About SRP - Introduction - Part 3

Excerpted from Structured Relapse Prevention: An Outpatient Counselling Approach.

Introduction Part 1 / Part 2 / Part 3 / Part 4
PDF version (complete Introduction)

How Does SRP Work?

SRP is a flexible program, designed to accommodate clients’ different needs and treatment goals.

SRP counselling focuses on engaging the client to:

assess his or her goals and commitment to change
design an individually tailored treatment plan
identify his or her strengths and resources
learn to anticipate triggers to alcohol or other drug use, and develop alternative ways of coping
develop confidence by practising coping skills in real-life risk situations
make connections between alcohol and other drug use and other life situations
ultimately, take over the therapist’s role by anticipating risk situations and pre-planning coping strategies.

What Does SRP Include?

A complete program involving SRP typically includes:

full clinical assessment with personalized feedback
one or more Motivational Interviewing appointments prior to SRP counselling
engaging the client in developing an individually tailored treatment plan consisting of:
- a treatment contract
- a personal hierarchy of triggers to alcohol or other drug use, to be worked on in treatment through homework assignments
- client goal setting and self-monitoring.
eight to 12 counselling sessions (individual or group)
Initiation of Change homework assignments
Maintenance of Change homework assignments.

Program Overview

There are five major components of SRP counselling:

Assessment
Motivational interviewing
Individualized treatment planning
Initiation of change counselling
Maintenance of change counselling.

A summary of each of these components, and, in the case of the last two, a description of the tools used, is given below.

Assessment

Counselling begins with a full clinical assessment, with a focus on the following areas of the client’s situation:

psychosocial functioning
history of alcohol and other drug use, and of related problems and consequences
reasons for and commitment to change
coping strengths and weaknesses.

This assessment is complemented by a detailed exploration of the client’s most problematic triggers to alcohol or other drug use over the year prior to entering treatment. (Triggers may involve internal mood states as well as environmental and social situations that affect clients.) The Inventory of Drug-Taking Situations (IDTS-8) assessment tool (provided in this manual) should be included as part of the Assessment phase.

Motivational Interviewing

Personalized feedback of the assessment results takes place within the context of the Motivational Interviewing phase, which helps the client reach, and then begin to act on, a decision to change his or her alcohol or other drug use. Motivational Interviewing focuses on exploring the client’s expressed reasons for changing his or her alcohol or other drug use, on the perceived pros and cons associated with such a change, and on the strength of his or her commitment to change, supplemented by a discussion of the client’s triggers for use and his or her coping strengths.

The client must reach an explicit decision to try to work toward changing his or her substance use before proceeding to SRP counselling.

Individualized Treatment Planning

Following the Assessment and Motivational Interviewing components, each client is engaged in developing an individually tailored treatment plan. The steps include:

an orientation to SRP counselling, with the client agreeing to sign a treatment contract
a review by the client of specific recent triggers to alcohol or drug use, with the client deciding on a personal hierarchy of risk areas to be worked on in treatment through a series of homework assignments
goal setting by the client and self-monitoring of triggers.

Initiation of Change

The actual SRP counselling consists of two phases―Initiation and Maintenance―which comprise the final two components of the approach. The Initiation phase focuses on counselling strategies known to be powerful in initiating a change in behaviour, while the Maintenance phase concentrates on strategies with greater potential for the long-term maintenance of this change (i.e., relapse prevention).

Powerful initiation aids include avoidance of risk situations for alcohol or other drug use; coercion (e.g., a legal mandate); hospitalization or residential treatment; protective medications (e.g., Antabuse); the involvement of a partner or other responsible person; and a relatively directive role by the therapist.

Four counselling sessions are typically involved in the initiation phase of SRP counselling. If both group and individual sessions are available, clients should be encouraged to choose their preferred treatment situation.

Maintenance of Change

In the Maintenance, or relapse prevention, phase, performance aids used in the Initiation phase are gradually withdrawn as the focus shifts to the client’s own coping strategies. The strategies are designed to help the client develop confidence and self-efficacy in being able to confront and successfully cope with triggers to alcohol or other drug use. Planned homework assignments, involving gradual exposure to increasingly more difficult drug use triggers, encourage clients to anticipate their identified high-risk situations and to practise new coping strategies between counselling appointments. Four to eight counselling sessions are typically involved in this phase.

Return to the index of excerpts from Structured Relapse Prevention: An Outpatient Counselling Approach.