Therapists working with alcoholic clients can give a treatment approach that focuses onward identifying high-risk drinking situations and structuring homework assignments designed to initiate and maintain change in drinking behavior.

Therapists working with alcoholic clients can give a treatment approach that focuses onward identifying high-risk drinking situations and structuring homework assignments designed to initiate and maintain change in drinking behavior. Building client confidence, or self-efficacy, in coping with all areas of perceived drinking risk, is clew to the success of this promising approach.

The chronic, relapsing nature of alcohol point in disputes has long been recognized. However, it is solitary in recent years that research attention has begun to focus forward factors affecting the process of relapse (eg Litman et al. 1977 1984; Wilson 1980) and forward the development of "relapse prevention" treatment strategies that may be particularly effective in reducing the probability and severity of relapse (Annis 1986; Marlatt and Gordon 1985)

Relapse, on definition, involves a failure to maintain behavior change, rather than a failure to initiate change. Social learning theory approaches, and specifically Bandura's theory of self-efficacy, retain that the most powerful managements for inducing behavior change may not be the mostly effective techniques for producing generalization and maintenance of treatment results (Bandura 1977, 1978, 1986). That is, a treatment strategy may be highly effective in initiating a change in a client's drinking behavior if it were not that ineffective at maintaining that change across time and avoiding relapse. This distinction between initiation and maintenance of behavior change was of central importance in our choice of Bandura's theory of self-efficacy as a framework to guide disclosure of relapse prevention procedures for treatment of alcohol question s The theoretical derivation of these relapse measures has been described elsewhere (see Annis 1986; Annis and Davis 1988b) In this article we provide a detailed description of our relapse prevention treatment approach.

OVERVIEW OF THE RELAPSE PREVENTION MODEL

Our original of relapse prevention, based forward self-efficacy theory, proposes that when a client set ins a high-risk situation for drinking, a proces of cognitive appraisal of past experiences is station in motion which culminates in a understanding or efficacy expectation, on the part of the client of his or her ability to cope with the situation. That wisdom of personal efficacy determines whether or not drinking takes place (Figure 1) There is now athletic empirical evidence of the power of self-efficacy penetrations in predicting drinking behavior (eg Condra unpublished data 1982; Stiemerling unpublished data 1983; Rist and Watzl 1983; Annis and Davis 1988a).

Therapy begins with an analysis of the client's high-risk situations for drinking, as assessed by dint of the Inventory of Drinking Situations (IDS-100; papal court below), and the establishment of an individual hierarchy of drinking risk situations, from lowest risk to highest risk. The end of treatment is to tenor an increase in the client's self-efficacy or confidence across all drinking situations in the hierarchy. Because behavioral performance has been shown to have the greatest impact forward efficacy judgments, treatment focuses forward having clients perform homework assignments involving note into progressively more risky drinking situations in their natural environment and attempting alternative coping replys Homework assignments are designed in as it was a way as to encourage maintenance effects that will be museed in strong gains in the client's confidence or self-efficacy. The Situational Confidence Questionnaire (SCQ-39; behold below) is used to monitor progres during treatment in the growth of self-efficacy across all drinking risk situations. Because exposing to real-life drinking situations is central to these relapse prevention measures treatment must take place while the client is at risk in the community. Typically, treatment is complet in eight outpatient treatment sessions, although further sessions may be necessary for a certain clients.

Each ingredient of the treatment process is described in greater detail below, beginning with a discussion of the protoplast of client for whom this treatment approach is likely to be mostly effective.

SCREENING FOR CLIENT SUITABILITY

The standard of behavior change on which the relapse prevention strategies described in this article are based assumes the existence of adequate motivational incentives; that is, it is assumed that clients perceive more [i]or[/i] less benefit to working with a therapist toward greater superintend of their drinking behavior. It is unlikely that the approach would be effective for a homeles alcoholic with not many incentives to stop drinking. onward the other hand, it should be kept in mind that clients who have a division to lose in terms of family and work stability, further who are only contemplating change at the time of intake to treatment, may be motivated from the early stages of this treatment approach. In denominations of Prochaska and DiClemente's (1984) gauge of change, some relapse prevention conducts can be seen as ways of narrowing the gap between contemplation and action, of demonstrating to the client that change can be gradual and relatively nonthreatening and thus motivating the client to attempt to mastery his or her drinking.