Taxonomy of high‐risk situations for alcohol relapse: evolution and development of a
Open accessAbstract
The purpose of this paper is to provide an historical overview of the development of the taxonomy of high‐risk situations for relapse in patients receiving abstinence‐based treatment for alcoholism. Research conducted during the 1970s on determinants of relapse is briefly reviewed, beginning with a preliminary analysis of relapse patterns in alcoholics treated with aversion therapy. Theoretical foundations underlying the development of the taxonomy are then discussed with an emphasis on social‐learning theory and its implications for cognitive‐behavioral interventions for relapse prevention. Findings supporting the efficacy of coping‐skills training for high‐risk relapse situations, based on a prospective treatment outcome study for inpatient alcoholics, are also presented in support of the clinical validity of the relapse model. The paper concludes with a description of the refined and extended taxonomy of high‐risk situations and the associated cognitive‐behavioral model of relapse described in the Marlatt & Gordon (1985) text on relapse prevention.
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- Findingown data§ Early theories of relapse determinants
In the aversion study, craving related to withdrawal symptoms was rarely reported by patients as a trigger for the first drink after treatment.
“In our own analysis of situations in which relapse occurred following aversion therapy (Table 1), craving related to withdrawal symptoms was rarely reported by patients as a trigger for taking the rst drink after treatment.”
Quote in the paperSubstantial claim - Findingown data§ Early theories of relapse determinants
In those frustration-and-anger situations, patients took a drink rather than expressing their anger assertively.
“Rather than expressing this anger assertively, however, the patient ended up taking a drink.”
Quote in the paperNot a substantial claim - Findingown data§ Preliminary relapse taxonomy: results from an aversion therapy outcome study
In the aversion study, no situation given or unable to remember accounted for 7% (3 of 48) of first-lapse situations.
“| No situation given or unable to remember | | 3 | 7 |”
Quote in the paperNot a substantial claim - Findingown data§ Early theories of relapse determinants
Most frustration-and-anger relapse situations in the aversion study involved the patient being blocked in a goal-directed activity, usually by another person's criticism, and feeling angry.
“Most of the situations in the rst category, frustration and anger, involved an episode in which the patient was frustrated in some goal-directed activity (typically by another person who criticized him), and reported feelings of anger.”
Quote in the paperNot a substantial claim - Findingown data§ Preliminary relapse taxonomy: results from an aversion therapy outcome study
In the aversion study, negative emotional state accounted for 10% (5 of 48) of first-lapse situations.
“| Negative emotional state | Patient living alone, no job; complained of feeling bored and useless; could see no reason why he should not take a drink | 5 | 10 |”
Quote in the paperNot a substantial claim
- Findingown data§ Preliminary relapse taxonomy: results from an aversion therapy outcome study
At the 15-month follow-up, no significant differences in drinking outcome measures remained between the aversion therapy and control conditions.
“One year later, at the 15-month follow-up, no signi® cant differences in drinking outcome measures remained between the treatment and control conditions.”
Quote in the paperSubstantial claim - Findingown data§ Preliminary relapse taxonomy: results from an aversion therapy outcome study
During the first 90 days of follow-up in the aversion study, 48 of 65 patients consumed at least one alcoholic drink.
“During the ® rst 90 days of the follow-up period, 48 of 65 patients consumed at least one alcoholic drink.”
Quote in the paperNot a substantial claim - Findingown data§ Preliminary relapse taxonomy: results from an aversion therapy outcome study
The aversion therapy condition produced significant decreases in drinking and relapse rates at the 3-month follow-up compared with the standard inpatient-only condition.
“The results showed that the aversion therapy condition produced signi® cant decreases in drinking and relapse rates at the 3-month follow-up compared to the standard inpatient-only condition.”
Quote in the paperSubstantial claim - Findingown data§ Drinking analog studies
In that analog study, subjects given the opportunity to express their anger before drinking consumed significantly less alcohol than subjects who did not have the opportunity to retaliate.
“More importantly, subjects who were given the opportunity to express their anger prior to drinking consumed signi® cantly less alcohol than subjects who did not have the opportunity to retaliate.”
Quote in the paperSubstantial claim - Findingown data§ Preliminary relapse taxonomy: results from an aversion therapy outcome study
In the aversion study, social pressure accounted for 23% (11 of 48) of first-lapse situations.
“| Social pressure | Patient went with the ª boysº to a bar after work. They put pressure on him to ª join the crowdº and he was unable to resist | 11 | 23 |”
Quote in the paperNot a substantial claim - Findingown data§ Preliminary relapse taxonomy: results from an aversion therapy outcome study
In the aversion study, frustration and anger accounted for 29% (14 of 48) of first-lapse situations.
“| Frustration and anger | Patient tried to call his wife (they separated); she hung up on him; he became angry and took a drink | 14 | 29 |”
Quote in the paperSubstantial claim - Findingown data§ Drinking analog studies
In the analog study with heavy social drinkers, angered subjects drank significantly more than non-angered controls.
“Results showed that angered subjects drank signi® cantly more than non-angered controls.”
Quote in the paperSubstantial claim - Findingown data§ Early theories of relapse determinants
In the aversion study, social-pressure relapse situations involved patients reporting inability to resist direct or indirect attempts by others to engage them in drinking.
“In the second category, social pressure, the patients reported being unable to resist either direct or indirect attempts by others to engage him in drinking.”
Quote in the paperNot a substantial claim - Findingown data§ Preliminary relapse taxonomy: results from an aversion therapy outcome study
In the aversion study, intrapersonal temptation accounted for 21% (10 of 48) of first-lapse situations.
“| Intrapersonal temptation | Patient walked by a bar, and ª just unconsciously walked in, no real reasonº ; could not resist the temptation to take a drink | 10 | 21 |”
Quote in the paperSubstantial claim - Findingown data§ Early theories of relapse determinants
All initial lapse episodes in the aversion study could be assigned to relatively few categories.
