New approaches to using relapse prevention therapy in the criminal justice system.
G. Alan Marlatt's cognitive-behavioral model of relapse prevention (RP), as described in his 1985 book co-edited with Judith R. Gordon, was originally developed as a theory of alcohol relapse and a related set of intervention strategies designed to help clients who had completed treatment maintain abstinence by anticipating and coping with the problem of relapse. Soon after, the principles and practices of relapse prevention therapy (RPT) were applied to tobacco use, illicit drugs and addictive behaviors not related to substance abuse such as problem gambling, overeating and compulsive sexual behavior. A narrative review by Kathleen Carroll and a meta-analysis by Jennifer E. Irvin and her colleagues concluded that RPT is an empirically supported treatment that is effective in the prevention and treatment of substance use disorders. The National Institute of Drug Abuse also classifies RPT as an evidence-based practice.
The increasing implementation of correctional programs based on RPT suggests that corrections professionals would benefit from a greater understanding of relapse and how relapse and criminal recidivism are related. While it was Marlatt and Gordon's 1985 book that stimulated correctional program development in the past 20 years, a 2005 revision and update of RPT by Marlatt and Donovan provides a contemporary review.
RPT in Corrections
RPT for substance-abusing offenders. Most corrections professionals are aware of the growing research evidence that rehabilitation programs based on cognitive-behavior therapy (CBT) are among the most effective treatments to reduce recidivism. So, it is not surprising that the flood of drug-involved offenders into correctional systems in the 1980s and the influence of the "what works" movement emphasizing evidence-based correctional practice led to the implementation of correctional programs based on RPT.
During the 1990s, both the U.S. Federal Bureau of Prisons (BOP) and the Correctional Service of Canada (CSC) developed, implemented and tested prison-based programs based on the RP model--the Residential Substance Abuse Treatment program in the U.S. and the Offender Substance Abuse Pre-Release Program in Canada. These programs utilized RPT as their treatment platform and as their source for specific cognitive-behavioral relapse prevention interventions. Evaluation research on the effectiveness of these offender substance abuse programs reviewed by Parks and Marlatt has demonstrated decreases in substance abuse relapse and criminal recidivism. The strongest treatment effects for RPT with substance abusing offenders occur when the in-prison substance abuse program is followed by continuing care in the community.
RPT with sex offenders. In the past 30 years, RPT has also become the dominant psychosocial treatment modality used in sex offender treatment programs, providing both the theoretical framework and specific strategies to reduce sex offense. In 1989, D. Richard Laws helped to launch the field of modern sex offender treatment with the publication of his book Relapse Prevention with Sex Offenders. In 2000, Laws and his colleagues provided a review of the applications of RPT to sex offenders and offered suggestions for remaking RPT to be more effective with this population. A recent review by Steve Aos and colleagues from the Washington State Institute for Public Policy concluded that sex offender treatment based on RPT has a moderate, but reliable, impact in reducing sex offender recidivism.
Meta-analysis of RPT in correctional programming. In 2003, Craig Dowden and his colleagues conducted a meta-analysis that provided an estimate of the overall impact of correctional programming based on RPT in reducing recidivism. They concluded that rehabilitation programs incorporating RPT consistently showed a moderate reduction in recidivism with larger recidivism reductions occurring when: there was a greater number of RPT core components; there was a more detailed description of the program; and the program targeted criminogenic needs. These three mediators of RPT program effectiveness demonstrate the importance of a cognitive-behavioral approach, focusing on program targets related to recidivism and a multimodal strategy using RPT core components in sufficient number and dosage to effect behavior change.
Dowden and his colleagues also identified several core components of RPT that reduced recidivism. The three most potent ingredients of RPT in offender programming are: 1) training significant others, including family and friends as well as spouses or girlfriends/boyfriends, in RP; 2) relapse rehearsal; and 3) conducting an offense chain analysis. Additional research is needed to identify more of RPT's significant components and the best way to combine these elements for greater impact in correctional programming.
