SYNOPSIS

A Sample study on Effectiveness of Relapse Prevention

therapy on individuals with Alcohol Use Disorder
Masters of Arts (Psychology)
MPCE 016

Submitted by

Name: Zaibunnisa

Enrolment No.: 185313267

Regional Centre: Nizam college Hyderabad

Guide: DR. C. VENKATA SUBBAIAH

M.Sc., M.Phil. in Clinical Psychology & Ph.D.

Discipline of Psychology
School of Social Sciences (SOSS)
Indira Gandhi National Open University (IGNOU)
Maidan Garhi, New Delhi – 110068
 INTRODUCTION
Consumption of alcohol is the third-largest disease and disability risk factor in the world
and is associated with many significant socio-economic issues, including crime, child
neglect and abuse, and workplace absenteeism. Approximately 4.5 % of the global illness
and injury burden is due to alcohol consumption. Measures of drug-related problems,
including assessments of alcohol as a risk factor in the Global Burden of Disease, have
focused primarily on damaging the health of the drinker. Nevertheless, it is clear that
alcohol often also affects other people's health and well-being around the drinker–family
members and friends, and others in the group and more generally.
The World Health Organization (WHO) reports that there are nearly two billion people
worldwide who consume alcoholic beverages and 76.3 million people with diagnosable
drug use disorders. The 2010 study of 67 risk factors and risk factor clusters for death and
disability showed that alcohol consumption was the second leading risk factor for death and
disability, accounting for 5.5 per cent of disability-adjusted life years lost globally.This is
up from 4.6% reported in 2004 and 4.0% in 2000. Overall, there is a causal relationship
between alcohol consumption and more than sixty types of disease and injury. 
The Global Alcohol and Health Information System is a key tool for measuring and
tracking the health situation and patterns in alcohol consumption, alcohol-related damage
and policy responses in countries. The dangerous use of alcohol triggers the deaths of 2.5
million people per year. There are 60 different types of diseases in which alcohol plays a
major causal role. It also affects the well-being and health of people around the drinker. In
2005, total consumption worldwide was 6.13 litres of pure alcohol per person aged 15 years
and older. Unrecorded consumption accounts for almost 30% of the overall adult
consumption worldwide.
According to national drug survey of India, alcohol is the most common psychoactive
substance used by Indians. Nationally, about 14.6% of the population (between 10 and 75
year of age) uses alcohol. In terms of absolute numbers, there are about 16 crore persons
who consume alcohol in the country. Use of alcohol is considerably higher among men
(27.3%) as compared to women (1.6%). For every one woman who consumes alcohol,

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there are 17 alcohol using men. Among alcohol users, country liquor or ‘desi sharab’ (about
30%) and spirits or Indian Made Foreign Liquor (about 30%) are the predominantly
consumed beverages. States with the highest prevalence of alcohol use are Chhattisgarh,
Tripura, Punjab, Arunachal Pradesh and Goa.
Alcohol Use Disorder is a persistent relapsing brain disease characterized by an impaired
ability to stop or regulate alcohol consumption amid detrimental cultural, occupational or
health effects. It can range from mild to extrem, and regardless of severity, recovery is
possible.
The American Psychiatric Association's fourth edition of the Diagnostic and Statistical
Manual (DSM-IV) identified two distinct disorders alcohol addiction and alcohol
dependence with specific criteria for each. The fifth edition, DSM-5, combines the two
conditions of DSM-IV, alcohol addiction and alcohol dependence into a single disorder
called alcohol use disorder. For women, low-risk drinking on any given day is described as
no more than three drinks and no more than seven drinks per week. To men no more than 4
drinks per day and no more than 14 drinks per week are described. Data from National
Institute On Alcohol Abuse And Alcoholism reveals that only about 2 out of 100 people
who drink within these limits have alcohol use disorder.
Alcohol and its repercussions impose a drastic and additional economic burden on alcohol-
using families and borne by spouses and children disproportionately. For any condition for
themselves and their family members, alcohol users reported additional costs related to
hospitalization and prescription expenses. Loans at higher interest rates forced the families
further into a debt trap. A large proportion of various welfare / job-guarantee/compensation
schemes benefits are evidently spent on alcohol (' On the day the (welfare) payments are
received, (the recipient) spends the whole day drinking alcohol and alcohol dues are paid
out of these payments. Users reported a smaller proportion of their income spent on food
and essential items and savings, as well as higher loans and debts. Non-user families had a
significantly higher asset-holding score than user families.
In the last five years, a significant proportion of users (5.2 per cent) than non-users (4.2 per
cent) reduced consumption of food and essential commodities, incurred higher debts (users
(15.7 per cent) v /s non-users (12.4 per cent)), borrowed money at higher interest rates

