About SRP - Introduction - Part 4

Excerpted from Structured Relapse Prevention: An Outpatient Counselling Approach.

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

Monitoring Tools

Both phases of SRP counselling make use of a number of client monitoring forms. These forms record weekly homework assignments (i.e., anticipated triggers, proposed coping responses, actual coping used and outcomes) and document weekly goal setting, daily recording of urges and temptations, level of confidence experienced, details of any lapse or relapse that occurs and specific coping exercises.

The Situational Confidence Questionnaire (SCQ-8) is administered periodically over the course of treatment to monitor the client’s growth in confidence in coping with substance-use triggers across each of eight risk areas for relapse.

These treatment monitoring tools can help focus further homework assignments on areas in which the client reports a continuing lack of confidence in dealing with specific types of substance use triggers. An attempt is made to raise the client’s confidence and self-efficacy in all areas of identified risk before he or she is discharged from treatment.

SRP and the Five Stages of Change

The five phases of SRP counselling can be matched to the five stages of change: precontemplation, contemplation, preparation, action and maintenance.

SRP Counselling Phase	Stage of Change
1. Assessment	Precontemplation
2. Motivational Interviewing	Contemplation
3. Individualized Treatment Planning	Preparation
4. Initiation of Change Counselling	Action
5. Maintenance of Change Counselling	Maintenance

Empirical Support for SRP

Results of clinical trials of SRP counselling have shown excellent treatment process and treatment outcome results, which are summarized below.

For a discussion of some of the empirical findings, as well as a more complete examination of the theoretical and conceptual issues related to relapse prevention, see “Relapse Prevention” by Herie and Watkin-Merek (2004), reproduced in Appendix B.

Treatment Process

Most homework assignments (83 per cent) are successfully completed by clients. Homework assignments that are generated by the client are more likely to be completed successfully (90 per cent) than those generated by the therapist (73 per cent).
Although homework assignments involve entry into risk situations for substance use, most clients successfully adhere to their treatment goals. Typically, any lapses occur outside of the conduct of homework assignments.
Negative mood states and interpersonal conflict increase the likelihood that a lapse will lead to a serious relapse.

Treatment Outcome

In the year following SRP treatment, most clients dramatically reduce their substance use (e.g., in one study, alcohol consumption was reduced to about one-eighth of the pretreatment levels).
Group SRP counselling can be just as effective as Individual SRP counselling.
Clients with well-differentiated Inventory of Drug-Taking Situations profiles (i.e., those who can identify a hierarchy of risk situations) do better in SRP counselling than clients with undifferentiated profiles.
Clients with good outcomes show high confidence levels and make use of coping strategies when faced with high-risk situations.
The greater the number and variety of coping strategies used by a client, the lower the likelihood of relapse.

Results from client satisfaction surveys indicate that 95 per cent of clients rate the program as effective in helping them deal with their problems.

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