Preventing Criminal Conduct
Traditional applications of RPT have been limited to rehabilitation programming for offenders who are already incarcerated or on probation and is primarily focused either on substance abuse or sex offending. In this section of the article, our attention will turn to contemporary approaches using RPT in corrections that apply the RP model in new and creative ways.
Relapse prevention planning for criminal law practice. Recently, David Wexler has suggested that RPT could provide a model to promote crime reduction within the therapeutic jurisprudence framework by familiarizing criminal defense lawyers, prosecutors and judges with the RP model for their use during the adjudication process. Wexler argues that RPT can assist these officers of the court to collaboratively create recidivism prevention plans designed to help a defendant avoid, or cope with, high-risk scenarios for crime when living in the community on probation or after a period of incarceration. Wexler recommends that recidivism prevention plans developed within the RP model include victim input as well as the input and cooperation of the defendant and his or her family, friends, neighbors and other community members to create conditions to prevent recidivism that would then be ordered by the court and supervised by probation officers. Finally, Wexler observes that by engaging the offender and others in a thorough process of examining both the distal and proximal precursors of criminal conduct, both self-change and effective monitoring by others can be accomplished under the supervision of and with the support of the court.
Relapse prevention in offender reentry. In his recent paper on offender reentry, Jeremy Travis observes that the criminal justice system currently lacks an effective means to manage the reintegration of released offenders into the community and that traditional approaches to parole based solely on surveillance and sanctions have not reduced recidivism. Travis suggests that an innovative solution to this dilemma can be found in the RP model because a greater understanding of alcohol and drug relapse has the potential to stimulate the development of new strategies for offender risk management similar to the use of RPT for addictive behavior problems.
Travis suggests that reentry planning based on the RP model provides an alternative to the typical emphasis on "zero tolerance" in the criminal justice system by recognizing re-offense as an ongoing threat that requires proactive management by the offender, the community and the criminal justice system. Rather than automatically punishing an offender for re-offense or remanding him or her to custody, the RP model suggests that the occasion of criminal recidivism is an opportunity to debrief the incident, understand its predictable and controllable causes, and help the offender work harder and smarter at re-offense prevention with the support of the community and the court.
James McGuire echoes the sentiments expressed previously by Wexler and goes on to say "that the process of learning to avoid relapse ... becomes a priority at the point of transition from institutions to the community ..." At this point, there is a focus on parole decisions and formulating a release plan. He argues that offenders reentering the community must "acknowledge the existence of various problems, develop some understanding of how these are inter-connected with each other and ... acquire new coping skills that will enable them to avoid re-offense."
McGuire further emphasizes that offender motivation to be aware of and prepare to cope with recidivism risk factors will be enhanced if the court and correctional officers use positive reinforcement to reward successful offender self-management. McGuire states that one implication of therapeutic jurisprudence is that research on offender rehabilitation, the therapeutic alliance, motivational enhancement and relapse prevention should not "remain confined to the domain of social science when they have the capacity to illuminate offending behavior and inform legal responses to it." He states further, "By capitalizing on what we now know about offender treatment and personal change, such a development could maximize the therapeutic benefit of legal decisions."
RPT delivered by probation and parole officers. John A. Cunningham and his colleagues describe another innovative application of RPT based on a related cognitive-behavioral model of relapse called structured relapse prevention (SRP), developed by Helen Annis in her seminal studies of relapse conducted at the Addiction Research Foundation in Toronto. SRP is an outpatient program that combines motivational enhancement strategies and cognitive-behavioral interventions. A field test of SRP delivered by probation and parole officers was conducted in Ontario, Canada to assess the feasibility and effectiveness of this approach. Ten probation and parole officers were trained to deliver SRP and provided the SRP program to 55 offenders during a one-year period. The SRP protocol was modified for use in probation, and correctional officers were readily able to learn and apply the model in the supervision of their offenders.