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(users (5.9 per cent) v /s non-users (3.8 per cent)). Compared to non-users, a significant
number of users found it difficult to purchase food and essential items (11 per cent vs. 6.9
per cent); pay rent (4 per cent vs. 2 per cent); pay school fees for children (2.8 per cent vs.
6.4 per cent) or have had difficulties with creditors (2.5 per cent vs. 5.4 per cent). The
proportion of school-aged children who were out of school prematurely in user families
was significantly higher. Users were also much more likely than non-users to have
decreased efficacy or productivity at work due to greater absenteeism on their own or to
have taken more leave of absence due to a family member's illness.
Persons with interaction with alcohol users (in the family or between friends) specifically
registered a significantly higher proportion of adverse events than those without. The
adverse events ranged from physical and emotional abuse and disability, financial
impairment, inability to live up to expectations, social humiliation and physical deprivation.
Non-drinking partners also had to carry extra responsibilities, as drinkers could not do what
was required of them or had to spend time caring for drunk or sick drinkers.
The greater role of alcohol in domestic violence was recognized universally as also creating
a public nuisance. Among households of alcohol users, the number of children (more than
two times) facing abuse (whether verbal or physical), children experiencing violence or
being left among risky situations was disproportionately higher. Kids in alcohol using
households were almost three times more likely to have less money for childcare related
activities.
While greater than 10 per cent had experienced physical abuse /violence, had been
involved in road traffic accidents, had suffered property damage due to intoxicated
strangers, half of the respondents reported having been disturbed by strangers ' drinking, a
third reported having had serious arguments with intoxicated strangers or had been abused /
threatened, about 20 per cent reported feeling unsafe in public places or public transport.
Despite the high rate of reporting only a small proportion (2.7 per cent in direct contact and 
1.6 per cent without direct contact) sought legal recourse or called the police.
Alcohol abuse and mental illness are a major public health problem. 0.7% of all years of
life lost due to poor health, disability or early death can be attributed to alcohol. The co-
occurrenceof addiction and mental disorders has important implications as it contributes to,

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the increased risk of various psychological, behavioral and social problems, impaired
decision-making, failure to adhere to therapy, increased risk of relapse, increased risk of
self-harm (including suicide risk).
General population based surveys have documented that the odds of developing a mood
disorder and an anxiety disorder are 3.6 and 2.6 times higher, respectively, if someone is
dependent on alcohol as compared to one who is not dependent on alcohol.
Prolonged alcohol abuse has been related to physiological and behavioral changes in the
brain. Alcohol dependence can lead to widespread atrophic changes in the brain. In
contrast, some brain regions, such as frontal lobe structures, are more vulnerable to
negative effects of alcohol compared to other regions. All these changes in the brain can
contribute to the emergence of a comorbid psychiatric condition. It has been proposed that
common neurobiological pathways may be involved in alcohol dependence and various
psychiatric disorders. Moreover, the psychosocial stresses that go hand in hand with a life-
impacting alcohol dependence can exacerbate a susceptibility to mental illness. Alcohol has
been reported to cause suicidal tendencies, stree, mood swings, ambivalent attitudes and
memory problems. The one-year prevalence rate of anxiety disorders among those with
alcohol dependence in the general population has been reported to be 36.9%.
Even if addiction is caused by some biological process, recovery from alcoholism requires
people to be inspired to make significant changes. Addictions such as alcoholism are
largely psychological. Psychology is a discipline that explores human behaviour. The
majority of human behaviour is learned behaviour. This is also true of addictive behaviour.
Psychological research has helped us to understand how people learn to participate in
extremely unhealthy actions. Most specifically, that research allows us to understand how
people could unlearn actions.
Another psychological source of dependency is people's feelings and values. This is
because a lot of our actions comes from our thoughts and beliefs. This includes addictive
behaviours. For example, if someone believes that recovery is not possible, it is highly
unlikely that they will make an effort to stop it. Psychologists have developed techniques
to help people change their minds and beliefs, their feelings and behaviour change as well.

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The third cognitive source of dependence is the developmental maturity of an individual.
The desire to reconcile our actions with our beliefs and values is what distinguishes adult
human beings from immature ones. In the end, this ability separates human beings from
other animals. When we consistently act without thought and instead act according to every
desire, urge, and impulse, we work at the developmental level of a two-year-old child.
Alcohol abuse addictions can occur because someone lacks this developmental maturity.
They may be very self-centred and intent on fulfilling impulsive impulses without regard to
the consequences.
Psychology has also helped us understand that while people find it so difficult to stop
extremely unhealthy actions, people may find it difficult to improve because they lack good
problem-solving skills and enough motivation. Alcoholism may also arise as a means of
coping with uncomfortable feelings and tension. Psychotherapy can help to strengthen
people's motivation and develop their problem-solving skills, stress-reduction abilities and
coping skills.
Psychological disorders may play a role in the development of any dependence, even
alcoholism. Such issues have sometimes accompanied dependency, and dependence has
acted as a coping device. Sometimes they've started evolving following addiction.
No matter why these challenges have arisen, people need to learn how to cope with them.
Otherwise, there is a very high risk of relapse. Such various problems and complications
often suggest a latent, unexplained psychological disorder. In addition, alcohol abuse and
other psychological disorders happen at a rather alarming pace. In this case, alcohol abuse
may be an effort to alleviate the effects of other psychological disorders. Addiction
practitioners also call it self-medication. If these root conditions are not diagnosed or
treated for dependence, the likelihood of relapse is very high.
Miller and Hester (1980)studied more than 500 alcoholism outcome studies and reported
that more than 75 percent of subjects relapsed within 1 year of treatment. A study published
by Hunt and colleagues showed that nicotine, heroin and alcohol had a very similar rate of
relapse over a one-year period of 80-95 per cent. A significant proportion (40–80 percent )
of patients receiving treatment for alcohol use disorders have at least one drink, a “lapse,”