“It was clear from the results presented in Table 1 that all the initial lapse episodes could be assigned to relatively few categories.”
Quote in the paperSubstantial claim - Findingown data§ Preliminary relapse taxonomy: results from an aversion therapy outcome study
In the aversion study, miscellaneous other situations accounted for 10% (5 of 48) of first-lapse situations.
“| Miscellaneous other situations | Patient reported that everything was going so well for him that he wanted to celebrate by having a drink | 5 | 10 |”
Quote in the paperNot a substantial claim - Findingown data§ Drinking analog studies
The discussion-only group did not differ significantly from the group that received only the standard hospital program.
“The discussiononly group did not differ signi® cantly from the”
Quote in the paperSubstantial claim - Interpretationcitation§ Evolution of a cognitive± behavioral model of the relapse process
The high-risk situations and the individual's response to them are most closely associated with the occurrence of relapse itself.
“While other factors may also play a role in the relapse process, such as demographic and other individual differences, past drinking history, degree of cognitive impairment, and the type of treatment received, it is the effect of these high-risk situations and the individual's response to them that is most closely associated with the occurrence of the relapse itself.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Marlatt, 1978a
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- The authors state this as an assumption: External events can increase subjective desire or craving for alcohol.
- Premisecitation§ Evolution of a cognitive± behavioral model of the relapse process
For most alcoholics, drinking has become the predominant, overlearned, and habitual response to stressful situations.
“For most alcoholics, drinking has become the predominant, overlearned, and habitual response to stressful situations (Marlatt, 1978a, p. 293).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Marlatt, 1978a
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Premisecitation§ Drinking analog studies
Later studies by the same research group showed similar reductions in alcohol consumption following training in global coping skills such as mindfulness meditation and aerobic exercise.
“Later studies conducted by our group showed similar reductions in alcohol consumption following training in global coping skills such as mindfulness meditation and aerobic exercise (Marlatt & Marques, 1977; Marlatt et al. , 1984).”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites Marlatt & Marques, 1977
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites Marlatt et al., 1984
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Premisecitation§ Preliminary relapse taxonomy: results from an aversion therapy outcome study
Aversion therapy for alcoholism was based on the premise that pairing alcohol cues with an unconditioned aversive stimulus would produce a conditioned aversion to the sight and smell of alcohol.
“According to the aversive conditioning literature available at the time (e.g. Rachman & Teasdale, 1969; Brush, 1971) aversion therapy for alcoholism was based on the premise thatpairing alcohol cues with an unconditioned aversive stimulus (i.e. electric shock or emeticinduced nausea) would produce a conditioned aversion to the sight and smell of alcohol.”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites Rachman & Teasdale, 1969
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites Brush, 1971
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Interpretationreasoning§ Evolution of a cognitive± behavioral model of the relapse process
If an alcoholic does not know how to cope with high-risk situations when they occur in the natural environment, the probability of relapse will increase.
“If the alcoholic does not know how to cope with these high-risk situations when they occur in the natural environment, the probability of relapse will increase¼”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Marlatt, 1978a
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Study design and conductown data§ Preliminary relapse taxonomy: results from an aversion therapy outcome study
Inter-rater reliability for assigning 20 relapse descriptions to categories was 0.95 percentage agreement.
“Reliability of the categorization system was assessed by asking two raters to independently assign 20 descriptions to the appropriate category; percentage of agreement between the two raters was 0.95.”
Quote in the paperSubstantial claim - Premisecitation§ Preliminary relapse taxonomy: results from an aversion therapy outcome study
If an organism can be trained and reinforced for emitting an alternative response to the same discriminative stimuli, a more permanent behavior change is facilitated.
“If, however, the organism can be trained and reinforced for emitting an alternative response to these same discriminative stimuli, a more permanent behavior change is facilitated.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Hilgard & Bower, 1966
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Premisereasoning§ Early theories of relapse determinants
Both Jellinek's model and Ludwig and Wikler's model shared the assumption that relapse was determined primarily by aversive withdrawal symptoms, or craving.
“Both Jellinek and Ludwig & Wikler shared the assumption that relapse was determined primarily by aversive withdrawal symptoms (craving).”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites Jellinek, 1960 source
- cites Ludwig & Wikler, 1974
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Interpretationown data§ Postscript 1996
Not every lapse leads to a full relapse, that is, a return to pretreatment or baseline drinking levels.
“While initial lapses are critical and important in the process of recovery, not all lapses eventuate in total relapse (return to pretreatment or baseline drinking levels).”
Quote in the paperSubstantial claim - Interpretationown data§ Drinking analog studies
Overt practice and rehearsal are required for new learning to take place, at least among chronic male alcoholics.
“supporting the view that actual overt practice and rehearsal is necessary for new learning to occur, at least in this population of chronic male alcoholics.”
Quote in the paperSubstantial claim - Premisecitation§ Drinking analog studies
Hunt, Barnett and Branch (1971) found closely similar post-treatment relapse or survival rates among alcoholics, opiate addicts and smokers.
“Our interest in extending the taxonomy to behaviors other than alcohol consumption was stimulated by the results of a seminal paper by Hunt, Barnett & Branch (1971) showing very similar post-treatment relapse (or survival) rates for alcoholics, opiate addicts and smokers.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Hunt, Barnett & Branch (1971)
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Interpretationown data§ Drinking analog studies
This was the first controlled outcome study to demonstrate that relapse prevention training works in alcoholism treatment.
“This study was the rst controlled outcome study to document the effectiveness of relapse prevention training for alcoholism treatment.”
Quote in the paperSubstantial claim - Premisecitation§ Early theories of relapse determinants
Jellinek's disease model failed to mention any external, environmental, or situational triggers that might play a pivotal role in the relapse process.
