Marlatt and Gordon's Relapse Prevention Model

Marlatt and Gordon's Relapse Prevention Model It is an effective therapeutic alternative for people with an addictive disorder who are in the maintenance phase. It is used mainly to treat alcoholism, although it is also used for other substances.

It is based on a series of strategies to work on coping skills, cognitive restructuring and promoting a healthy lifestyle.

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Marlatt and Gordon's relapse prevention model: characteristics

The Marlatt and Gordon Relapse Prevention Model was developed by these two authors in 1985. It is part of a cognitive-behavioral therapy, called CBT, aimed at treating some addictive disorders, such as alcohol addiction.

Thus, CBT is made up of two components: relapse prevention and training in social and coping skills (Coping / social skills training, CSST). However, the Marlatt and Gordon Relapse Prevention Model can also be applied in isolation.

This model consists of a branch of cognitive behavioral programs and is also the first-line treatment for alcoholism, which in turn includes different techniques psychological.

The main objective of the model is teach, train and empower the patient to experience relapses as part of the cessation process, and as one more way of learning, which makes it possible to acquire new healthy habits. On the other hand, as its name suggests, and although relapses are "normal" and are part of the process, the model has the mission of preventing them from reappearing in the future.

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Relapses on the drug

Thus, the Marlatt and Gordon Relapse Prevention Model focuses on relapses that often appear during the maintenance phase of an addictive disorder, or, commonly called, the detoxification.

But what exactly does relapse consist of? Marlatt (1993) defined it as “a transitory process, a series of events that may or may not be followed by a return to baseline levels of observable objective behavior before the treatment".

That is, it can be a specific state, it doesn't always have to be a point of "no return" during the detox process; nor does it necessarily have to involve going back to the treatment start box.

Cognitive factors

According to the Marlatt and Gordon Relapse Prevention Model, In the relapse process typical of addictions, 3 cognitive factors interact:

• Self-efficacy: that is, the perceived ability to cope with situations.
• The expectations of the results of the consuming behavior.
• The attributions of causality.

Abstinence violation effect (VAS)

In the Marlatt and Gordon relapse prevention model, an essential concept is proposed, the so-called abstinence violation effect (VAS). This effect arises when the person decides to use again (in the case of alcoholism), that is, when a relapse occurs. It is formed, according to his voice, by two cognitive-affective elements:

1. An effect of cognitive dissonance.

A cognitive dissonance occurs in the subject who is about to drink, or who directly drinks (but does not know if keep doing it), since his interests (achieving abstinence and recovering) conflict with his wishes (to drink). It is a cognitive dissonance.

2. A personal attribution effect

If, once the subject relapses, he attributes the occurrence of his drinking behavior again (personal attribution) to stable, internal and global factors, then decreases her resistance to future temptations to do it again.

That is, the loss of control that leads a person with an alcohol addiction to drink again is determined by the violation effect of abstinence.

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Training

A few years later from Marlatt and Gordon's Relapse Prevention Model, in 1995, Marlatt himself developed a specific relapse prevention training together with another author, Dimeff, closely related to the initial model. This training very well differentiated two terms: the "fall" and the "relapse", and based on this difference, it was developed through a sequence of steps:

• Inform the subject that relapses are possible.
• Differentiate fall vs. relapse.
• Assume the role in the process of falling or relapse.
• Analyze the factors that have led you to fall or react.
• Train specific coping skills in high-risk situations.
• Train you in decision-making towards non-consumption in high-risk situations.
• Train you in comprehensive coping and lifestyle strategies to stay abstinent.

Indications in therapy

As we have seen, the Marlatt and Gordon Relapse Prevention Model it is used to treat addictive disorders to certain substances (drugs), mainly alcoholism (where an effective therapy has been demonstrated, and of first choice).

On the other hand, the model is also indicated for treating heroin addiction, and is considered probably effective for this type of disorder. Furthermore, in this case, the model adopts a multitude of formats in the literature. It is usually part of a broader cognitive-behavioral therapy (as in the case of alcoholism).

Bibliographic references:

• Horse. (2002). Manual for the cognitive-behavioral treatment of psychological disorders. Vol. 1 and 2.
• Castilla, P. (2016). The prevention of relapses in drug addiction from the Marlatt model. Contributions from social work. Social work today, 77: 109-133.
• Marlatt, G. TO. (1993). Preventing relapse into addictive behaviors: A cognitive-behavioral treatment approach. In M. Casas and M. Gossop (Eds.), Relapse and relapse prevention (pp.137-160). Sitges: Editions in Neurosciences.
• Secades, R. and Ramón, J. (2003). Guide to effective psychological treatments for drug addiction: alcohol, cocaine and heroin.