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within the first year of after treatment, whereas around 20 percent of patients return to pre-
treatment levels of alcohol use.
Relapse, broadly defined as an event or incident of backsliding, deterioration or subsiding,
maybe a common denominator in the result of interventions designed to address
psychological problems or health-related habits, notably those based to alcohol and drug
abuse. That is, many people who attempt to change health-related habits (e.g., lose weight,
spend more time with their families, stop smoking, etc.) may encounter failures and slips
(lapses) that sometimes escalate and become relapses.
The original transgression of problem behavior, after a stop effort, is described as a "lapse,"
which could eventually lead to continuing transgressions at a level similar to that before a
stop and defined as a "relapse." The possible outcome of the slip is that the patient will
choose to abstain and thus continue on the path to positive change, "prolapse." Most
authors interelapse preventionret relapse as a phase rather than a discrete occurrence, and
thus seek to identify the factors that contribute to relapse.
Relapse Prevention Therapy is a cognitive-behavioural approach to the management of
addictive behaviours which specifically addresses the complexity of the relapse cycle and
offers coping strategies that are helpful for sustaining improvement. Relapse prevention is
an important component of the treatment of alcoholism. The relapse prevention model
suggested by Marlatt and Gordon indicates that both visible determinants (e.g. high-risk
conditions, coping skills, result perceptions, and abstinence violation) and latent
antecedents (e.g. behavioural variables and desires and cravings) may lead to relapse.
Using this cognitive behavioral evaluation of addictive behaviors, Relapse Prevention
Therapy starts with the identification of the possible social, intra-personal, environmental
and physical risk of relapse and the unique set of conditions and circumstances that may
potentially precipitate a slip.
Relapse and recurrence of heavy alcohol use after a time of abstinence or mild use happens 
in  many drinkers who have been treated for addiction. The relapse prevention framework
includes a number of unique and international treatment approaches that enable counsellor
and patient to discuss each phase of the relapse cycle. Specific interventions include
recognising specific high-risk situations for each client and improving the client's ability to

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cope with those situations, increasing the client's self-efficacy, eliminating myths about the
effects of alcohol, managing lapses, and reorganization the client's perceptions of the
relapse process. Global strategies include balancing the client's lifestyle and helping him or
her develop beneficial addictions, using stimulus control techniques and emergency
management techniques, and creating relapse road maps. Many experiments offered
theoretical and practical support for the relapse prevention model.

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 REVIEW OF LITERATURE
The empiric literature on recovery of addictions has grown considerably over the last
decade. Since the size and range of this research precludes a comprehensive review, the
following section outlines a broad body of literature-reflective observations that are
applicable to Relapse prevention theory. The research studied concentrate mainly on
alcohol, drugs and tobacco withdrawal, however, it should be recognized that relapse
prevention concepts have been extended to an increasing range of addictive behaviours.
Miguel Camacho-Gomez, Pere Castellvi (2019) researched on Effectiveness of Family
Intervention for Preventing Relapse. The risk of regression during the early years of the
first episode of psychosis greatly increases the risk of chronicity. The effectiveness of
family psychosis treatment to prevent relapse remains unknown. The efficacy of Family
intervention was assessed up to 24 months of follow-up to prevent relapse and other
relapse-related outcomes in post-first episode of psychosis patients. Such findings suggest
that Family intervention is effective in reducing relapse rates, length of hospitalization and
psychotic symptoms, and in -functioning in first episode of psychosis patients up to 24
months.
Witkiewitz, K., Bowen, S., & Donovan, D. M. (2011) researched on moderating effects of
a craving intervention on the relation between negative mood and heavy drinking following
treatment for alcohol dependence. The study is a secondary analysis of data from the
combined study, a randomized clinical trial that combined pharmacotherapy with
behavioral intervention in the treatment of alcohol dependence. Their goal in the current
study was to examine whether a treatment module that targeted craving would predict
changes in negative mood during the 16-week combined behavioral intervention (n = 776)
and the relation among changes in mood, craving, and changes in heavy drinking during
treatment and 1 year posttreatment. The craving module of the combined behavioral
intervention may weaken the relation between negative affect and heavy drinking by
fostering greater decreases in craving during treatment.
Katie Witkiewitz, PhD and Sarah Bowen, PhD (2010) researched on Individuals with
substance use disorders (N=168; age 40.45, (SD=10.28); 36.3% female; 46.4% nonwhite)

