The Marlatt and Gordon Relapse Prevention Model

A theoretical contribution to plan strategies to help avoid falling into drug temptation.

The Relapse Prevention Model of Marlatt and Gordon consists of an effective therapeutic alternative for people with an addictive disorder who are in the maintenance phase. It is used primarily to treat alcoholism, although it can also be used for other substances.

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

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.The CBT is oriented to treat some addictive disorders, such as alcohol addiction.

Thus, CBT consists of two components: relapse prevention and coping/social skills training (CSST). However, Marlatt and Gordon's Relapse Prevention Model can also be applied in isolation.

This model consists of an offshoot of cognitive behavioral programs and is also the treatment of first choice for treating alcoholism, which in turn includes different psychological techniques.

The main objective of the model is to to teach, enable and empower the patient to experience relapses as part of the process of detoxification, and as another way of learning how to learn to deal with alcoholism.The main objective of the model is to teach, enable and empower the patient to live the relapses as part of the process of detoxification, and as another 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's mission is to prevent them from recurring in the future.

Drug relapses

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

But what exactly is relapse? Marlatt (1993) defined it as "a transient process, a series of events that may or may not be followed by a return to baseline levels of objective behavior observable prior to treatment".

That is, it may be a point state, it need not always be a point of "no return" during the detoxification process.Nor does it necessarily mean going back to square one of the treatment.

Cognitive factors

According to Marlatt and Gordon's Relapse Prevention Model, 3 cognitive factors interact in the process of relapse in addictions:

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

Abstinence Violation Effect (AVE)

In Marlatt and Gordon's Relapse Prevention Model, an essential concept, the so-called Abstinence Violation Effect (AVE), is proposed. This effect arises when the person decides to use again (in the case of alcoholism). (in the case of alcoholism), i.e. when a relapse occurs. It is made up, in its voice, of two cognitive-affective elements:

1. a cognitive dissonance effect.

Cognitive dissonance is produced in the subject who is about to drink, or who drinks directly (but does not know whether to continue doing so), since his or her interests (achieving abstinence and recovering) conflict with his or her desires (drinking). This is 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 his or her resistance to future temptations to return to drinking decreases..

In other words, the loss of control that leads a person with an addiction to alcohol to drink again is determined by the Abstinence Violation Effect.

Training

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

• Inform the subject that relapses are possible.
• Differentiate between fall vs. relapse.
• Assume the role in the process of fall or relapse.
• Analyze the factors that led to the fall or relapse.
• To train specific coping skills in high-risk situations.
• To train in decision making towards non-consumption in high-risk situations.
• Training in global coping and lifestyle strategies to remain abstinent.

Indications in therapy

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

On the other hand, the model is also indicated to treat heroin addiction, and is considered likely to be effective for this type of disorder. Moreover, in this case, the model takes a multitude of formats in the literature. It is often part of a broader cognitive-behavioral therapy (just as in the case of alcoholism).

Bibliographical references:

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