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Addictions: Treating Family Manipulation, Mistrust, & Misdirection Substance Abuse Addiction: Treating Family Manipulation, Mistrust, and Misdirection - 10 CEUs

Section 14
Considerations for Addiction Relapse Prevention

CEU Question 14 | CE Test | Table of Contents | Addictions
Psychologist CEUs, Social Worker CEUs, Counselor CEUs, MFT CEUs

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On the last track, we discussed the final five steps in preparing for a structured family intervention: writing an intervention letter, brainstorming objections, determining bottom lines, rehearsal, and the intervention itself.

On this track, we will discuss formulating a relapse agreement, and the six questions that need to be considered when a relapse occurs. These are is detox necessary? Is the addict currently in a program? How much support does the addict have at home? Is something blocking recovery? Are there signs of a mental health issue? Is the addict following all the directions and still relapsing?

Brain Functioning & Relapse
Families of addicts usually start worrying about a relapse while the addict is still in treatment, and these fears are well founded. A normal 30-day inpatient treatment program may give the body time to heal physical addiction, but thirty days is not enough time for the behavior control centers in the brain to recover.

Even after four months at a halfway house, the addict’s brain still has to work hard to control behavior on a conscious level. Environmental cues still trigger drug cravings at the unconscious level, and powerful cravings occur in the area of the brain responsible for emotional memory. These memories blindside the addict, and take over both mind and body.

As you know, the decision-making regions of the brain are still defective after a treatment program, and a recovering addict’s judgment remains poor. The ability to weigh consequences is faulty, and the addict has trouble learning from past mistakes. An addict using this brain may say "I’m going to do things my way". It isn’t hard to imagine that "my way" will probably lead back to alcohol or drugs.

Formulating a Relapse Agreement
With clients concerned about their loved one’s relapse, I suggest formulating a relapse agreement. This technique gives the addict incentive to follow the guidelines given to them for recovery, while keeping them involved in the decision. I usually have my clients use this technique during the last half of the treatment program. For this process, the family, and the sponsor if the addict has one, and the addict’s counselor meet with the addict and say directly, "I hope you never have to face a relapse, but we need to talk about the possibility. What would you want us, as a family, to do if you start drinking or taking drugs again?"

Once the addict has come up with a good relapse agreement, the agreement is put down on paper. The addict, counselor, and family all sign it. I usually encourage the family to ask if everyone from the intervention team can have a copy, but let the addict make the final decision. It is important for the addict to feel she has control over the agreement, or else it won’t have value later.

As you know, formulating a relapse agreement should not turn into a power struggle. As you know, this will breed resentment in the addict and make it easier for her to relapse. However, the counselor should therapeutically encourage strong, healthy decisions. If the addict does not make a good decision, for example, "If I relapse, you should leave me alone," the family obviously can refuse to sign the agreement, and the counselor could encourage the addict to ask her peers for feedback in group therapy. The family group can meet later to look at a new agreement.

Six Key Relapse Questions
Not every relapse is the same: an addict active in AA who has a slip should be treated differently than an addict who takes up using drugs where they left off with no program of recovery. When discussing relapse, there are six important questions I ask my clients to consider.

-- Relapse Question # 1 - First, is detox necessary? As you know, this depends on the drug, how much is being used, and how long the relapse has lasted. For example, a relapsed heroin addict will need detox, but pot smokers or cocaine addicts will not.

-- Relapse Question # 2 - Second, is the addict currently involved in a 12-step program? Does he or she have a sponsor? If yes to both, it may only be necessary for the addict to attend more meetings, and meet with her sponsor more often. If she is involved in AA but has no sponsor, finding a sponsor may be the solution. If the addict has neither of these, it may be necessary to consider going back to inpatient treatment or a halfway house.

-- Relapse Question # 3 - Third, how much support does the addict have at home? Do others in the addict’s house drink or use drugs? Is he or she living alone? Does he or she have structure in their life? It may be that the addict returned home too soon, or that the home environment is bad for recovery. A halfway house, or moving to a sober house, may be the best solution.

