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Relapse Prevention: A Critical Analysis

NCJ Number
164134
Journal
Sexual Abuse: A Journal of Research and Treatment Volume: 8 Issue: 3 Dated: (July 1996) Pages: 177-200
Author(s)
T Ward; S M Hudson
Date Published
1996
Length
24 pages
Annotation
This paper critically examines both Marlatt's original relapse prevention (RP) model and Pithers' application of this perspective to the treatment of sex offenders.
Abstract
RP procedures aim to enhance clients' self-management skills in order to maintain the initial positive behavioral change induced by therapy (Marlatt and Gordon, 1985). Marlatt's conceptualization has proven valuable in the field of addiction, particularly his observation of the commonalities across addictive disorders. RP is essentially based on social learning theory, and initial and maintaining causal factors are distinguished. Since the relapse process constitutes the core assumption of the RP model, this paper describes it in detail. The relapse process is divided into events and processes that lead individuals to high-risk situation (HRS) that set the scene for a possible relapse, lead from HRS to a lapse, and facilitate the transition from a lapse to a relapse. Although Marlatt emphasizes the importance of interaction between the multiple factors that lead to both the establishment of addictive disorders and relapse, his RP model does not adequately reflect these relationships. He does not convincingly address the relationships among lapses, HRS, apparently irrelevant decisions, etc. The RP model was initially applied to sex offenders by Pithers and his colleagues (1983), who subsequently developed the Vermont Program. In adapting the RP approach to sex offenders, Pithers made a number of changes to the model. The presence of a clearly and legally defined victim required the redefinition of both the lapse and the relapse, moving them to points earlier in the behavioral chain. Overall, the authors of this paper conclude that RP has proven to be a valuable framework for the organization and delivery of treatment to sex offenders; however, the innovations in treatment have not been matched by theoretical developments. Both Marlatt's and Pithers' RP models contain a number of conceptual weaknesses that make them incomplete as models of the relapse process in the addiction and sexual offending areas, respectively. 44 references