Relapse prevention

Domain II · Behavioural & cognitive · Marlatt, Gordon · 1985

What it is

RP is a cognitive-behavioural maintenance model, not a fixed-session therapy. It can be delivered on its own, as aftercare, or as the maintenance phase of any addiction treatment, individually or in groups. Developed for alcohol and drug problems, it has been adapted to smoking, gambling, eating…

Format

• Status of the structure. The primary sources do not prescribe numbered phases or a fixed session count for classic RP. They describe an assessment logic and two families of intervention: specific strategies for immediate determinants and global lifestyle self-control strategies. The phase sequence…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• Facilitators are expected to keep their own practice.
• Over-reliance on craving ratings as a relapse predictor.
• Maps that are too abstract. Use real names, times and places.
• Cards left at home. A phone note or lock-screen version works too.
• Housemates who use. Negotiate shared-space arrangements or involve them.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.