“Consistent with a disease model that focuses exclusively on physical dependence and withdrawal as primary determinants of relapse, Jellinek failed to mention any external, environmental or situational triggers that might play a pivotal role in the relapse process.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Jellinek, 1960 source
- Premisenone given§ Early theories of relapse determinants
The disease model as exemplified in Jellinek's 1960 book was the predominant and most influential theoretical perspective on alcoholism relapse then available.
“The disease model as exempli® ed in Jellinek's 1960 book was the predominant and most in¯ uential theoretical perspective on alcoholism relapse then available.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Jellinek, 1960 source
- Premisecitation§ Early theories of relapse determinants
Litman and colleagues' survey of alcoholics derived four primary high-risk situations through factor analysis: negative mood states, external situations previously associated with drinking, social-interpersonal anxiety, and decreased cognitive vigilance with rationalizations.
“In this study, Litman's group conducted a survey of alcoholics to assess those situations which were most likely to precipitate relapse; four primary high-risk situations were derived through factor analysis. These included negative mood states such as depression and anxiety, external situations previously associated with drinking, social± interpersonal anxiety and decreased cognitive vigilance”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Litman et al., 1977 source
- Study design and conductown data§ Scoring rules
Inter-rater agreement for the eight main subcategories was 88% in an independent reliability test.
“In an independent test of reliability, the inter-rater agreement was 88% for the eight main subcategories listed in Table 2.”
Quote in the paperSubstantial claim - Premisecitation§ Postscript 1996
Retrospective self-report carries methodological limitations.
“We were also aware of the methodological limitations associated with retrospective selfreport (Marlatt, 1978b; Marlatt, 1981; Babor, Stephens & Marlatt, 1987).”
Quote in the paperSubstantial claim0 of 3 sources checked- cites Marlatt, 1978b
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites Marlatt, 1981
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites Babor, Stephens & Marlatt, 1987 source
- May combine two claims. 7
- Classified as probably not a substantial claim. 10
May combine two claims.
Findingcitation§ Drinking analog studiesIn the authors' controlled trial, the skills-training group outperformed both control groups, with significant reductions in the number of drinks consumed, the days of continuous drinking before abstinence was regained, and the number of days intoxicated.
“The skills-training group proved to be more effective than either control group, showing signi® cant reductions on such outcome measures as number of drinks consumed, days of continuous drinking before regaining abstinence, and number of days intoxicated.”
- Also stated in: § Postscript 1996 · boosted
“By using these continuous measures of treatment outcome, we were able to demonstrate that relapse prevention training had a signi® cant impact on the magnitude and extent of post-treatment drinking compared to control conditions.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Chaney, O'Leary & Marlatt, 1978 source
- Also stated in: § Postscript 1996 · boosted
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown data§ Preliminary relapse taxonomy: results from an aversion therapy outcome studyIn the aversion therapy outcome study, 65 male inpatient alcoholics were randomly assigned to electrical aversion therapy or to a control condition that received only the usual inpatient program.
“In this study, 65 male alcoholics in an inpatient treatment center were randomly assigned to receive electrical aversion therapy or to a control condition receiving only the usual inpatient program.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
Study design and conductreasoning§ Drinking analog studiesThe discussion-only group was included to control for the additional time and attention received in the skills-training condition.
“The purpose of the discussion-only group (patients in this condition discussed feelings about relapse, but received no coping-skills training) was to control for the additional time and attention patients received in the skills-training condition.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim. May combine two claims.
Premisecitation§ Preliminary relapse taxonomy: results from an aversion therapy outcome studyPunishment training literature concluded that punishment produces a temporary suppression of responding, an effect that is short-lasting and limited to settings where the original punishment cues are present.
“Results from the then available learning-theory literature on punishment training (e.g. Hilgard & Bower, 1966) concluded that although punishment (application of a noxious stimulus such as shock following a response such as eating or drinking) produces a temporary suppression of responding, this effect is short-lasting and limited to settings in which the original punishment cues are present”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Hilgard & Bower, 1966
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown data§ Drinking analog studiesIn the analog drinking study, subjects were randomly assigned to one of three conditions.
“Subjects, consisting of male and female heavy social drinkers, were randomly assigned to one of three conditions.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Premisecitation§ Early theories of relapse determinantsBurt (1974) reported that 80% of his sample took their first drink in a location different from their preferred drinking setting before treatment, a finding counter to predictions from conditioned relapse theory.
“Burt (1974) reported that 80% of his sample (30 men and four women) took their ® rst drink in a location which differed from their preferred drinking setting prior to treatment, a nding counter to predictions from conditioned relapse theory.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Burt, 1974 source
Classified as probably not a substantial claim.
Study design and conductown data§ Drinking analog studiesIn the prospective clinical trial, patients were randomly assigned to one of three conditions: coping skills training, a discussion-only group, and a no-additional treatment group.
“Patients were randomly assigned to one of three conditions: coping skills training, a discussion-only group and a no-additional treatment group (in which patients received only the regular month-long inpatient treatment program).”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Premisecitation§ Early theories of relapse determinantsSocial-learning theory posited that problem drinking can be considered a maladaptive attempt to cope with stress elicited by environmental demands.
“Social-learning theory posited that problem drinking can be considered a maladaptive attempt to cope with stress elicited by environmental demands.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Bandura, 1969
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
Premisecitation§ Early theories of relapse determinantsAlcoholics who fail to exercise an adaptive alternative coping response when confronted by stressful situations following treatment may turn to alcohol as the dominant, habitual response, particularly if they have a history of relying on alcohol to reduce tension or stress.
“Alcoholics who fail to exercise an adaptive alternative coping response when confronted by stressful situations following treatment may turn to alcohol as the dominant, habitual response (particularly if the patient had a history of relying on alcohol as a means of ª selfmedicationº to reduce tension or stress).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Bandura, 1969
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
Premisecitation§ Postscript 1996Negative emotional states and exposure to social pressure are high-risk situations for relapse to alcohol and other substance use, whether measured prospectively or retrospectively, a finding that later studies continue to replicate.
