Overview of Structured Relapse Prevention (© 2009 CAMH)
A key development in the second edition of the SRP manual, Structured Relapse Prevention: An Outpatient Counselling Approach, is the adaptation of SRP for people with concurrent substance use and mental health problems (concurrent disorders, or CDs).
Over the past decade, there has been an increasing appreciation of the needs of people with concurrent substance use and mental health issues. A variety of studies seeking to establish the prevalence rate of concurrent disorders have shown that roughly half of people with either a mental health or substance use disorder had concurrent disorders at some point in their life (Health Canada, 2002; Kessler et al., 1996; Regier et al., 1990).
In an Ontario study of clients seeking treatment for substance use problems, 68 per cent had a concurrent mental health disorder (Ross et al., 1995). (As one would expect, the study indicates that the prevalence rates are higher in agency and hospital populations than in the general population. However, the rates in clinical populations vary considerably, depending on the setting and the method of diagnosis.)
The adaptations recommended for running an SRP program for clients with concurrent disorders include:
- shortening group duration (90 minutes, instead of two hours in the “substance-use only” SRP group)
- using fewer clinical tools per treatment session (even one or two paper-and-pencil tools may be overwhelming for some clients with concurrent disorders)
- modifying clinical tools to incorporate CD-specific treatment goals (such as taking prescribed medications or coping with the symptoms of mental disorders and/or the side-effects of prescribed medications [PDF only])
- spending more time in the group processing discussion on access to services and navigating the mental health and substance use treatment systems
- making the clinical tools easier to complete
- including a follow-up SRP group three to four months after the last weekly session to review ongoing or emergent treatment needs, to help clients progress toward their goals and to identify next steps.
The complete concurrent disorders adaptation of the SRP approach is available in Structured Relapse Prevention: An Outpatient Counselling Approach (2nd edition). If you wish, you can order this full SRP manual, which includes a CD-ROM from which all the client tools and exercises can be accessed and printed.
- Motivational interviewing
- Individualized treatment planning
- Initiation of change
- Maintenance of change
Self-monitoring tools and coping skills exercises
Structured Relapse Prevention for clients with concurrent disorders
Adapting SRP to diverse clinical settings and client needs