In order to help a client handle high-risk situations, the counselor must first have the client identify situations in which they have the desire to engage in the addictive behavior. The counselor can do so by interviewing the client about past relapses or having the client keep a log of when they feel inclined to engage in the behavior. The counselor should also assess the client's motivation and current ability to cope.


The counselor can then teach the client coping skills for both specific situations (for example, assertive communication skills) and more general strategies (for example, positive self-talk and meditation). 

Strategies for Identifying and Coping with High-Risk Situations in the Relapse Prevention Model

Ultimately, it is the individual's response to the high risk situation that affects whether or not they will relapse. For example, a person who uses effective coping skills, such as leaving the situation or positive self talk, is less likely to relapse than someone who does not use effective coping skills. A person who has coped successfully with a high-risk situation will experience a greater sense of self-efficacy, thereby decreasing their chance of relapse in the future.

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The four immediate determinants of relapse are:

- High risk situations
- Coping skills
- Outcome expectancy
- Abstinence Violation Effect

Immediate Determinants of Relapse

When helping individuals overcome an addiction, it is important for the counselor to help the client develop a greater sense of self-efficacy, so they believe they can move past the addiction and resist the temptation to relapse.

Self-Efficacy in Addictions Counseling

Although an individual will start to experience greater self-efficacy as they abstain from using a substance, certain high-risk situations will pose a threat to the person's sense of control, which may lead them to relapse. Some characteristics of high-risk situations are:

- Negative emotional states
- Interpersonal conflict, which can lead to negative emotions
- Social pressure, both direct and indirect (for example, being around other people who are consuming alcohol)
- Positive emotional states
- Exposure to alcohol-related stimuli (for example, seeing an ad for alcohol)
- Attempts to test one's personal control/willpower

High Risk Situations and Relapse

The act of purposely inflicting pain and damage to one’s body. Methods include cutting, burning, scratching, and other means of self-injury. Self-harm can also be emotional or internal, which may involve acts like deliberately triggering oneself or consuming toxic substances.

Self-Harm

Coping refers to the conscious, deliberate, and purposeful regulation of emotions, especially in situations perceived as threatening or stressful.

Coping

Larimer, M.E., Palmer, R.S., & Marlatt, G.A. (1999). Relapse prevention: An overview of Marlatt's cognitive behavioral model. Alcohol Research & Health, 23(2), 151-160. 

Relapse Prevention:  An Overview of Marlatt's Cognitive Behavioral Model

Coping Skills and Relapse

A person's likelihood of relapsing will change depending on their expected outcome of engaging in the addictive behavior. A person who only focuses on the positive effects of a behavior and discounts the negative effects is more likely to relapse, especially in high risk situations where the behavior may be perceived to help the individual cope with negative emotions. 

Outcome Expectancies and Relapse

The abstinence violation effect states that it is a person's emotional response to a single lapse in substance use which will determine whether or not they ultimately relapse. For example, someone who considers the lapse to be a personal failure is more likely to continue to engage in the addictive behavior to attempt to escape the feeling of failure, thereby leading to a full relapse. On the other hand, someone who considers the lapse to be an instance where they did not cope effectively is more likely to see the lapse as a single mistake they can learn from. 

Abstinence Violation Effect

- Conditions that cause fluctuations in emotion, like depression and anxiety, can lead sufferers to search for release. 
- Those who self-harm have reported that while they do not want to do it, it is accessible and provides some measure of relief. 
- Shame, low self-esteem, and other sources of emotional pain can lead to the desire to inflict personal harm.
- Some may use self-harm to communicate the severity of their pain and express a need for help

Reasons and Causes for Self-Harm

- Younger adults
- Women
- Black, Asian, Minority Ethnic groups (BAME groups)
- People experiencing economic hardship
- People with disabilities, chronic physical illnesses and mental disorders

Higher risk groups for self-harm and suicidal ideation 

Contrary to popular belief, self-harm does not always indicate active suicidality. Instead, many who engage in self-harm cite it as a coping mechanism that helps them continue to live despite deep emotional pain and adversity. While some injuries could be lethal, those who self-harm often mitigate their own risk by planning their injuries, sterilizing the instruments they use, and practicing after-care. 

Non-Suicidal Self-Harm

- Accommodation
- Support-seeking
- Social Isolation
- Self-reliance
- Problem-solving
- Helplessness
- Escape
- Opposition
- Submission

Categorization of Loneliness Coping Strategies Among University Students

- Meaning-making coping model
- Emotion-focused coping
- Problem-focused coping 
- Transactional model of stress and coping 
- Dual process model of loss 


Coping Models/Strategies

- Preventive Coping: coping with events far in the future such as age related milestones or expected functional losses
- Proactive Coping: coping that focuses on reducing the impact of events likely to occur - they are temporally removed from the stressor
- Anticipatory Coping: problem solving based methods that happen farther along the chain of coping when an event is imminent 
- Post - Impact Coping: can either be short term or long term; problem focused coping to resolve immediate impacts and cognitive coping to equip an individual for residual effects 

Temporal Aspects of Coping 

Coping flexibility is an individual's ability to cope in different ways, and change their method of coping (E.g. Reframing), towards various stimuli.

Coping Flexibility 

Maladaptive coping includes attack self, attack other, withdrawal, and avoidance. Adaptive coping focuses on restoring relationships. 

Coping with Shame

- Having a negative, past-oriented approach to coping can cause a person to be stuck 
- A positive, future-oriented approach gives an individual hope and shows them there are opportunities in the future that will improve their quality of life
- This positive approach has been linked to increased psychosocial outcomes in psychological and social QOL, perceived well-being, life satisfaction, and negatively linked to depression and anxiety

Coping and Adversity

Researchers have agreed that there are unhealthy and healthy ways of managing stress.

Ways of Coping with Stress

- Seeking Connection
- Avoidance
- Support-seeking
- Cognitive Strategies
- Meaning-focused
- Distraction

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