Probation officers delivering the program commented on the common-sense appeal of the SRP model and found it easy to use. They also said it was sometimes a welcome alternative for offenders who were resistant to attending substance abuse treatment. While it was difficult for the probation officers to integrate delivering SRP into their other duties, overall they reported they would recommend the implementation of SRP. The authors note, "On the basis of the field test results, the Ontario Ministry of the Solicitor General and Correctional Services recommended dissemination of SRP to Probation and Parole Officers throughout the province."
An RP model for community supervision. For many years Canadian criminologist Edward Zamble has been asking, "How do we make community supervision more effective?" As a result of his research on the coping deficiencies of offenders and the recidivism process, Zamble came to the conclusion that the greatest limitation in current supervision practices is that "they lack a coherent theoretical justification or rationale." He also speculated that a theoretical account of the recidivism process based on the RP model could provide corrections professionals with guidelines for offender monitoring and more effective supervision strategies in order to "identify the proximal antecedents to criminal recidivism generally ... [and to] tell a supervising officer what the signs are that a given offender is about to commit a new offense."
Zamble discovered the major difference between recidivists and nonrecidivists was not the amount of stress or problems they were exposed to or the severity of their past crimes but rather the way they interpreted and responded to external events and their internal states. He further suggested that recidivism was typically preceded by an observable pattern of precursors and seemed to vary predictably depending on offender characteristics and the type of crime committed. Zamble observed that much like alcohol and drug relapse, criminal recidivism is the result of a breakdown process, and the causes of recidivism are distinct from those that may have caused the original crimes to occur. Labeling this theory the coping-relapse model of criminal recidivism, Zamble and his colleagues describe recidivism as beginning with a learned propensity to commit crimes evoked by stressful life events whose impact is worsened by inadequate coping skills. This leads to compensatory responses such as substance abuse, antisocial thinking, seeking anti-social associates and, finally, committing crimes consistent with the person's past repertoire of criminal behaviors.
Noting the critical point for effective supervision, Zamble says, "These emotions and thoughts are identifiable, distinctive, and characteristic of offenders in similar circumstances. [Further that] the model hypothesizes that the psychological precursors of recidivism would be visible to an objective observer ... That outside observer could be the parole officer, acting in a redefined role ... [to] monitor the verified antecedents of recidivism." Finally, Zamble says that if the antecedents or precursors of recidivism could be identified in a given case then perhaps the offender, the parole officer and the offender's significant others could create a checklist of warning signs leading to recidivism and intervene in appropriate ways to prevent the occurrence of a new offense when any of the warning signs begin to appear.
RPT as a case management tool. The author and his colleagues have been attempting to create an RPT case management tool to move from the more general statement of the coping-relapse model of recidivism proposed by Zamble to the specific application of RPT in community supervision. In order to use RPT as a case management tool for a given offender, the corrections professional must first complete a detailed assessment used to create a criminal behavior profile that contains three elements: crime cycles consisting of all known offense scenarios; offense scenarios describing all crimes or crime types committed in the past; and offense chain pathways that lead step-by-step to the offense scenarios. The criminal behavior profile forms the basis for a recidivism prevention plan created in collaboration with the offender to be used by the offender, his or her significant others, and the correctional officer to monitor recidivism risk and intervene accordingly.
Crime cycles consist of the repertoire of offenses that have occurred repeatedly in an offender's criminal history. Each of these crime cycles occurs under a specific and predictable set of conditions called offense scenarios. Offense scenarios include the "who, what, how, with whom, to whom, when, where and why" of each crime cycle. In order to create offense scenarios, specific information is required for each offense or a sufficient number of similar offenses. This specific information is gathered both through a file review of criminal records and an interview with the offender. Part of the offender interview is also used to identify the last component of the profile, the offense chain pathways that lead the offender step-by-step toward new acts of criminal behavior, which are likely to occur during exposure to an offense scenario where committing a crime is difficult to avoid.