-- Relapse Question # 4 - Fourth, is something blocking recovery?  Do transportation issues make it difficult to get to meetings? Do long hours at work get in the way? When I counsel addicts, I ask them what they would do if this block prevented them from getting to their addiction. Usually, they would be able to find a way around it.  Matt told me that his wife was resentful of the time he spent at AA meetings. I suggested that he invite his wife to go to meetings with him, and then go out for coffee with other recovering couples.

-- Relapse Question # 5 - Fifth, are there signs that a mental health issue is blocking recovery? If so, the addict should probably see a psychologist experienced with addiction.

-- Relapse Question # 6 - Lastly, is the addict following all the directions, working a strong program of recovery, and still relapsing? In this case, something is missing in the program. In all likelihood, the addict needs more support. If my client’s loved one keeps relapsing despite following all of his recovery guidelines, I suggest they meet with an addiction specialist to determine what needs are not being met, and what kind of support is required.

On this track, we have discussed formulating a relapse agreement, and the six questions that need to be considered when a relapse occurs. These are is detox necessary? Is the addict currently in a program? How much support does the addict have at home? Is something blocking recovery? Are there signs of a mental health issue? Is the addict following all the directions and still relapsing?

Peer-Reviewed Journal Article References:
Acheson, A., Vincent, A. S., Cohoon, A., & Lovallo, W. R. (2019). Early life adversity and increased delay discounting: Findings from the Family Health Patterns project. Experimental and Clinical Psychopharmacology, 27(2), 153–159.

Ariss, T., & Fairbairn, C. E. (2020). The effect of significant other involvement in treatment for substance use disorders: A meta-analysis. Journal of Consulting and Clinical Psychology, 88(6), 526–540.

Church, S., Bhatia, U., Velleman, R., Velleman, G., Orford, J., Rane, A., & Nadkarni, A. (2018). Coping strategies and support structures of addiction affected families: A qualitative study from Goa, India. Families, Systems, & Health, 36(2), 216–224. 

Redish, D. A., Jensen, S., Johnson, A., & Kurth-Nelson, Z. (2009). “Reconciling reinforcement learning models with behavioral extinction and renewal: Implications for addiction, relapse, and problem gambling”: Correction. Psychological Review, 116(3), 518. 

Vallejo, Z., & Amaro, H. (2009). Adaptation of mindfulness-based stress reduction program for addiction relapse prevention. The Humanistic Psychologist, 37(2), 192–206.

Witkiewitz, K., Lustyk, M. K. B., & Bowen, S. (2013). Retraining the addicted brain: A review of hypothesized neurobiological mechanisms of mindfulness-based relapse prevention. Psychology of Addictive Behaviors, 27(2), 351–365.

Online Continuing Education QUESTION 14
If the addict comes up with a relapse agreement that is not healthy or satisfactory, what could the family do? To select and enter your answer go to CE Test.

This CD set has covered such topics as:   Manipulation, Mistrust, and Misdirection; The Threaten, Punish, and Relent Cycle; Resistance, Recycling, and Relegation; Family Survival Skills; Establishing Communication Within the Family; Positive Anger; The Caretaking Trap; The Blame Game; Mirroring the Addict; Five Negotiation Styles; Structuring the Intervention; Intervention Checklists; and Formulating a Relapse Agreement.
I hope you have found the information to be both practical and beneficial. We appreciate that you've chosen the Healthcare Training Institute as a means for receiving your continuing education credit.

Other Home Study Courses we offer include: Treating Teen Self Mutilation; Treating Post Holiday Let-Down and Depression; Living with Secrets: Treating Childhood Sexual Trauma; Interventions for Anxiety Disorders with Children and Adults; and Balancing the Power Dynamic in the Therapeutic Relationship. 

I wish you the best of luck in your practice. Thank you.  Please consider us for future home study needs.
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