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recruited after intensive stabilization, then randomly assigned to either eight weekly
sessions of mindfullness relapse prevention therapy or a treatment-as-usual control group.
Approximately 73% of the sample was retained at the final four-month follow-up
assessment. Results confirmed a moderated-mediation effect, whereby craving mediated
the relation between depressive symptoms (Beck Depression Inventory) and substance use
(Time Line Follow Back) among the treatment-as-usual group, but not among mindfullness
relapse prevention therapy participants. Specifically, mindfullness relapse prevention
therapy attenuated the relation between postintervention depressive symptoms and craving
(Penn Alcohol Craving Scale) two months following the intervention (f2=.21). This
moderation effect predicted substance use four-months following the intervention (f2=.18).
Relapse prevention therapy appears to influence cognitive and behavioral responses to
depressive symptoms, partially explaining reductions in postintervention substance use
among the mindfullness relapse prevention therapy group. Although preliminary, the
current study provides evidence for the value of relapse prevention mindfulness practice
into substance abuse treatment and identifies one potential mechanism of change following
mindfullness relapse prevention therapy.
Magill and Ray (2009) performed a meta-analysis of 53 supervised Cognitive Behavioural
Treatment treatments for substance use disorders. As noted by the authors, the cognitive
behavioural therapy studies evaluated in their review were primarily based on the relapse
prevention model. Generally, the findings were consistent with the analysis undertaken by
Irvin and colleagues, in that the researchers found that 58 per cent of people who underwent
cognitive behavioural therapy reported better outcomes than those under similar
circumstances. By addition to the observations of Irvin and colleagues, Magill and Ray
found that cognitive behavioural therapy was most beneficial for people with drug
problems.
As of 2009, the meta-analysis found little evidence for the effectiveness of skills-based
relapse prevention interventions in the prevention of tobacco relapse. Furthermore, a new
re-analysis of these findings has yielded different results. Re-analysis of stratified
behavioral interventions based on specific intervention content, while also imposing stricter
analytical criteria for the duration of follow-up assessments. In these analyzes, cognitive

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behavioural therapy / relapse prevention-based self-help approaches showed a significant
overall effect across raising long-term abstinence (pooled OR: 1.52,95 per cent CI: 1.15-
2.01, related on 3 studies) and team therapy showed significant short-term effectiveness
(pooled OR: 2.55, 95 per cent CI: 1.58-4.11, based on 2 studies)
Witkiewitz, K., & Marlatt, A. G. (2004) has researched relapse prevention as an effective
alternative to the treatment of numerous issues, including substance abuse. This new review
sums up the basic principles of relapse prevention and the cognitive-behavioural relapse
model. This new article also involves the 1996 Carroll (1996) randomized controlled
relapse test, which included Marlatt's relapse components. Witkiewitz and Marlatt have
also rebuilt a relapse model that is needed for future research.
McCrady, Barbara.S (2000) developed criteria for defining therapies with empirical
support for efficacy. Every medication for alcohol abuse and dependency has been rated as
effective; 4 therapies for other opioid use conditions have been graded "possibly
successful." Experts in the Alcohol Treatment sector have asked whether drug treatments
with good empiric evidence are not on the task force list. This article presents the results of
the application of the standards of the Task Force to 13 major psychosocial alcohol
treatments considered to have strong empiric support. Brief intervention and relapse
prevention met the criteria of the task force for "effective" treatment. However, there were
insufficient published studies meeting task force criteria for these 2 treatments.
Motivational enhancement met criteria to be rated "probably efficacious."
Irvin and colleagues (1999) conducted a meta-analysis of relapse prevention techniques in
the treatment of alcohol, tobacco, cocaine, and polysubstance use. Twenty-six studies
representing a sample of 9,504 participants were included in the review. The results
demonstrated that relapse prevention was a successful intervention for reducing substance
use and improving psychosocial adjustment. In particular, relapse prevention was more
effective in treating alcohol and polysubstance use than it was in the treatment of cocaine
use and smoking, although these findings need to be interelapse preventionreted with
caution due to the small number of studies (n = 3) evaluating cocaine use. relapse
prevention was equally effective across different treatment modalities, including individual,
group, and marital treatment delivery, although all of these methods were most effective in