“studies continue to replicate the essential ndings of our early studies of relapse triggers: that contextual factors such as the experience of negative-emotional states and exposure to social pressure constitute high-risk situations for relapse to alcohol and substance use (e.g. Hodgins, el-Guebaly & Armstrong, 1995), whether assessed prospectively or retrospectively.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Hodgins, el-Guebaly & Armstrong, 1995 source
Probably not a substantial claim: may not pass S3 (load-bearing).
Premisecitation§ Early theories of relapse determinantsBoth models also stress that the magnitude of withdrawal, and thus the potential for relapse, is determined primarily by prior degree of physical dependence on alcohol.
“Both models also stress that the magnitude of withdrawal (and thus potential for relapse) is determined primarily by prior degree of physical dependence on alcohol.”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites Jellinek, 1960 source
- cites Ludwig & Wikler, 1974
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
Study design and conductown data§ Postscript 1996The authors ran a series of controlled drinking analogue studies and a prospective treatment outcome study in order to establish construct and predictive validity for their cognitive-behavioral model.
“As a result, we conducted a series of controlled drinking analog studies and a prospective treatment outcome study to provide construct and predictive validity for our cognitive± behavioral model.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim.
Study design and conductown data§ Scoring rulesRater training went on until the two raters agreed closely.
“Training continued until a high degree of agreement between raters was obtained.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim.
Interpretationreasoning§ Postscript 1996Assessing a patient's high-risk situations gives both patient and therapist a way to handle relapse risks or actual lapses.
“The ª good newsº about research ndings on relapse precipitants is that the assessment of a patient's high-risk situations for relapse gives both the patient and the therapist a ª handleº on how to cope with relapse risks or actual lapses.”
Quote in the paperSubstantial claimMay combine two claims.
Premisecitation§ Early theories of relapse determinantsExisting literature documented high relapse rates for alcoholism treatment outcome in general, but few if any studies documented information on distal and proximal determinants of relapse, magnitude of relapse episodes, or patients' cognitive and affective reactions to relapse.
“Although existing literature documented high relapse rates for alcoholism treatment outcome in general (e.g. Hill & Blane, 1967; Emrick, 1974), few if any studies documented information on the distal and proximal determinants of relapse, magnitude of relapse episodes (lapse vs. relapse), or the patient's cognitive and affective reactions to relapse.”
Quote in the paperSubstantial claim0 of 2 sources checked- cites Hill & Blane, 1967 source
- cites Emrick, 1974
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
The authors state this as an assumption.
External events can increase subjective desire or craving for alcohol.
“By asking respondents to also report on ª things that happened to you in the outside world that triggered off your need or desire to take the ® rst drinkº there is an implicit assumption that external events may increase subjective desire or craving for alcohol.”
The authors state this as an assumption.
The cognitive-behavioral model of relapse applies only to people who have voluntarily committed to abstinence or to a self-imposed rule about consumption.
“An important condition of the theory is that it applies only to those cases in which the individual has made a voluntary choice or decision to change a target behavior”
The paper relies on this without support.
Around 1970 the disease model was the dominant ideology behind abstinence-based alcoholism treatment.
“Relapse is a term derived from the disease model, the dominant ideology underlying the abstinencebased alcoholism treatment approaches of the day (c. 1970).”
Cites
The publisher hasn’t deposited this paper’s reference list.
Research works printed but not linked: 10
- CUMMINGS, C., GORDON, J. R. & MARLATT, G. A. (1980) Relapse: strategies of prevention and prediction, in MILLER. W. R. (Ed.) The Addictive Behaviors: Treatment of Alcoholism, Drug Abuse, Smoking, and Obesity , pp. 291± 321 (Oxford, Pergamon Press).
- EMRICK, C. D. (1974) A review of psychologically oriented treatment of alcoholism, Quarterly Journal of Studies on Alcohol , 35, 523± 549.
- LUDWIG, A. M. & WIKLER, A. (1974) ª Cravingº and relapse to drink, Quarterly Journal of Studies on Alcohol , 108± 130.
- MARLATT, G. A. (1976) The Drinking Pro® le: a questionnaire for the behavioral assessment of alcoholism, in: MASH, E. J. & TERDAL, L. G. (Ed.) Behavior-Therapy Assessment , pp. 121± 137 (New York, Springer).
- MARLATT, G. A. (1978b) Behavioral assessment of social drinking and alcoholism, in: MARLATT, G. A. & NATHAN, P. E. (Eds), Behavioral Approaches to Alcoholism , pp. 35± 57 (New Brunswick, NJ, Rutgers Center of Alcohol Studies).
- MARLATT, G. A. (1981) The drinking history: problems of validity and reliability, in: MEYER, R. E. (Ed.) Evaluation of the Alcoholic: Implications for Research, Theory, and Treatment , Research Monograph No. 5, pp. 25± 39 (Rockville, MD, National Institute of Alcohol Abuse and Alcoholism).
- MARLATT, G. A. & GORDON, J. R. (1980) Determinants of relapse: implications for the maintenance of behavior change, in DAVIDSON, P. O. & DAVIDSON, S. M. (Eds) Behavioral Medicine: Changing Health Lifestyles , pp. 410± 452 (New York, Brunner/ Mazel).
- MARLATT, G. A. & GORDON, J. R. (Eds) (1985) Relapse Prevention: Maintenance Strategies in the Treatment of Addictive Behaviors (New York, Guilford Press).
- MARLATT, G. A. & MARQUES, J. K. (1977) Meditation, self-control, and alcohol use, in: STUART, R. B. (Ed.) Behavioral Self-management: Strategies, Techniques, and Outcomes , pp. 117± 153 (New York, Brunner/ Mazel).
