Customer Reviews

Relapse Prevention, Second Edition: Maintenance Strategies in the Treatment of Addictive Behaviors

5 star:		(2)
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3 star:		(1)
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Book is a good reference for literature review on relapse prevention.
Book offers little help in designing a relapse prevention program for patients.

I am compelled to write this because there is only one review, and it misses the point. Marlatt is a pioneer in the field of addictions, and introduced science to the field of substance abuse treatment.

While it may be difficult for a layman to understand, it is a very important work for any professional in the field to have on their shelf.

I disagree with the previous comment. I am a "layman" and my addiction counselor recommended this book to me as someone who isn't using a 12 step model of addiction recovery. Yes it has "big words", but it makes perfect sense to me, and what's amazing is that the bulk of the writing was done in the early 1980's. I recommend this book to anyone not interested in the disease model of addiction theory.

M&D's first edition became an industry standard in the SAPs of the '90s, and with good reason. It conveyed a lot of solid empirical research into techniques that really did produce the best results possible at the time. The second edition, however, all but wholly ignores the tsunami of research into neurobiology and neuroplasticity that explains how addiction of all diverse types operates physiologically... as well as points directly at the best possible interventions.

Reading this, and its companion volume, Assessment of Addictive Behaviors, to densify my grasp of the addiction co-morbidity so often seen in the DSM Axis II Cluster B personality disorders I deal with, I was shocked to see how far behind the curve these books are at this juncture, especially in the realm of neurobiological discoveries made largely during the 1990s.

I was initially pleased to see the penultimate article on sex offenders venture into Dialectical Behavior Therapy, but when I saw the authors' notions of behavioral targeting, I was stunned. I asked myself why. And I answered thus: This book -- and indeed much of what underpins addictions treatment -- comes from the "social welfare" school.

Most of the post-graduate "addictions specialists" I know are LCSWs rather than MFTs or LCPs. Why would we expect people educated as MSW's and Ph.D.-level "social psychologists" to know all that much about mapping of brain functions, neuropsychology or (as they called it ten years ago) "cognitive neuroscience?" It's not their fault. No one taught them, and they're not getting it in the continuing education, it appears.

It's a major problem in the mental health profession that will work itself out in time, but probably not within the next decade. So what we've got for the next decade is treatment direction that is, for the most part, largely ignorant of how the brain works and how to deal with the brain on the basis of how it works. Sigh.

Back for the moment to the chapter on sex offenders: I understand that the use of DBT is for relapse prevention (stage five of the addiction treatment process) rather than for action and commitment to abstinence (stage four). But if I don't first build a foundation of mindfulness techniques for distress tolerance and affect regulation during withdrawal in the A&C phase, I should expect pretty poor results with what the authors offered in the RP phase. And with sex offenders, that might not be a great thing for "society at large."

Neurological research suggests DBT and other mindfulness-based approaches, but not for "social skills." The adequately educated Psy.D. would use DBT / ACT / MBCT / SIQR+DD to target the actual problem: a brain that is overloaded with dopamine receptors and dendritic extensions in places where they are known to cause agitated emotions and aggressive behavior... and under-supplied with neural linkages between the pre-frontal and orbito-parietal cortices... and the limbic system.

The sex offender grew up abused, invalidated and agitated (a flat statement, but get down in the trenches with me and see for yourself). His brain is full of overly dense linkages where we don't want them and lacking in linkage density where we do want it. Most of them couldn't "soothe" themselves or be their own "good enough (inner) mothers" if their lives depended on it (see Margaret Mahler, Daniel Stern, Dan Seigel and Alan Schore on all this). So they need to acquire that "maternal instinct." We know how to use DBT (and ACT, MBCT and SIQR+DD) to do exactly that.

The list of publications on neuropsychology and neuroplasticity-based etiology and third-wave, cognitive-behavioral treatment applications to deal with that etiology had grown exponentially in the decade from 1995 to 2005. It looks like Marlatt, Donovan and their contributors missed it all somehow.

My suggestion: Read the book for its considerable edification on the (excellent) RP system, as well as for grounding in addictions theory, because there's plenty here that is helpful. But watch out for the ideas about CBT and DBT here, because they are pretty "old school."

While it does cover a range of addictions it is VERY techical and almost impossible for a layman to read. But, it does cover a lot and asses almost all addictions as well as eating disorders gambling and sexual crimes both seriously criminal and mildly criminal.