Programmed relapse

Under some circumstances, if a client fully intends to relapse, then you may want to control how this event unfolds. One strategy for doing so is called a programmed relapse. A programmed relapse often is conducted in session, if possible. If the client intends to lapse no matter what you do or say, then you might as well use that lapse in an educational fashion in session while having some control over it as well. Programmed relapses have been effectively used with some addictive behaviors to control the severity and duration of the event. 

Roberto has shined throughout his treatment. At every step in the process, you have been impressed with how hard he has worked on his treatment plan, and how committed he is to overcoming his problems associated with methamphetamine use. Now that he is actively involved in aftercare, 

How do you answer Roberto What will you do with him tonight in session  

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Treatment of drug addicts can be sqDarated into two phases detoxification and relapse prevention. Detoxification programs and treatment of physical withdrawal symptoms, respectively, is clinically routine for most drugs of abuse. However, pharmacological intervention programs for relapse prevention are still not veiy efficient. 

Substitution therapy with methadone or buprenorphine has been veiy successfiil in terms of harm reduction. Some opiate addicts might also benefit from naltrexone treatment. One idea is that patients should undergo rapid opiate detoxification with naltrexone under anaesthesia, which then allows fiuther naltrexone treatment to reduce the likelihood of relapse. However, the mode of action of rapid opiate detoxification is obscure. Moreover, it can be a dangerous procedure and some studies now indicate that this procedure can induce even more severe and long-lasting withdrawal symptoms as well as no improvement in relapse rates than a regular detoxification and psychosocial relapse prevention program. 

Roozen HG, Kerhof AJ, van den Brink W Experiences with an outpatient relapse program (community reinforcement approach) combined with naltrexone in the treatment of opioid-dependence effect on addictive behaviors and the predictive value of psychiatric comorbidity. Eur Addict Res 9 53—58, 2003 Rosen TS, Johnson HL Long-term effects of prenatal methadone maintenance. NIDA Res Monogr 59 73-83, 1985... 

McLaughlin P, et al. Rituximab chimeric anti-CD20 monoclonal antibody therapy for relapsed indolent lymphoma Half of patients respond to a four dose treatment program. J Clin Oncol 1998 16 2825-2833. 

Hunt WA, Barnett LW Branch LG (1971). Relapse rates in addiction programs. Journal of Clinical Psychology, 27, 455-456. 

Relapse prevention, as mentioned, is compatible with a variety of treatment models. For example, many Minnesota-model facilities have incorporated aspects of cognitive behavioral relapse prevention into their treatment and aftercare programs. There have been efforts to combine the relapse prevention model with disease-model instructions to maintain abstinence after treatment is completed. Minnesota-model relapse prevention is generally begun late in treatment and then continued into aftercare. There are numerous books and manuals that have incorporated relapse prevention methods into this particular model. 

Bonner, J.A. et al., Cetuximab prolongs survival in patients with locoregionally advanced squamous cell carcinoma of head and neck a phase III study of high dose radiation therapy with or without cetuximab, Proc. Am. Soc. Clin. Oncol., 22, 489S, Abstr. 5507, 2004. McLaughlin, R et al., Rituximab chimeric anti-CD20 monoclonal antibody therapy for relapsed indolent lymphoma half of patients respond to a four-dose treatment program, /. Clin. Oncol., 16, 2825-2833, 1998. 

Smokers who quit are at especially high risk for relapse. A counseling program in lieu of or in addition to medical treatment can be especially helpful in sustaining the patient s success. Therefore, we highly recommend that this be incorporated into the treatment regimen. 

Prophylaxis against relapses of rheumatic fever (secondary prevention of rheumatic heart disease) is discussed in Section II of this chapter. In most developed countries, national vaccination programs with vaccines against diphteria and Haemophilus influenzae type b have virtually eliminated the complications of diphteria and acute epiglottitis. 

The existence of the blood-brain barrier is an important consideration in the chemotherapy of neoplastic diseases of the brain or meninges. Poor drug penetration into the CNS has been a major cause of treatment failure in acute lymphocytic leukemia in children. Treatment programs for this disease now routinely employ craniospinal irradiation and intrathecally administered methotrexate as prophylactic measures for the prevention of relapses. The testes also are organs in which inadequate antitumor drug distribution can be a cause of relapse of an otherwise responsive tumor. 

Partial hospitalization programs for both AN and BN patients, can provide a transition from inpatient treatment for patients with a history of repeated hospitalizations and severe chronic illness or with severe com-orbid personality disorder or substance abuse problems. It is also suitable for patients who have had a recent relapse of weight loss and a return of poor anorectic behavior causing a severe impairment of function. Bulimics who are nonfunctioning from bingeing and purging may require a day program. 

Outpatient treatment for AN should be considered if the patient is in her first episode with no previous treatment and/or relapse after resuming a normal weight. Outpatient treatment can also occur following partial hospitalization or inpatient treatment programs. 

After detoxification, psychosocial therapy either in intensive inpatient or in outpatient rehabilitation programs serves as the primary treatment for alcohol dependence. Other psychiatric problems, most commonly depressive or anxiety disorders, often coexist with alcoholism and, if untreated, can contribute to the tendency of detoxified alcoholics to relapse. Treatment for these associated disorders with counseling and drugs can help decrease the rate of relapse for alcoholic patients. 

Hunt, William A., L. Walker Barnett, and Laurence G. Brandt. 1971. "Relapse Rates in Addiction Programs." foumal of Clinical Psychology 27 455-56. 

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