RELAPSE PREVENTION: HOW REALISTIC IS ABSTINENCE?


Subheadings:
-What is Relapse Prevention?
-Models of Relapse Prevention
-What is Abstinence?
-What is Addiction?
-Models of Addiction?
-How realistic is Abstinence?


What is Relapse Prevention?
Relapse prevention is a self-control programme designed to teach individuals who are trying to change their behaviour how to anticipate and cope with the problem of relapse. In a very general sense, relapse refers to a breakdown or failure in a person’s attempt to change or modify any target behaviour. Based on the principle of social learning theory, relapse prevention is a psychoeducational programme that combines behavioural skill-training procedures with cognitive intervention techniques.

Relapse Prevention Model: Because RP model combines both behavioural and cognitive components, it is similar to other cognitive behavioural approaches that have been developed as an outgrowth and extension of more traditional behaviour therapy programmes.

The RP model was initially developed as a behavioural maintenance programme for use in the treatment of addictive behaviours. In addictions the typical goals of treatment are either to refrain totally from performing a target behaviour (e.g.,to abstain from drug use), or to impose regulatory limits or controls over the occurrence of a behaviour(e.g., a diet as a means of controlling food intake. Over the decades, three main models have emerged to explain addiction: the moral model, learning model, and medical model (Wilbanks, 1989). The main differences that arise out of these models are the causes they attribute to drug use and the role of free will.
What is Addiction?

Models of addiction:
The moral model suggests that addiction is a choice based on bad values (Wilbanks, 1989). On the other end, the medical model views addiction as a compulsion that is completely out of the addict’s control (Wilbanks, 1989).

The learning model contends that addiction is influenced by environmental factors (Schaler, 1991: 44) and thus individuals make choices in a predetermined or constrained setting.
According to Wilbanks (1989), the moral model views addiction as a choice made by individuals with low moral standards. Addicts are characterized as inherently bad people who do bad things that are driven by their values. Naturally, treatment for addiction is argued to be punishment (Schaler, 1991).

Moral model
·        America’s war on drugs is a good example of a punitive method against addiction that is consistent with the moral model. The war on drugs seeks harsh punishments for those involved with drugs rather than rehabilitative methods. The underlying assumption is that those engaged in drug related offences, including drug abuse, choose to behave that way. The moral model of addiction emerged as a result of the major influences of religion in people’s lives. Theologians and clergymen were highly respected and viewed as very knowledgeable about human behaviours (Wilbanks, 1989: 408).
·        In a liberal society, free will and individual autonomy are highly emphasized and valued ideals. The moral model appeals to our common sense because it is consistent with these liberal views. Addicts are conceived as free willed individuals making rational choices and the reason they engage in drug use is because they have bad morals.

In the face of reality, the moral model is insufficient to capture the phenomenon of drug addiction. It ignores factors such as physiological effects of drugs and sociological backgrounds of addicts that are likely to have an important impact on their drug use.

Disease model:
The moral model began to lose its influence when physicians and doctors were seen as having more expertise on humans than theologians and religion began to fade into the backdrop of people’s lives (Wilbanks, 1989: 408).

Initially, the disease model was integrated with the moral model where addiction was seen as a problem for people with weak morals (Wilbanks, 1989).

However, addiction affecting even those with strong morals could not be ignored.
In order to account for this, the disease model of addiction was fully adopted while the moral model was discarded. As a result, the disease model of addiction became prominent.

In 1956, alcoholism was declared a disease by the American Medical Association (Wilbanks, 1989: 410).
By 1960’s to 1970’s, research claimed that alcoholism has a genetic disposition (Hirschman, 1995: 538).
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