- RACHMAN, S. & TEASDALE, J. (1969) Aversion Therapy and Behaviour Disorders: An Analysis (Coral Gables, FL, University of Miami Press).
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“Similar approaches are used in cessation programs for addictive behaviors (Marlatt, 1996).”
BackgroundSripada, C. (2021) · Behavioural Brain Research · doi:10.1016/j.bbr.2021.113639 · Cited by 89 · see citing works
High-Risk Situations Associated with Parasuicide and Drug Use in Borderline Personality Disorder
Welch, S. S., & Linehan, M. M. (2002) · Journal of Personality Disorders · doi:10.1521/pedi.16.6.561.22141 · Cited by 74 · see citing works
Araújo-Soares, V., McIntyre, T., MacLennan, G., & Sniehotta, F. F. (2009) · Psychology & Health · doi:10.1080/08870440802040707 · Cited by 71 · see citing works
Kornreich, C., Brevers, D., Canivet, D., Ermer, E., Naranjo, C., Constant, E., Verbanck, P., Campanella, S., & Noël, X. (2012) · Addiction · doi:10.1111/j.1360-0443.2012.03995.x · Cited by 71 · see citing works
“Interpersonal problems have been associated with emotion recognition impairments [5] and such problems may lead to relapse [17], suggesting that the observed impairments in emotion recognition among individuals with alcoholism are of clinical significance.”
BackgroundRelapse determinants reported by men treated for alcohol addiction
Strowig, A. B. (2000) · Journal of Substance Abuse Treatment · doi:10.1016/s0740-5472(00)00122-7 · Cited by 64 · see citing works
A Critical Review of the Social and Behavioral Contributions to the Overdose Epidemic
Cerdá, M., Krawczyk, N., Hamilton, L., Rudolph, K. E., Friedman, S. R., & Keyes, K. M. (2020) · Annual Review of Public Health · doi:10.1146/annurev-publhealth-090419-102727 · Cited by 59 · see citing works
Treatment Considerations in Internet and Video Game Addiction
Greenfield, D. N. (2018) · Child and Adolescent Psychiatric Clinics of North America · doi:10.1016/j.chc.2017.11.007 · Cited by 57 · see citing works
Votaw, V. R., Pearson, M. R., Stein, E., & Witkiewitz, K. A. (2020) · Alcoholism Clinical and Experimental Research · doi:10.1111/acer.14283 · Cited by 53 · see citing works
“…present study was a secondary analysis of data from a multisite naturalistic prospective observational study, the Relapse Replication and Extension Project (RREP) (Lowman et al., 1996), which aimed to replicate and extend a taxonomy of relapse developed by G. Alan Marlatt (Marlatt, 1996).”
BackgroundInfluentialThe Need to Belong Can Motivate Belief in God
Gebauer, J. E., & Maio, G. R. (2011) · Journal of Personality · doi:10.1111/j.1467-6494.2011.00730.x · Cited by 54 · see citing works
The More the Better? The Number of Plans Predicts Health Behaviour Change
Wiedemann, A. U., Lippke, S., Reuter, T., Ziegelmann, J. P., & Schüz, B. (2010) · Applied Psychology Health and Well-Being · doi:10.1111/j.1758-0854.2010.01042.x · Cited by 49 · see citing works
Scholz, U., Nagy, G., Schüz, B., & Ziegelmann, J. P. (2008) · British Journal of Social Psychology · doi:10.1348/014466607x266606 · Cited by 51 · see citing works
Agapie, E., Avrahami, D., & Marlow, J. (2016) · CHI Conference on Human Factors in Computing Systems · doi:10.1145/2858036.2858142 · Cited by 44 · see citing works
“Thus, relapse prevention methods should make it clear that such mistakes are common and not a sign of personal failure [22].”
BackgroundHigh-risk relapse situations and self-efficacy: Comparison between alcoholics and heroin addicts
El, G. E. S., & Bashir, T. Z. (2004) · Addictive Behaviors · doi:10.1016/j.addbeh.2004.02.003 · Cited by 37 · see citing works
Ewing, S. W. F., Filbey, F. M., Chandler, L. D., & Hutchison, K. E. (2009) · Alcoholism Clinical and Experimental Research · doi:10.1111/j.1530-0277.2009.01104.x · Cited by 38 · see citing works
“Over the past 2 decades, many psychosocial alcohol interventions have explicitly included content addressing management of depressive and/or anxiety symptoms (e.g., Kavanagh et al., 2006; Marlatt, 1996).”
BackgroundHogarth, L., & Hardy, L. (2017) · Psychopharmacology · doi:10.1007/s00213-017-4765-8 · Cited by 36 · see citing works
“tive reinforcement theories (Cox and Klinger 1988; Kassel et al. 2003; Khantzian 1997; Marlatt 1996; Mathew et al. 2017; Sinha 2001) and incentive learning theory (Dickinson”
InfluentialLoeber, S., Rustemeier, M., Paslakis, G., Pietrowsky, R., Müller, A., & Herpertz, S. (2018) · Psychiatry Research · doi:10.1016/j.psychres.2018.03.081 · Cited by 36 · see citing works
Choi, S., Adams, S. M., MacMaster, S. A., & Seiters, J. (2013) · Journal of Psychoactive Drugs · doi:10.1080/02791072.2013.785817 · Cited by 35 · see citing works
Exercise for methamphetamine dependence: Rationale, design, and methodology
Mooney, L. J., Cooper, C. B., London, E. D., Chudzynski, J. E., Dolezal, B. A., Dickerson, D. L., Brecht, M., Peñate, J., & Rawson, R. A. (2013) · Contemporary Clinical Trials · doi:10.1016/j.cct.2013.11.010 · Cited by 33 · see citing works
DiBello, A. M., Rodriguez, L. M., Hadden, B. W., & Neighbors, C. (2015) · Addictive Behaviors · doi:10.1016/j.addbeh.2015.05.008 · Cited by 33 · see citing works
“Negative interpersonal events are an important determinant in predicting the motivation underlying drinking and alcohol-related problems (DeHart, Tennen, Armeli, Todd, & Affleck, 2008; Hussong, Hicks, Levy, & Curran, 2001; Marlatt, 1996; Mohr et al., 2001).”
