High-risk situations

The final element in management s communication of a desire to reduce human error is the identification and elimination of error-likely situations. Every task is an opportunity for a human error, but some situahons represent greater risks than others. Identifying these high-risk situations is not easy and an expertise in applying human factors principles to the workplace is an essential prerequisite for this identification. Eliminating these hazardous situations is often relatively simple once they have been identified. In some cases it may be appropriate to provide error-tolerant systems, which are those that facilitate identification of and recovery from the errors. 

Marlatt GA (1996). Taxonomy of high-risk situations for alcohol relapse Evolution and development of a cognitive-behavioral model. Addiction, 91, S37-49. 

Poor coping in high-risk situations may cause lowered self-efficacy and increased positive expectancies for drug use. True or False ... 

Research has found that certain vulnerabilities can place a client in a high-risk situation for a relapse (Marlatt Donovan, in press Marlatt Gordon, 1985). 

When confronted with a high-risk situation like the ones just described, the client has choices for how to cope. If the client has been instructed well in the use of skills, has spent significant amounts of time rehearsing how she or he will respond to such situations, and has practiced those responses under real conditions, then she or he will likely cope with a high-risk situation without using drugs. However, sometimes the client does not cope well, perhaps because she or he has not anticipated such a situation, has not learned the appropriate skill, has not learned to use that skill in this situation, or has chosen not to use a skill she or he knows. 

For whatever reason, the client may not successfully negotiate the high-risk situation in a way that averts the risk. Unsuccessful coping may cause two unfortunate events to occur. The first is a reduction in her or his self-efficacy to successfully cope with the situation without drug use. As you may remember, self-efficacy involves the sense of mastery of a situation that results from competence and confidence. Client competence and confidence can take a beating when a high-risk situation is not handled effectively. 

If the client has skills deficits in coping effectively with a high-risk situation, then the next step is to ascertain whether the skill set is present but not being generated in this particular situation. If the skill set is present, then skills generalization is the next step, and the client should rehearse the skills under the conditions that best simulate the situation in question. If the skills are absent, then you must teach them, and after the skills are taught, the client must practice, practice, practice, under a variety of conditions to promote generalization. 

Skills for Coping With High-Risk Situations... 

Many of the skills that will help a client successfully negotiate a high-risk situation have been described in Chapter 5, so I will not reiterate those here in any great... 

Family involvement can be quite helpful in the relapse prevention effort. One potentially useful strategy is for families to make efforts to reduce relationship stressors. These efforts will likely require couples or family therapy, which ideally will improve communication within the family system and potentially reduce friction. In addition, family members may learn to reduce any negatively expressed emotions toward the client. Family and couples therapy would be highly recommended if those stressors represent a high-risk situation for the client in question and if the family members or partner are supportive of the client s efforts toward recovery. 

Your relapse prevention plan will help remind you of what to do to successfully cope with high-risk situations when you are confronted with them. If you are facing a tough situation in which you are tempted to use drugs, your plan will remind you to seek help. Contact your counselor or therapist before you use drugs, if possible. Even if you do have a lapse, remember that it is not the end of the world, but rather a chance to improve your recovery plan. Remember to call your counselor or therapist as soon as you can after a lapse. Lapses are not unusual and your counselor or therapist can help you return to recovery. 

Apparently irrelevant decisions. Decisions that clients make that may place them in high-risk situations without their being aware of the risk. 

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