Determinants of Relapse: Implications for Treatment

Abstract

Few would doubt that the techniques of behavior therapy or behavior modification are capable of bringing about meaningful changes in behavior. In the past two decades, we have developed a plethora of intervention procedures which have proven effective in modifying a wide variety of target behaviors ranging from snake phobias to sexual dysfunctions. Despite our successes, in being able to initiate changes in behavior, we are still grappling with the difficulties involved in maintaining behavioral change over time and across situations. The study of addictive behaviors provides ample opportunity to examine the maintenance problem, for recidivism rates are notoriously high across the spectrum of such behaviors. In fact, the use of the word maintenance is ubiquitous in the area of addiction treatment programs (i.e, methadone maintenance, heroin maintenance) and this usage stands as further evidence of the highly recalcitrant nature of addiction. The commonality of relapse rates across these problem behaviors is striking: about two-thirds of all relapses occur within the first ninety days following treatment (Hunt, Barnett, and Branch, 1971). These data strongly suggest the possibility of common elements underlying the mechanism of relapse itself. While the importance of individual properties of various substances cannot be ignored , particularly as they affect the development of abuse patterns within user groups, the approach we have adopted seeks to understand the determinants and reactions to the relapse episode itself, viewed as a discrete behavioral entity. Our approach applies specifically to the study of relapse in human subjects, where cognitive factors playa paramount role as they interact with other behavioral and physiological factors. For this 1183 A. J. Schecter (ed.), Drug Dependence and Alcoholism