BackgroundAlcohol‐Related Interpretation Bias in Alcohol‐Dependent Patients
Woud, M. L., Pawelczack, S., Rinck, M., Lindenmeyer, J., Souren, P. M., Wiers, R. W. H. J., & Becker, E. S. (2014) · Alcoholism Clinical and Experimental Research · doi:10.1111/acer.12334 · Cited by 33 · see citing works
Stein, E., Votaw, V. R., Swan, J. E., & Witkiewitz, K. A. (2020) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2020.108227 · Cited by 29 · see citing works
“…was a secondary analysis of data (n=563) from the Relapse Replication and Extension Project (RREP; Lowman, Allen, Stout, & Group, 1996), a multisite, observational, prospective study intended to replicate and expand Marlatt’s taxonomy of relapse determinants (Marlatt, 1996) in a diverse sample.”
BackgroundAssessing heart rate variability biofeedback as an adjunct to college recovery housing programs
Eddie, D., Conway, F. N., Alayan, N., Buckman, J. F., & Bates, M. E. (2018) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2018.06.014 · Cited by 31 · see citing works
“…from substance use disorder (SUD) typically arise in-the-moment from interactions between emotional states, difficulty regulating affect, and cues and stressors that elicit craving and urges to use (Brown, Vik, Patterson, Grant, & Schuckit, 1995; Marlatt, 1996; Shiffman, 2009; Sinha, 2007).”
BackgroundLifetime physical and sexual abuse and substance use treatment outcomes in men.
Schneider, R. A., Cronkite, R., & Timko, C. (2008) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2008.01.001 · Cited by 29 · see citing works
Votaw, V. R., Stein, E., & Witkiewitz, K. A. (2021) · Alcohol and Alcoholism · doi:10.1093/alcalc/agab012 · Cited by 30 · see citing works
“We utilized data from the Relapse Replication and Extension Project (RREP) (Lowman et al., 1996), a multisite prospective observational study on predictors of alcohol relapse (Marlatt, 1996).”
MethodGalloway, G. P., Singleton, E. G., The Methamphetamine Treatment Project Corporate Authors, Anglin, M. D., Rawson, R. A., Patricia, M.-C., Joseph, B., Richard, B., Alison Hamilton, B., Cynthia, B., et al. (2008) · Substance Abuse: Research and Treatment · doi:10.4137/sart.s775 · Cited by 24 · see citing works
Drug and Alcohol Programmes: Concept, Theory, and Practice
McMurran, M. (2006) · doi:10.1002/9780470713341.ch6 · Cited by 22 · see citing works
Kovacs, G., Wu, Z., & Bernstein, M. S. (2021) · CHI Conference on Human Factors in Computing Systems · doi:10.1145/3411764.3445695 · Cited by 23 · see citing works
“Relapse management techniques, which aim to combat such lapses [18, 83, 87, 93, 115], are implemented by some”
Background(2017) · doi:10.1037/rel0000152 · Cited by 21 · see citing works
“In this definition we see the ways in which forgiveness can neutralize negative emotion, a known trigger for relapse to active addiction (Marlatt, 1996; Marlatt & Gordon, 1980).”
Clinical Considerations in Internet and Video Game Addiction Treatment
Greenfield, D. N. (2021) · Child and Adolescent Psychiatric Clinics of North America · doi:10.1016/j.chc.2021.09.003 · Cited by 18 · see citing works
Early Signs of Emotional Recognition Deficits in Adolescent High-Binge Drinkers
Leganes‐Fonteneau, M., Pi-Ruano, M., & Tejero, P. (2019) · Substance Use & Misuse · doi:10.1080/10826084.2019.1662810 · Cited by 15 · see citing works
“This inability to correctly perceive social cues may impede adequate performance in social contexts, increasing the chances of relapse (Marlatt, 1996; Rupp, Derntl, Osthaus, Kemmler, & Fleischhacker, 2017).”
BackgroundRelapse and Craving in Alcohol-Dependent Individuals: A Comparison of Self-Reported Determinants
Snelleman, M., Schoenmakers, T. M., & van de Mheen, D. (2018) · Substance Use & Misuse · doi:10.1080/10826084.2017.1399420 · Cited by 13 · see citing works
“The reported determinants of both relapse and craving showed many similarities with the categories of the taxonomy of high risk situations developed by Marlatt (1996). We decided to use this taxonomy as a template for comparing the determinants of relapse and craving since all determinants fit the framework (see Table…”
BackgroundMethodResultInfluentialSimonelli, M. C. (2005) · Nursing Forum · doi:10.1111/j.1744-6198.2005.00003.x · Cited by 14 · see citing works
Mericle, A. A., Kaskutas, L. A., Polcin, D. L., & Karriker‐Jaffe, K. J. (2018) · Journal of Social and Clinical Psychology · doi:10.1521/jscp.2018.37.1.1 · Cited by 12 · see citing works
“…can include high-risk people, places, and events, the relapse prevention literature has primarily focused on intraand interpersonal situations (Marlatt, 1996) rather than on the larger environmental or “contextual” factors which could serve as triggers or give rise to these high-risk intra-…”
BackgroundAcharya, R., & Dolan, M. (2011) · Personality and Mental Health · doi:10.1002/pmh.179 · Cited by 12 · see citing works
Integrative Review of Nonviolent Communication Intervention Studies
Yang, J. W., & Kim, S. (2016) · Perspectives in Nursing Science · doi:10.16952/pns.2016.13.1.36 · Cited by 11 · see citing works
The (in)Significance of the Addiction Debate
Goldberg, A. E. (2019) · Neuroethics · doi:10.1007/s12152-019-09424-5 · Cited by 11 · see citing works
Identifying Risk Factors for Postpartum Tobacco Use
(2007) · doi:10.1111/j.1547-5069.2007.00157.x · Cited by 11 · see citing works
A full and thankful heart: writings about gratitude by Alcoholics Anonymous co-founder, Bill Wilson
Krentzman, A. R. (2019) · Addiction Research & Theory · doi:10.1080/16066359.2018.1547816 · Cited by 8 · see citing works
“Individuals in early recovery are burdened with a preponderance of negative mood (Koob 2008) which is a predictor of relapse (Hendershot et al. 2011; Marlatt 1996).”