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treating alcohol use. Considering relapse prevention was originally developed as an adjunct
to treatment for alcohol use that this metaanalysis found it was most effective for
individuals with alcohol problems. This finding suggests that certain characteristics of
alcohol use are particularly amenable to the current relapse prevention model and that
scientist–practitioners should continue to modify/enhance relapse prevention procedures to
incorelapse preventionorate the idiosyncrasies of other substance use (e.g., cocaine,
smoking, heroin) and nonsubstance (e.g., depression, anxiety) relapse. For example,
Roffman has developed a marijuana-specific relapse prevention intervention, which has
produced greater reductions in marijuana use than a comparison social support treatment.
Marlatt and Gordon's work (1999) have replaced traditional treatment strategies that
have conceptualized relapse prevention as a negative outcome equivalent to failure.
Through developing a framework that included contextual determinants relevant to high-
risk circumstances, coping skills, outcome goals, and identifying an' abstinence breach
effect,' relapse prevention has progressed to a series of approaches to help identify high-risk
conditions, maximize self-efficiency, strengthen coping skills for impulses and cravings,
and develop scheduling strategies to balance a client's lifestyle.
Many relapse prevention research provided therapies with the basic components of early
Marlatt and Gordon's work. The elements of the model were based on a well-supported
cognitive-behavioural approach to therapy.
Guydish (1998) randomized controlled trial assessed the efficacy of day versus residential
treatment. A total of 534 clients receiving treatment at the Walden House in San Francisco
from 1992-1994 were randomly chosen to either day or residential treatment settings. Day
and residence shared the same therapeutic community treatment with the residents of the
Walden House, and the clients went home every day. Treatment analyzes included 238
patients who attended at least one interview (6-, 12-, and 18-month follow-up) and 118
clients who completed all follow-up interviews.
Analysis of relapse analysis at 6-, 12-, and18-month follow-up demonstrated statistically
significant "time-based" experiences. Monitoring demographic disparities and monitoring
psychosocial indicators for alcohol abuse, anxiety, psychiatric symptoms, and social
support, it was three times more likely for day-to-day treatment-assigned patients to

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withdraw at 6 months post-admission. Setting time differences were not important at 12-
and 18-month intervals.
Residential-compared to day-treatment facilities, findings suggest that the risk of relapse
may be decreased during the initial months of treatment.
Mc Kay (1997) looked at the differences between standard post-care group counselling
(12-step-oriented) and individualized post-care relapse prevention. All participants
underwent 4 weeks of Intensive Outpatient primary treatment prior to induction and
randomization to the sample.
The findings published were significant. Standard aftercare has achieved significantly
higher rates of sustained abstinence over the 6-month study period than relapse prevention
aftercare. Conversely, in patients who had some use of cocaine during months 1-3, relapse
prevention was more efficient in restricting the extent of use during that timespan. The
authors (McKay, J. R., Alterman, A. I., Cacciola, J. S., Rutherford, M. J., O'Brien, C. P., &
Koppenhaver, J. ) also put forward the likelihood that relapse prevention, by its very nature,
might draw attention to the probability of a lapse, and question whether or not this could
give rise to some sense of permission for use in subjects less motivated by complete
abstinence. It should also be remembered that participating in relapse prevention involved a
greater level of activity on the part of participants than regular group counselling and that
clients who were not firmly committed to abstinence may not have been willing to
participate entirely. Treatment of relapse prevention is beneficial for patients who choose to
use it during aftercare. Baseline Self-efficacy (personal belief in success) was a statistically
significant indicator of cocaine use in the follow-up timeframe.
Carroll, K. M. (1996) presented a comprehensive review of 24 randomized controlled
relapse prevention trials for smoking cessation, alcohol, marijuana, cocaine and other
drugs. Carroll looked at the evidence and made a clear argument for continued research that
would step beyond the immediacy of time periods immediately after diagnosis with long-
term follow-up results in order to confirm the real effects of treatment Most of the results
indicated that relapse prevention was effective compared to no long-term intervention but
less effective compared to the control group conditions or other successful therapies.

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Evidence was strongest for termination of smoking, but the numerous studies and samples
in the studies were small.
1. Alcohol 1978, 88, and 89 trials did not produce any major difference in the
treatment group with regards to abstinence or alcohol consumption. Patients with
higher sociopathy have better outcomes as measured by days of abstinence and
heavy drinking days, while patients with lower sociopathy reported better outcomes
when diagnosed with an immersive therapy strategy. Patients with particularly high
deficiencies in coping skills have better outcomes. A treatment plan which included
relapse avoidance counselling to couples recorded further days of abstinence and
increased marital adaptation.
2. Cannabis: No major treatment results for days of cannabis use or abstinence are
observed at 12 weeks or 1 year.
3. Cocaine: Severely addicted users of cocaine are significantly more likely to
maintain prolonged sustained abstinence if they received relapse avoidance care.
relapse prevention may be beneficial to reduce the severity of relapses if they occur
and the duration of symptoms after therapy is over.
Rawson, R. A. (1993), conducted a comprehensive review of the various relapse
prevention models, many of which were incorrectly tested in 1993. Models are not
inherently manualized, which creates difficulty to analysis in a controlled setting in order to
determine which results are detectable. Rawson discussed the basis of Marlatt and Gordon's
relapse prevention and provided details on Gorski's Cenaps Model (no empiric) and
Wallace's relapse prevention model for Crack Cocaine Users, which had not moved from
model to specific methodology. The Annis Alcoholism Model, a randomized controlled
trial, reveals no differences between groups at 6 months. Roffman's method for the
management of cannabis addiction was also tested in a randomized study that found a
larger decrease in drug use than the comparable social support protocol, but no significant
difference in abstinence for the 30-day follow-up period. McAuliffe's Recovery Training
and Self Help Model (RTSH) was assessed in a large randomized controlled trial in which
subjects either received RTSH or were referred to certain another community-based

