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Behavioral Therapies Development Program - Effective Drug Abuse Treatment Approaches

Relapse Prevention Therapy (RPT)

Relapse Prevention Therapy (RPT) is based on cognitive-behavioral principles and seeks to address the significant problem of relapse in substance use disorders through the development of self-control strategies. While the name "relapse prevention" implies exclusive focus on the prevention of relapse after abstinence is initiated, in actuality, relapse prevention encompasses several strategies intended to facilitate abstinence. RPT was developed for the treatment of problem drinking by Marlatt & Gordon, (1985) and the techniques were adapted by Carroll, Rounsaville & Keller (19991) for use with cocaine users.

Relapse Prevention Therapy (RPT) is a collection of interdependent techniques which are intended to enhance self-control. The goal of this treatment is abstinence from cocaine and other substances through the identification of high risk situations for relapse and the implementation of more effective coping strategies. Specific techniques include fostering the resolution to stop cocaine use through exploring positive and negative consequences of continued use, self-monitoring to identify high-risk situations for relapse, and the development of strategies for coping with and avoiding cocaine craving and high-risk situations. Successful application of RPT requires the therapist's proficiency with the relapse prevention principals and familiarity with the nature of cocaine abuse so the therapist may anticipate problems the patient is likely to encounter and help the patient identify effective strategies for avoiding or confronting such problems. Although in many cases RPT is conceived as preparation for longer-term treatment, the initial focus of this approach is on the inception and maintenance of abstinence from cocaine.

Kathleen Carroll, Bruce Rounsaville and their colleagues at Yale University found evidence that Relapse Prevention help patients maintain the gains that they have made in treatment after they are out of treatment. Specifically, they found that cocaine abusers who were provided Relapse Prevention showed improvement during treatment, as did subjects who received "clinical management." However, at 6 and 12-month follow-up, only those cocaine abusers who had received the behavioral therapy were able to maintain the gains they made in treatment, whereas those in the clinical management condition did not.

Marlatt, G. & Gordon, J.R.. (eds.), Relapse Prevention: Maintenance Strategies in the Treatment of Addictive Behaviors, Guilford, New York, 1985.

Carroll, K., Rounsaville, B., & Keller, D. (1991). Relapse prevention strategies for the treatment of cocaine abuse. American Journal of Drug and Alcohol Abuse, 17 (3), 249-265.

Carroll, K. & Rounsaville, B., Nich, C., Gordon, L., Wirtz, P., & Gawin, F. (1994). One-year follow-up of psychotherapy and pharmacotherapy for cocaine dependence: delayed emergence of psychotherapy effects. Archives of General Psychiatry, 51, 989-997.

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