BackgroundAlcohol, Aggression, and Violence
McMurran, M. (2002) · doi:10.1002/9780470713464.ch8 · Cited by 8 · see citing works
Relapse Situations According to Marlatt’s Taxonomy in Smokers
Piñeiro, B., & Becoña, E. (2013) · The Spanish Journal of Psychology · doi:10.1017/sjp.2013.91 · Cited by 8 · see citing works
“The most important model that has been used for assessing the relapse process is Marlatt’s cognitivebehavior model (Cummings, Gordon, & Marlatt, 1980; Marlatt & Gordon, 1985), which has been updated since its original publication (Marlatt, 1996; Marlatt & Donovan, 2005; Witkiewitz & Marlatt, 2004).”
BackgroundMethodInfluentialRoordink, E. M., Steenhuis, I. H., Kroeze, W., Hoekstra, T., Jacobs, N., & van Stralen, M. M. (2023) · Annals of Behavioral Medicine · doi:10.1093/abm/kaac077 · Cited by 8 · see citing works
Precipitants of Relapse Among Heroin Addicts
ElGeili, E. S. S., & Bashir, T. Z. (2005) · Addictive Disorders & Their Treatment · doi:10.1097/00132576-200503000-00005 · Cited by 8 · see citing works
Psychologische Suchttheorien als Erklärungsansätze
Soyka, M., & Küfner, H. (2017) · Nervenheilkunde · doi:10.1055/s-0038-1627034 · Cited by 7 · see citing works
Fleming, M. N., Wycoff, A. M., Hepp, J., Griffin, S. A., Helle, A. C., Freeman, L. K., Vebares, T. J., & Trull, T. J. (2021) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2021.109021 · Cited by 5 · see citing works
The Social Processes of Excessive Online Gaming Homophily: Peer Selection or Influence?
Li, C., Yu, Q., Zhang, J., Lv, Z., Liu, Q., & He, J. (2024) · Journal of Youth and Adolescence · doi:10.1007/s10964-024-02032-4 · Cited by 6 · see citing works
“In addition, based on Marlatt ’ s (1996) theory of addiction relapse, social pressure is an important social situational variable that contributes to an individual ’ s relapse.”
Bakou, A. E., Shuai, R., & Hogarth, L. (2021) · Journal of Addiction · doi:10.1155/2021/5801781 · Cited by 4 · see citing works
Kim, J. Y., Kim, J., Park, S., & Fear, N. T. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.07.010 · Cited by 5 · see citing works
(2014) · doi:10.1080/10720162.2014.895461 · Cited by 5 · see citing works
“…intrapsychic, interpersonal, or ecological—that are repeatedly physically proximate or temporally coincident with addictive behavior will be neurologically linked or associated with addiction (Hyman & Malenka, 2001; Larimer, Palmer, & Marlatt, 1999; Marlatt, 1999; Marlatt & Gordon, 1985).”
BackgroundInfluentialA Gamified Approach for Alcohol Use Disorder Therapy in Virtual Reality
Bazhanov, A. V., Landhaeusser, V., Kammler-Sücker, K. I., Lenz, B., & Meixner, G. (2024) · IEEE International Conference on Healthcare Informatics (ICHI) · doi:10.1109/ichi61247.2024.00062 · Cited by 4 · see citing works
“…their own senses (visual, olfactory, tactile, aural) [13], (2) internal triggers, which can trigger the patient through emotions (e.g., anger, grief, anxiety, sadness, happiness), and (3) social triggers, which are generated through the interaction with other people (i.e. social pressure) [14].”
BackgroundDependência tabágica, assertividade e alexitimia em doentes cardíacos
Rocha, V., Guerra, M. P., & Maciel, M. J. (2010) · Paidéia (Ribeirão Preto) · doi:10.1590/s0103-863x2010000200003 · Cited by 5 · see citing works
Mindfulness Training Targets Addiction at the Attention‐Emotion Interface:A Neurocognitive Framework
Garland, E. L., & Froeliger, B. (2014) · Wiley eBooks · doi:10.1002/9781118294895.ch40 · Cited by 4 · see citing works
Ellis, J. D., Lister, J. J., Wohl, M. J. A., Greenwald, M. K., & Ledgerwood, D. M. (2023) · Addictive Behaviors · doi:10.1016/j.addbeh.2022.107604 · Cited by 3 · see citing works
Emmelkamp, P. M. G., Vedel, E., & Kamphuis, J. H. (2007) · doi:10.1002/9780470713242.ch4 · Cited by 5 · see citing works
Somohano, V. C., Shank, T. M., Manuel, J., Mallik, D., Rehder, K. L., & Bowen, S. W. (2021) · The Journal of Alternative and Complementary Medicine · doi:10.1089/acm.2021.0123 · Cited by 3 · see citing works
“37 Internal consistency was excellent ( a = 0.93).”