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programming. Six-and12-month follow-up points showed higher levels of opioid
abstinence at follow-up points, more employability and less criminal behaviour.
Rawson's own Matrix neurobehavioral model offers intensive treatment for six months,
including relapse prevention; family involvement; urine testing; and 12-step intervention in
the plan. Encouraging decreases in use have been recorded in pilot studies, and both CSAT
and NIDA have funded validation trials over the last few years, and CSAT findings are
expected soon, while the NIDA experiment will continue until September 2004.
Chaney and colleagues (1978) provided the first randomized trial of relapse prevention
techniques in an inpatient population of problem drinkers. Forty individuals receiving
inpatient alcohol treatment at a Veterans Administration hospital were randomly assigned
to either group-based skills training, an insight-oriented discussion group, or treatment as
usual. The skills training relapse prevention-type intervention modeling, behavioral
rehearsal, coaching, and identifying and coping with high-risk situations. The results
demonstrated that the skills training group had significantly fewer days drunk, less alcohol
consumption, and shorter drinking periods than the two comparison groups. The authors
concluded “that problem drinkers’ responses to situations that present a high risk of relapse
can be improved through training”.
A good portion of the research material for outcome preferences, cravings, and trigger
reactivity, in general, is emerging from work on smoking cessation. Given considerable
evidence showing a strong correlation between self-efficacy and care outcomes, the
mechanism by which self-efficacy affects outcomes is still uncertain. Studies of cue-
reactivity in addiction have shown that drug-related signals induce desire (self-reported)
and lower physiological responses, but cue-reactivity is still not shown to be a good
predictor for relapse. Support is minimal to therapies that address shifting standards and
carry about improvements in post-treatment use. Motivation can be positive or negative (I
want to stop, but don't think I'm strong enough to resist) and moving away from that
ambivalence is quite difficult. The article calls for the beginning of the scientific research
needed to test the efficacy of the recently proposed, more complex model.

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 RATIONALE OF THE STUDY

Many new to recovery need to learn how to deal with the stress of daily life in order to
prevent addiction and sustain their sobriety. Relapse prevention therapy is a program
designed to identify the causes, patterns and consequences of a person's relapse during
aftercare of addiction treatment. The treatment from dependence is important to be able to
comprehend and prepare for relapse.
Relapse prevention armors freshly recovered addicts and alcoholics with self-confidence
and awareness that they need to lead their normal lives without risk of relapse. Most
relapsing addicts and industry professionals view relapse as an inevitable part of the
treatment from dependence. The rate of relapse is high, so it is increasingly important to be
vigilant and aware about relapse. Most overdose deaths occur right after recovery.
Tolerance is when an addict may take a high dosage of a drug or alcohol as their body has
become used to it. Tolerance increases after detoxification and reduction of alcohol release
throughout the skin. When a relapsing addict takes the amount of drugs or alcohol they
used before sobriety, their bodies are no longer able to handle it.
Relapse does not only happen again at the level of use of drugs or alcohol. Relapse comes
in steps and is often ignored due to the fact that the addict does not recycle himself
mentally. Learning the symptoms of relapse, taking part in a relapse prevention program, or
finding therapist's treatment are all important steps to stop relapse. Addictions and
Recovery states that there are three levels of relapse: psychological relapse, cognitive
relapse, and physical relapse. The use of drugs or alcohol is the third stage of addiction, and
there are many steps that can be taken before that happens.
There are a number of different approaches to relapse prevention therapy. The three most

commonly utilized are: Coping Skills- sessions that identify high-risk situations and how to

cope with them without relapse; Clinical Therapy- sessions that focus on understanding the

process and consequences of relapse; Lifestyle Change- sessions that encourage treatment

prior to relapse and a moderated lifestyle.

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The current review of literature has not done a sample study on relapse prevention therapy

after its interverntion on alcohol abusers. The study of effectiveness of relapse prevention

therapy has been focused on a demographic group outside of India. Hence the present study

is going to take a sample from a population of alcohol abusers from Indian demographic

group mainly in the city of Hyderabad and assessment will be done on alcohol abusers who

have undergone relapse prevention therapy to observe its efficacy.

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 RESEARCH METHODOLOGY

Research Problem:

To assess the effectiveness of Relapse Prevention Therapy on individuals with Alcohol Use

Disorder.

Objectives:

The following objectives are formulated for the proposed study:

 To asses the level of alcoholic dependence individuals

 To assess the occurrence of relapses among alcoholic dependant individuals

 To study the effectiveness of relapse prevention therapy on alcohol dependence

individuals on pre theraputic and post therapeutic inteverntion among alcohol

dependence inviduals.

 To study the impact of sociodemographical variable among alcohol dependence

inviduals and their relapse occurrence.

 To asses the impact of relapse prevention therapy on alcohol depencdance inviduals

relapse occurrence.

