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      Relapse prevention for addictive behaviors

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          Abstract

          The Relapse Prevention (RP) model has been a mainstay of addictions theory and treatment since its introduction three decades ago. This paper provides an overview and update of RP for addictive behaviors with a focus on developments over the last decade (2000-2010). Major treatment outcome studies and meta-analyses are summarized, as are selected empirical findings relevant to the tenets of the RP model. Notable advances in RP in the last decade include the introduction of a reformulated cognitive-behavioral model of relapse, the application of advanced statistical methods to model relapse in large randomized trials, and the development of mindfulness-based relapse prevention. We also review the emergent literature on genetic correlates of relapse following pharmacological and behavioral treatments. The continued influence of RP is evidenced by its integration in most cognitive-behavioral substance use interventions. However, the tendency to subsume RP within other treatment modalities has posed a barrier to systematic evaluation of the RP model. Overall, RP remains an influential cognitive-behavioral framework that can inform both theoretical and clinical approaches to understanding and facilitating behavior change.

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          Most cited references 108

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          Addiction motivation reformulated: an affective processing model of negative reinforcement.

          This article offers a reformulation of the negative reinforcement model of drug addiction and proposes that the escape and avoidance of negative affect is the prepotent motive for addictive drug use. The authors posit that negative affect is the motivational core of the withdrawal syndrome and argue that, through repeated cycles of drug use and withdrawal, addicted organisms learn to detect interoceptive cues of negative affect preconsciously. Thus, the motivational basis of much drug use is opaque and tends not to reflect cognitive control. When either stressors or abstinence causes negative affect to grow and enter consciousness, increasing negative affect biases information processing in ways that promote renewed drug administration. After explicating their model, the authors address previous critiques of negative reinforcement models in light of their reformulation and review predictions generated by their model.
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            Automatic and controlled processes and the development of addictive behaviors in adolescents: a review and a model.

            This paper presents a review and a model of the development of addictive behaviors in (human) adolescents, with a focus on alcohol. The model proposes that addictive behaviors develop as the result of an imbalance between two systems: an appetitive, approach-oriented system that becomes sensitized with repeated alcohol use and a regulatory executive system that is not fully developed and that is compromised by exposure to alcohol. Self-regulation critically depends on two factors: ability and motivation to regulate the appetitive response tendency. The motivational aspect is often still weak in heavy drinking adolescents, who typically do not recognize their drinking as problematic. Motivation to regulate use often develops only years later, after the individual has encountered serious alcohol-related problems. Unfortunately, at that point behavioral change becomes harder due to several neurocognitive adaptations that result from heavy drinking. As we document, there is preliminary support for the central elements of the model (appetitive motivation vs. self-regulation), but there is a paucity of research directly addressing these mechanisms in human adolescents. Further, we emphasize that adolescent alcohol use primarily takes place in a social context, and that therefore studies should not solely focus on intra-individual factors predicting substance use and misuse but also on interpersonal social factors. Finally, we discuss implications of the model for interventions.
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              Delineating mechanisms of change in child and adolescent therapy: methodological issues and research recommendations.

              Mechanisms of therapeutic change are rarely studied in child and adolescent therapy. Our central thesis is that the study of mechanisms of treatment is an excellent investment for improving clinical practice and patient care. Indeed, extending treatment trials to clinical settings, without complementary research that studies why and how treatment works, could have great limitations. In this article, we discuss the importance of studying mechanisms, the logical and methodological requirements, and why almost no studies to date provide evidence for why or how treatment works. Standard statistical practices (tests of mediation) and designs (randomized controlled clinical trials) contribute greatly to outcome research but have little to say about mechanisms given the way they are commonly used. The article ends with recommendations to guide research on mechanisms of therapeutic change.
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                Author and article information

                Journal
                Subst Abuse Treat Prev Policy
                Substance Abuse Treatment, Prevention, and Policy
                BioMed Central
                1747-597X
                2011
                19 July 2011
                : 6
                : 17
                Affiliations
                [1 ]Centre for Addiction and Mental Health, 33 Russell St., Toronto, ON, M5S 2S1, Canada
                [2 ]Department of Psychiatry, University of Toronto, 250 College St., Toronto, ON M5T 1R8, Canada
                [3 ]Department of Psychology, Washington State University, 14204 NE Salmon Creek Ave, Vancouver, WA, 98686, USA
                [4 ]Department of Psychology, University of Washington, Box 351525, Seattle, WA 98195, USA
                Article
                1747-597X-6-17
                10.1186/1747-597X-6-17
                3163190
                21771314
                Copyright ©2011 Hendershot et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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