Influential김지희, & Lee, Y.-H. (2014) · Korean Journal of Health Psychology · doi:10.17315/kjhp.2014.19.1.014 · Cited by 3 · see citing works
Sawh, L., & Smelson, D. A. (2017) · Springer eBooks · doi:10.1007/978-3-319-49206-3_9 · Cited by 3 · see citing works
Social cognition in severe alcohol use disorder
D’Hondt, F., Rolland, B., & Maurage, P. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-816720-5.00004-9 · Cited by 2 · see citing works
Kräplin, A., Scherbaum, S., Bühringer, G., Goschke, T., & Schmidt, A. (2018) · The Neuroscience and Neuropsychology of Gambling · doi:10.1080/14459795.2018.1448426 · Cited by 2 · see citing works
“sonal problems and conflicts have long been recognized as gambling motives (Ledgerwood & Petry, 2006a; Stewart, Zack, Collins, & Klein, 2008) and one important precondition for relapse in GD and a variety of other addictive disorders (Ledgerwood & Petry, 2006b; Marlatt, 1996; McCormick, 1994).”
BackgroundA Taxonomy of Situations within the Context of Risk Analysis
Szekeres, A., & Snekkenes, E. A. (2019) · Conference of Open Innovations Association (FRUCT) · doi:10.23919/fruct48121.2019.8981536 · Cited by 2 · see citing works
“The theoretically constructed, domain specific taxonomy of high-risk situations for relapse in relation to alcohol abstinence was proposed in [18].”
BackgroundHagman, B. T. (2009) · NC Digital Online Collection of Knowledge and Scholarship (The University of North Carolina at Greensboro) · Cited by 2 · see citing works
Miller, W. R., & McLellan, A. T. (2011) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2011.06.004 · Cited by 2 · see citing works
“…and scientific manner when a multisite study failed to replicate details of his widely cited taxonomy of relapse antecedents (Lowman, Allen, & Miller, 1996; Marlatt, 1996b, 1996c), and he revised hismodel to incorporate the new findings (Marlatt &Donovan, 2005;Witkiewitz &Marlatt, 2004).”
BackgroundKahan, J., & Žiaková, E. (2021) · Proceedings of CBU in Social Sciences · doi:10.12955/pss.v2.218 · Cited by 1 · see citing works
“This finding is positive concerning the prospect of abstinence in addicted people, as well as with adolescents, given that loneliness is one of the negative emotional states, categorized as risk situations that create conditions for relapse (Marlatt & Gordon, 1985; Marlatt, 1996; Hosseinbor et al., 2014).”
BackgroundExercise for Substance Use Disorders
Mooney, L. J., Cooper, C. B., London, E. D., Chudzynski, J. E., & Rawson, R. A. (2014) · Springer eBooks · doi:10.1007/978-88-470-5322-9_47 · Cited by 1 · see citing works
A Gamified Approach for Alcohol Use Disorder Therapy in Virtual Reality: A Randomized Trial
(2025) · doi:10.1109/ichi64645.2025.00073 · Cited by 1 · see citing works
“A high-level categorization is to divide the cues into external cues (which can trigger the person through their own senses) [25], internal cues (which trigger the patient through emotions) [26], and social cues (which trigger the patient through various kinds of social interactions) [27].”
Bayart, P., & Rusinek, S. (2012) · Journal de Thérapie Comportementale et Cognitive · doi:10.1016/j.jtcc.2012.03.001 · Cited by 1 · see citing works
Elsayed, F. K., & Moussa, M. A. (2026) · Research Square · doi:10.21203/rs.3.rs-9227492/v1
Langener, S., VanDerNagel, J., Klaassen, R., & Heylen, D. (2026) · International Journal of Human-Computer Interaction · doi:10.1080/10447318.2026.2659298
Cognitive–behavioural approaches in the treatment of alcohol addiction
Donaghy, M. E. (2008) · Elsevier eBooks · doi:10.1016/b978-0-7506-8800-0.50011-2
Gray, B. A., Bolts, O. L., Fitzke, R. E., Douglass, M. A., Pedersen, E. R., & Prince, M. A. (2023) · Substance Use & Misuse · doi:10.1080/10826084.2023.2267112
“We adapted items for potential cannabis use contexts based on common high-risk situations outlined in Marlatt’s (Marlatt, 1996b) taxonomy of relapse model, which are environmental, emotional, or interpersonal contexts that may posit greater risk for drinking behaviors and/ or alcohol use relapse.”
BackgroundMethodExercise for Substance Use Disorders
Mooney, L. J., & Rawson, R. A. (2020) · Springer eBooks · doi:10.1007/978-3-030-36391-8_34
Choice is not enough: the concepts of impulse and self‐control
West, R., & Brown, J. (2013) · Wiley eBooks · doi:10.1002/9781118484890.ch4
Ambulante suchttherapeutische Versorgung von Jugendlichen
Basedow, L. A., van der Meer, A. S., Kuitunen‐Paul, S., & Golub, Y. (2025) · KJP up2date · doi:10.1055/a-2342-4210
- Authors
- Marlatt, G. A.
- Corresponding author
- Marlatt, G. Alan
- Venue
- Addiction
- Publisher
- Wiley
- Published
- 1996-12
- Volume
- 91
- Issue
- 12s1
- Pages
- 37-50
- ISSN
- 0965-2140 (ISSN-L)
- 1360-0443
- OpenAlex
- W2074055750
- Cited by
- 95
- References
- 0
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 2 · 2023: 4 · 2022: 1 · 2021: 10 · 2020: 5 · 2019: 5 · 2018: 6 · 2017: 5 · 2016: 3 · 2015: 2 · 2014: 6 · 2013: 4 · 2012: 2
- FWCI
- 0.31
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Addiction (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Health Professions › General Health Professions › Community Health and Development
- Social Sciences › Psychology › Developmental and Educational Psychology › Behavioral and Psychological Studies
- Keywords
- alcohol relapse, high-risk situations, relapse prevention, alcoholism, abstinence-based treatment, aversion therapy, social learning theory, cognitive-behavioral intervention
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