HYPOTHESES OF THE STUDY:

The following hypotheses are formulated to empirically validate the above objectives:

 Relapse prevention therapy will have a positive effect on maintaining abstinence

and preventing relapse.

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  There will be significant difference between pre intervention and post

intervention of relapse prevention therapy on occurrence of relapse among

alcohol dependent individuals

 There will be significant impact of sociodemographic on occurrence of relapses

in alcohol dependent individuals.

OPERATIONAL DEFINATIONS:

Alcohol Use disorder:

Alcohol Use Disorder is a persistent relapsing brain disease characterized by an impaired

ability to stop or regulate alcohol consumption amid detrimental cultural, occupational or
health effects. It can range from mild to extrem, and regardless of severity, recovery is
possible.
Relapse Prevention Therapy: Relapse Prevention Therapy is a cognitive-behavioural
approach to the management of addictive behaviours which specifically addresses the
complexity of the relapse cycle and offers coping strategies that are helpful for sustaining
improvement.
SAMPLE:
The sample will be taken from those who meets the criteria of multiple occurrence of

relapse on alcohol use disorders as per the guidelines, using Purposive sampling method.

Inclusion criteria

 Individuals effected with Alcohol Use disorder.

 Individuals admitted at various rehabilitation centers for treatment Relapse

prevention therapy.

 Individuals who have undergone Relapse prevention therapy.

 Individuals who have given their consent for the study.

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  Individuals present at the time of data collection.

 Male patients

Exclusion criteria

 Individuals who are not diagnosed with Alcohol Use Disorder

 Individuals who did not show signs of relapse therefore did not undergo relapse

prevention therapy.

 Female patients

Sample size

The sample will consist of 30 men between the ages of 18-30, admitted at various

Rehabilitation centers.

RESEARCH DESIGN:

The research design is purposeful sampling method where sample is chosen based on

specific criteria.

TOOLS:

 Written informed consent

 Kuppuswamy socio demographic scale analyzing demographic and socioeconomic
of the sample.
 Michigan Alcoholism Screening Test by Seizer (1971) is a simple, self scoring

test that helps to assess a drinking problem. It consists of 21 yes or no questions.

Score one point if you answered "no" to the following questions: 1 or 4. Score one

point if you answered "yes" to the following questions: 2, 3, 5 through 22. A total

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 score of six or more indicates hazardous drinking or alcohol dependence and further

evaluation by a healthcare professional is recommended.

 The NEO-FFI-3 by Costa and McCrae (1990) is a 60-item version of the NEO-PI-3

that provides a quick, reliable, and accurate measure of the five domains of

personality (Neuroticism, Extraversion, Openness, Agreeableness, and

Conscientiousness). All updates made in the NEO-PI-3 are reflected in this

instrument. Scores can be reported to most test-takers on "Your NEO Summary,"

which provides a brief explanation of the assessment, and gives the individuals

domain levels and a strengths-based description of three levels (high, medium, and

low) in each domain. For example, low N reads "Secure, hardy, and generally

relaxed even under stressful conditions," whereas high N reads "Sensitive,

emotional, and prone to experience feelings that are upsetting." For profile

interpretation, facet and domain scores are reported in T scores and are recorded

visually as compared to the appropriate norming group

 Alcohol Craving Questionnaire (ACQ-NOW) is a 47-item self-administered,

multidimensional state measure of acute alcohol craving adapted from the Cocaine
Craving Questionnaire of Tiffany et al. As such, it measures four dimensions
(subscales) of alcohol craving labeled Emotionality, Purposefulness, Compulsivity,
and Expectancy. It takes 5 to 10 minutes to complete for persons with a seventh
grade reading level or above. The ACQ-NOW also has been modified into a short
form, the ACQ-SF-R, that contains 12 items strongly correlated with the four
subscales and total ACQ score. It has moderate to high reliability (alpha) and is
sensitive to change.
 The AWARE Questionnaire (Advance WArning of RElapse) was
designed as a measure of the warning signs of relapse, as described by Gorski

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 & Miller (1982). In a prospective study of relapse following outpatient
treatment for alcohol abuse or dependence (Miller et al., 1996) we found the
AWARE score to be a good predictor of the occurrence of relapse (r = .42, p
< .001). With subsequent analyses, we refined the scale from its 37-item
original version to the current 28-item scale (version 3.0) (Miller & Harris,
2000). This is a self-report questionnaire that can be filled out by the client.
Intervention tool
Relapse prevention therapy module includes a variety of cognitive and behavioral
approaches designed to target each step in the relapse process. These approaches include
specific intervention strategies that focus on the immediate determinants of relapse as well
as global self-management strategies that focus on the covert antecedents of relapse. Both
the specific and global strategies fall into three main categories: skills training, cognitive
restructuring, and lifestyle balancing. Specific Intervention strategies in Relapse Prevention
include Identifying and coping with high-risk situations, Enhancing Self-efficacy,
Eliminating myths and placebo, Lapse management, Cognitive restructuring.

