Drug and Alcohol Abuse Psychology Counseling Essay Sample
Question #1: Using the Cognitive-Behavioral model for relapse prevention, how would you respond to John? What additional information do you need? How is this information relevant to John’s situation?
One of the basic and essential premises of treatment for alcoholism is relapse prevention (RP). It is further defined as restoring alcoholic behavior after an abstinence or moderation phase. It happens to most habitual drinkers who have submitted themselves to alcohol therapy.
According to Marlatt and Gordon’s Cognitive Behavioral Model (1985) for relapse prevention, relapse occurs when there is a combined linkage of conditioned high-risk environmental situations, skills to cope with the high-risk situations, level of perceived personal control (self-efficacy), and the anticipated positive effects of alcohol.
In John’s case, I need to find out more information regarding his own “high-risk situations” where relapse might be possible. First, I need to know what his emotional, environmental and interpersonal state were when he could not stop himself from heavy drinking. Negative emotional states (depression, anger, anxiety, frustration, and boredom) are considered high-risk factors thereby initiating a relapse is deemed possible. In interpersonal situations, these may involve his family, loved ones, another person or a group of people which may also instigate negative feelings and can bring on relapse episodes. As to the environmental factor, this may include peer groups. Social pressure (direct or indirect) may persuade the person under alcohol therapy to a relapse. Second, I also need to identify the positive emotional states that heavy drinking has brought to John in the past.
This may include parties and celebrations where drinking is open to everyone. In addition, it is important for me to know if there are effects to John advertisements of alcoholic beverages or exposure to John’s preferred hang-outs or hubs where alcohol is available. Third, it is essential to learn as well about John’s coping skills or behavior when around a high-risk situation for a relapse. If John has displayed effective coping strategies in past experiences, then he is less prone to committing a relapse. In connection with this is fourth, the level of John’s self-efficacy or self-control should be investigated if an anticipated high-risk situation is coming. If he is firm enough to tell himself that he would not have even just one drink then he has a heightened sense of self-efficacy. Lastly, I should be informed of the positive effects of alcohol to John whether he considers this as “self-medication” or drinking gives him immediate gratification or relief to anxiety-inducing situations.
Going back to the present case where John seeks feedback from others regarding the invitation to a friend’s wedding, it solely depends on the answers to the valuable information I have mentioned above. His past experiences and past decisions are determining factors whether or not he should attend the occasion. But basing on the facts presented that he has only abstained for four months, I would tell him that if he gambles by going to the wedding, he would be surrounded by high-risk situations such as the presence of his drinking buddy in college, the mere presence of alcohol exposed to all guests, the presence of his wife who is also a social drinker, and moreover, the possible availability of drugs as well. I will tell him that with just one relapse, he could be an alcoholic again. I will mention to him the article I’ve read that even those who have abstained for 4 years, 90% of them have at least one relapse after treatment.
How much more for being sober only for 4 months? The risk of relapse is coming to a close. I will also explain to John the concept of “covert antecedents” to high-risk situations which focuses mainly on lifestyle factors. With the presence of his old college body (who could possibly remind him of his past lifestyle which is habitual drinking), his motivation to avoid drinking might be decreased. Adding to that, the social pressure of his friends who will be at the wedding may influence him to relapse. His wife who is a social drinker might add to his craving or urge to relapse. And one of the worse scenarios that might take place at the wedding is taking drugs. If he commits a relapse together with drugs, his addiction might not only be with drinking but with taking drugs as well, which could lead to a more serious problem. In short, I’m telling him of the possible consequences if he will attend the wedding but still the final decision to go or not to go would be his.
Question #2: Why would his therapist consider that Lyle has had one relapse? Do you agree or disagree?
In Lyle’s case, he mentioned that he has been struggling with sobriety. Meaning, in terms of coping skills and self-efficacy, he was still on the edge. He was not strong enough to resist drinking in high-risk situations. He kept on relapsing because he did not possess the “willpower” to limit consumption of alcohol.
Lyle’s therapist considered his situation that he has had one relapse only because it can only take one initial relapse to commit a subsequent relapse or relapses. However, this is not true in all cases. Lyle simply lacked determination to reform his alcoholism. So even with the exposure of one high-risk situation, which was a party, he was not able to control himself from drinking. With these instances, I agree with Lyle’s therapist that he has had one relapse only.
Lyles’s status can be explained through one of the immediate determinants of relapse which is the “Abstinence Violation Effect,” which is a type of reaction by a drinker to a lapse. When the goal of abstinence is violated or dishonored, uncontrolled alcoholism or complete rejection of the abstinence goal may result. In Lyle’s case, after one drink at a party, this was followed by a series of drinking sessions to the extent of intoxication and missing work as a result. The goal of sobriety has been broken. This outcome shows Lyle’s emotional response to the initial relapse he committed. Lyle attributed this failure to himself resulting in guilt emotions and this was manifested after that one initial lapse led to another lapse, then another until Lyle continuously relapses and relapses. What makes the situation worse was his alcoholism began affecting his work already. This is the reason why it can be said that Lyle has had only one relapse.
Furthermore, this can again be explained through “covert antecedents” to high-risk situations. This refers to Lyle’s previous lifestyle or drinking practices. If he used to indulge in drinking when he encountered stressful incidents, then it is not impossible that he would do the same in his present state even with the mere exposure of a high-risk situation, in this case, the party he attended. It could be also that he resorted to drinking for immediate gratification of a craving or urge. Another reason could be, drinking relieved him from negative emotional states. Maybe again, because of social pressures from friends or peer groups, Lyle was influenced to drink habitually. At present, it could be pressure from workmates. These information needs to be verified. But definitely, there is a good reason behind Lyle’s instability of alcohol sobriety.
According to studies, initial lapses usually occur in unexpected high-risk situations. Taking things lightly, Lyle undermined that in joining said party, he would be in control of himself. Unfortunately, he missed prompting himself that he has been struggling with sobriety. Moreover, there’s no one in his life who can at least remind him of his drinking problem or drinking therapy. Maybe it would have helped him in some way.
Larimer, M. E., Marlatt, G. A., & Palmer, R. S. (1999). Relapse Prevention: An Overview of Marlatt’s Cognitive-Behavioral Model. Alcohol Research & Health. Retrieved July 16, 2007, from http://www.encyclopedia.com/doc/1G1-59246580.html
National Institute on Alcohol Abuse and Alcoholism. (n.d.). Alcohol Relapse and Craving. Retrieved July 16, 2007, from http://alcoholism.about.com/cs/alerts/l/blnaa06.htm
“Relapse Triggers.” (2006). Retrieved July 16, 2007, from http://alcoholism.about.com/cs/relapse/a/aa000201a.htm
“Stress Should Be Avoided in Early Sobriety.” (2007). Retrieved July 16, 2007, from http://alcoholism.about.com/b/a/256422.htm