🔍 RP L1 T3: Factors Contributing to Relapse

📚 Please refer to the Materials section for additional learning resources and further reading. You may download these materials for future reference.

Before we go in-depth, let us try to recall a few facts on “determinants” of relapse discussed in Lesson 1, Topic 1

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In this topic, we will understand the factors contributing to Relapse. The predominant focus is one Cognitive Behavioural model for relapse.

Factors contributing to relapse encompass a complex interplay of personal, environmental, and psychological elements that can pose challenges to individuals striving for sustained behavioral change. Recognizing and understanding these factors is pivotal in developing effective strategies for relapse prevention

.As per Psychological Theories, two types of expectancies can play a crucial role in relapse

Outcome ExpectanciesAn individual’s beliefs about the effects of a drug if it is used in a given situation
Self-efficacy ExpectanciesAn individual’s estimation that he or she can successfully enact a behavior in a given situation

Marlatt and his colleagues have provided the most discussed and clinically applied model of the relapse process. It was originally
summarized by Marlatt and Gordon (1985) and subsequently updated and revised in important ways by Witkiewitz and Marlatt (2004).

High risk situations:
Immediate Determinants of Relapse

Marlatt and Gordon 1985

  • Initiation of Abstinence: Marlatt hypothesized that starting abstinence boosts a sense of personal control and self-efficacy.
  • Strengthening Self-Perceptions: These self-perceptions grow stronger as the period of abstinence extends.
  • Encounter with High-Risk Situations: Over time, the individual is likely to face situations that increase the risk of relapsing into substance use.
  • Central Feature of the Marlatt Model: High-risk situations are a key component of the Marlatt model of relapse.
  • Antecedents of High-Risk Situations: These can vary but often involve cognitive and lifestyle factors that lead to high-risk circumstances.
  • Coping and Behavioral Repertoire: If the person has effective coping strategies in their behavioral repertoire and uses them, it leads to a successful outcome.
  • Enhancing Self-Efficacy: Successful coping reinforces self-efficacy (as per Bandura, 1977), which in turn reduces the likelihood of relapse in similar future situations.
Witkiewitz KA, Marlatt GA, editors. Therapist’s guide to evidence-based relapse prevention. Elsevier; 2011 Apr 28.
Revised Conceptualization of Relapse process

In the previous topic, you came across two categories of situations where the relapse process can be initiated, i.e. Immediate determinants and Covert antecedents.

On the basis of new research relevant to the components of the original relapse prevention model, Witkiewitz and Marlatt (2004) provided a revised conceptualization of the relapse process. The new model i.e. Central Determinants of Relapse and Distal Risk factor for Relapse is below (Witkiewitz & Marlatt, 2007)

Central Determinants of RelapseDistal Risk factor for Relapse
Negative emotional states
Positive emotional states
Lesser levels of coping
Greater outcome expectancies regarding substance use
Lower self-efficacy
Abstinence-violation effect (AVE)
Greater craving
Interpersonal relapse precipitants
Family history of substance abuse,
Lesser extent of social support
Severity of dependence
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Supplementary reading on Coping with Lapses

27 Comments

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These topics are interrelated and very useful to help the addiction patient

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Hawa Singh Chopra April 19, 2025 at 7:51 pm

The topic is well explained and easy to understand
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Hawa Singh Chopra April 19, 2025 at 7:55 pm

I like the topic and very helpful in understanding the risk of loss of relaspe.

Very informative study material. And also easy to understand.

If we apply these skills in cessation and addiction we can reduce the rate of relapses bring a drug and tobacco alcohol free India

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