The intervention based tool will be carried out for a period of three months. RP clinical
protocols typically include 12 weekly sessions, and are empirically supported when
delivered over that time frame.

DATA ANALYSIS:
The data analysis will be done through statistical analyses which will include mean, mode,
standard deviation and ANOVA (Analyses of variance) using appropriate tools.

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 REFERENCES
 Marlatt, G.A. & Gordon, J.R. (1985). Relapse Prevention Maintenance Strategies in the
Treatment of Addictive Behavior. New York: Guilford Press.
 Marlatt, G.A. & Gordon, J.R. (1985). Relapse prevention. New York, Guilford.
 Rawson, R.A., Huber, A., Brethen, P.B., Obert, J.L, Gulati, V., Shoptow, S. & Ling, W.
(2000). Methamphetamine and cocaine users: Differences in characteristics and
treatment retention. Journal of Psychoactive Drugs, 32, 233-238.
 Larimer, M. E., Palmer, R. S., & Marlatt, G. A. (1999). Relapse prevention. An
overview of Marlatt's cognitive-behavioral model. Alcohol research & health : the
journal of the National Institute on Alcohol Abuse and Alcoholism, 23(2), 151–160.
 Rawson, R.A., Marinelli-Casey, P. & Anglin, M.D. (2004). (Methamphetamine
Treatment Project Corelapse preventionorate Authors). A multi-site comparison of
psychosocial approaches for the treatment of methamphetamine dependence. Addiction,
99(6), 708-17.
 Rawson, R.A., McCam, M.J., Flammino, F., Shoptaw, S., Miotto, K., Reiber, C. &
Ling, W. (2006). A comparison of contingency management and cognitive-behavioural
approaches for stimulant dependent individuals. Addiction, 101(2), 267-274,
DOI:10.1111/j.1360-0443.
 Lal R, Singh S. Assessment tools for screening and clinical evaluation of psychosocial
aspects in addictive disorders. Indian J Psychiatry 2018;60, Suppl S2:444-50
 World Health Organization. Global Status Report on Alcohol and Health 2014. Geneva,
Switzerland: World Health Organization; 2014. 
 Adinoff, B., Talmadge, C., Williams, M. J., Schreffler, E., Jackley, P. K., & Krebaum,
S. R. (2010). Time to Relapse Questionnaire (TRQ): a measure of sudden relapse in
substance dependence. The American journal of drug and alcohol abuse, 36(3), 140–
149. doi:10.3109/00952991003736363

22
 Witkiewitz, K., & Bowen, S. (2010). Depression, craving, and substance use following
a randomized trial of mindfulness-based relapse prevention. Journal of consulting and
clinical psychology, 78(3), 362–374. doi:10.1037/a0019172
 Dr. Jeffrey Berman MD (2016) The Importance of Relapse Prevention Therapy
 Larimer, Mary E.; Palmer, Rebekka S.; Marlatt, G. Alan (1999). "Relapse
Prevention" (PDF). 23 (2). National Institute on Alcohol Abuse and Alcoholism.
 ^ "What is Alcohol Addiction: What Causes Alcohol Addiction?". Medical Bug. 6
January 2012. Retrieved 24 May 2012.
 Marlatt GA, Donovan DM, editors. Relapse Prevention: Maintenance Strategies in the
Treatment of Addictive Behaviors. 2nd Edition. New York: Guilford Press; 2005. 
 Witkiewitz, K. (2011). Predictors of heavy drinking during and following treatment.
Psychology of Addictive Behaviors,25, 426-438.
 Witkiewitz, K. & Bowen, S. (2010). Depression, craving and substance use following a
randomized trial of mindfulness-based relapse prevention. Journal of Consulting and
Clinical Psychology, 78, 362-374.
 Magill, M., & Ray, L. A. (2009). Cognitive-behavioral treatment with adult alcohol and
illicit drug users: a meta-analysis of randomized controlled trials. Journal of studies on
alcohol and drugs, 70(4), 516–527. doi:10.15288/jsad.2009.70.516
 Witkiewitz, K., & Marlatt, G. A. (2004). Relapse Prevention for Alcohol and Drug
Problems: That Was Zen, This Is Tao. American Psychologist, 59(4), 224-235.
 Irvin JE, Bowers CA, Dunn ME, Wang MCJ Consult Clin Psychol. 1999 Aug; Efficacy
of relapse prevention: a meta-analytic review.67(4):563-70.
 Paul T. Costa, Jr., PhD, and Robert R. McCrae, PhD NEO Five-Factor Inventory-3™
 Robert R. McCrae, Paul T. Costa, A contemplated revision of the NEO Five-Factor
Inventory,Personality and Individual Differences Volume 36, Issue 3,2004 Pages 587-
596,ISSN 0191-8869
 Menon J, Kandasamy A. Relapse prevention. Indian J Psychiatry 2018;60, Suppl
S2:473-8

23
 Selzer, M.L. (1971). The Michigan Alcoholism Screening Test (MAST): The quest for
a new diagnostic instrument. American Journal of Psychiatry, 127, 1653-1658

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