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1. Relapse Prevention Therapy

Marlatt, G. Alan. (University of Washington, Department of Psychology Addictive Behaviors Research Center)

Relapse Prevention, a cognitive-behavioral therapy, was developed for the treatment of problem drinking and adapted later for cocaine addicts. Cognitive-behavioral strategies are based on the theory that learning processes play a critical role in the development of maladaptive behavioral patterns. In Relapse Prevention Therapy, individuals learn to identify and correct problematic behaviors. RPT encompasses several cognitive-behavioral strategies that facilitate abstinence as well as provide help for people who experience relapse.

The relapse prevention approach to the treatment of cocaine addiction consists of a collection of strategies intended to enhance self-control. Specific techniques include exploring the positive and negative consequences of continued use, self-monitoring to recognize drug cravings early on and to identify high-risk situations for use, and developing strategies for coping with and avoiding high-risk situations and the desire to use. A central element of this treatment is anticipating the problems patients are likely to meet and helping them develop effective coping strategies.

Research indicates that the skills individuals learn through Relapse Prevention Therapy remain after the completion of treatment. In one study, most people receiving this cognitive-behavioral approach maintained the gains they made in treatment throughout the year following treatment.

Relapse Prevention strategies can be used as a stand-alone treatment or as adjuncts to other treatment programs, such as twelve-step approaches, coping skills training, cue exposure, motivational interviewing, or community reinforcement approaches.

Clinical Guidelines for Implementing Relapse Prevention Therapy.

Marlatt GA, Parks GA, Witkiewitz K. Illinois: The Behavioral Health Recovery Management Project, 2002, 49p.

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Intervention Details:

Population studied:Adults; Adolescents; Many patient types
Drug studied:Alcohol dependence; Cocaine dependence; Applicable to most drug problems
Therapy format:Individual; Group
Therapy type:Behavioral; Cognitive-behavioral
Outcomes:Despite its benefits, RP-based treatment is not associated with higher abstinence rates compared with other valid treatment approaches; rather, it is associated with lower drinking rates and fewer drinking problems among patients who have experienced a relapse (Cheney et al, 1978). Combining RPT with medications (e.g. Naltrexone or Disulfiram) to treat alcoholism leads to improved outcomes as compared with either RPT or medication alone (Irvin et al, 1999).


  • CES score of -38 in Miller et al. (2003) review of treatment outcome research (rank=29)

Supporting References:

  1. Hendershot CS, Witkiewitz K, George WH, Marlatt GA. Relapse prevention for addictive behaviors. Subst Abuse Treat Prev Policy 2011;6:17. Free online:
  2. Marlatt GA, Donovan DM (eds.) Relapse Prevention : Maintenance Strategies in the Treatment of Addictive Behaviors / 2nd edition. New York: The Guilford Press, 2005.
  3. Marlatt GA, Parks GA, Witkiewitz K. Clinical guidelines for implementing relapse prevention therapy. The Behavioral Health Recovery Management Project, 2002, 49p. Free online:
  4. Irwin JE, Bowers CA, Dunn ME, Wang MC. Efficacy of relapse prevention: a meta-analytic review. Journal of Consulting and Clinical Psychology 1999;76(4): 563-570.
  5. Larimer ME, Palmer RS, Marlatt GA. Relapse prevention: An overview of Marlatt’s cognitive-behavioral model. Alcohol Research & Health 1999;23:151-160. Free online:
  6. Schmitz JM, Oswald LM, Jacks SD, et al. Relapse prevention treatment for cocaine dependence: group vs. individual format. Addictive Behaviors 1997;22:405-418.
  7. Carroll KM. Relapse prevention as a psychosocial treatment: a review of controlled clinical trials. Experimental and Clinical Psychopharmacology 1996;4:46-54.
  8. SAMHSA. Counselor's Manual for Relapse Prevention with Chemically Dependent Criminal Offenders (TAP Series 19). Rockville, MD: SAMHSA, 1996. Free online:
  9. Rawson RA, Obert JL, McCann MJ, Marinelli-Casey, P. Relapse prevention strategies in outpatient substance abuse treatment. Psychology of Addictive Behaviors 1993; 7:85-95.
  10. Carroll K, Rounsaville B, Keller D. Relapse prevention strategies for the treatment of cocaine abuse. American Journal of Drug and Alcohol Abuse 1991;17(3): 249-265.
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