relapse_prevention - Special Section on Relapse Prevention...

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PSYCHIATRIC SERVICES October 2005 Vol. 56 No. 10 1297 M uch like asthma, hyperten- sion, and diabetes, sub- stance use disorders are chronic, relapsing conditions (1). As the articles in this special section of Psychiatric Services show, this char- acteristic is no less true for people with severe mental illnesses than for others. A majority of clients with co- occurring disorders attain full remis- sion of their substance use disorder (at least six months without evidence of abuse or dependence), but they also tend to relapse by returning to problematic substance use. Even those who remain in remission for years continue to be at risk of relapse. Research on substance use disor- ders suggests that recovery is a longi- tudinal process that often involves re- turn to problematic substance use during the course of building a differ- ent life by acquiring new attitudes, skills, supports, relationships, habits, and coping strategies (1–3). During this process, clients’ intentions and efforts interact complexly with social, neighborhood, cultural, and societal factors (4). One might question whether “re- mission,” “relapse,” and “recovery” are in fact the best terms for describ- ing the complex process of overcom- ing problematic substance use and adopting a completely different lifestyle. Customary usage makes the terms unavoidable, but the rhetoric of medical terminology may oversimplify what the articles in this special section show to be a highly complex mixture of use, risk, context, and conse- quences, the nature of which depends heavily on the society in which it oc- curs. When it comes to substance use, we need to keep in mind that people with mental illnesses, like the rest of us, are human agents, not just passive sites of biomedical conditions. That said, we grant that the oversimplified terms are probably here to stay. Given the chronic, recurrent na- ture of substance use disorders and the longitudinal nature of recovery, relapse prevention should logically be a major focus of dual disorder treat- ment programs (5). However, recent reviews of dual disorder interventions (6–8) have documented that essen- tially all existing studies focus on en- gaging clients in treatment (the en- gagement stage), motivating them to- ward remission (the persuasion Future Directions in Preventing Relapse to Substance Abuse Among Clients With Severe Mental Illnesses Robert E. Drake, M.D., Ph.D. Michael A. Wallach, Ph.D. Mark P. McGovern, Ph.D. Dr. Drake and Dr. McGovern are affiliated with the department of psychiatry of Dart- mouth Medical School, 2 Whipple Place, Lebanon, New Hampshire 03766 (e-mail, Dr. Wallach is with the department of psychological and brain sciences of Duke University in Durham, North Carolina. This article is part of a spe- cial section on relapse prevention among patients with co-occurring substance abuse and other mental disorders. Robert E. Drake, M.D., Ph.D., served as guest editor of the section.
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relapse_prevention - Special Section on Relapse Prevention...

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