Curriculum for 12 Structured RP Groups Topic #1: The Process and Domains of Recovery Topic #2: Managing Cravings to Use Substances Topic #3: Managing Anger Topic #4: Managing Boredom and Using Leisure Time Topic #5: Managing Social Pressures to Use Substances Topic #6: Establishing a Recovery Support System Topic #7: How Mutual Support Programs Help Reduce Relapse Risk Topic #8: Identifying and Managing Relapse Warning Signs Topic #9: Identifying and Managing High Risk Relapse Factors Topic #10: Managing Setbacks (Stopping a Lapse or Relapse) Topic #11: Building a Long-Term Recovery Plan Topic #12: Lifestyle Balancing 7. Problem Solving or Therapy Groups............................................................95 Purpose of Groups Objectives of Groups Group Format Problems Discussed in Problem Solving or Therapy Group Sessions Problems Encountered in the Group Process Appendices ...............................................................................................................105 1. Endnotes 2. References and Suggested Readings 3. Interactive Workbooks and Journals 4. Web Sites Dedication to G. Alan Marlatt, PhD We dedicate this book to a friend and colleague, Alan Marlatt who recently passed away. He was a Professor of Psychology and the Director of the Addictive Behaviors Research Center at the University of Washington in Seattle. Alan was a pioneer in the field of addiction and the first to publish a comprehensive review of Relapse Prevention (RP) and focus on the importance of helping clients learn skills to manage their addiction, change their lives and take action early if they were unable to stay sober. His influence on the fields of addiction and psychology was enormous. Alan stimulated the addiction treatment field with his forward thinking, his research and his teaching on numerous topics related to addiction, treatment, recovery and relapse. He was a good friend and mentor to many of us in the U.S. and other countries. Alan was well respected for his many contributions to the field, and his book on RP is one of the most highly referenced books in the literature. He received many awards for excellence of his work including the Jellinek Memorial Award (1990), the Combating Substance Abuse Award by the Robert Wood Johnson Foundation (2001), Distinguished Researcher Award