The key to using RPT for recidivism prevention is to know an offender's crime cycles and their associated offense scenarios and offense chain pathways by conducting a thorough functional analysis of the distal and proximal precursors to offense. Intervening early in the process, before exposure to the offense scenario, can prevent a crime from occurring. However, it is not possible for an offender to avoid all offense scenarios, so offenders must also learn how to escape these offense scenarios or cope with them without committing a crime.
In an RPT-driven case management process, corrections professionals, the offender, and his or her significant others will use this functional analysis of criminal conduct consisting of crime cycles, offense scenarios and cognitive-behavioral offense chain pathways to prevent recidivism (i.e., as a checklist of warning signs). As a corrections professional gets a better picture of the circumstances that trigger recidivism by understanding the chain of events leading to offense scenarios, he or she can prevent crimes by using "coaching strategies" that improve an offender's coping skills such as teaching offenders how to better identify high-risk offense scenarios and to develop strategies to avoid them or escape them without committing a crime. A corrections professional can also use "catching strategies" that intervene to prevent crimes through surveillance and incapacitation such as increased monitoring, more frequent office contacts, and field visits at the offender's home or work.
Expanding the Use of RPT
While these new applications of the RP model offer corrections evidence-based interventions designed to reduce recidivism, much work remains to be done in refining and applying RPT beyond its traditional role in offender programming. Hopefully, correctional innovations based on RPT will continue to be developed, disseminated and tested to further the goals of crime reduction and successful integration of offenders into the community. The most important contributions of the RP model to the criminal justice system may be found in its implications for a philosophy of human nature that optimistically states that people can and do change and that crimes may be viewed as behaviors enacted by people, not traits forever defining them.
Aos, S., M. Miller and E. Drake. 2006. Evidence-based adult corrections programs: What works and what does not. Olympia, Wash.: Washington State Institute for Public Policy.
Carroll, K. M. 1996. Relapse prevention as a psychosocial treatment: A review of controlled clinical trials. Experimental and Clinical Psychopharmacology, 4(1):46-54.
Cunningham, J.A., M. Herie, G. Martin and B.J. Turner. 1998. Training probation and parole officers to provide substance abuse treatment: A field test. Journal of Offender Rehabilitation, 27(1/2): 167-177.
Dowden, C., D. Antonowicz and D.A. Andrews. 2003. The effectiveness of relapse prevention with offenders: A meta-analysis. International Journal of Offender Therapy and Comparative Criminology, 47(5):516-528.
Irvin, J. E., C. A. Bowers, M. E. Dunn and M. C. Wang. 1999. Efficacy of relapse prevention: A meta-analytic review. Journal of Consulting and Clinical Psychology, 67(4):563-570.
Laws, D. R., ed. 1989. Relapse prevention with sex offenders. New York: Guilford Press.
Laws, D.R., S.M. Hudson and T. Ward, eds. 2000. Remaking relapse prevention with sex offenders: A sourcebook. Newbury Park, Calif.: SAGE Publications.
McGuire, J. 2003. Maintaining change: Converging legal and psychological initiatives in a therapeutic jurisprudence framework. Western Criminology Review, 4(2):108-123.
Marlatt, G. A. and J. R. Gordon, eds. 1985. Relapse prevention: Maintenance strategies in the treatment of addictive behaviors. New York: Guilford Press.
Marlatt, G. A. and D. M. Donovan, eds. 2005. Relapse prevention: Maintenance strategies in the treatment of addictive behaviors, second edition. New York: Guilford Press.
Parks, G. A. and G. A. Marlatt. 1999. Keeping "what works" working: Cognitive-behavioral relapse prevention therapy with substance abusing offenders. In Strategic solutions: The international community corrections association examines substance abuse, ed. E. J. Latessa, 161-233. Lanham, Md.: American Correctional Association.
Travis, J. 2000. But they all come back: Rethinking prisoner reentry. Sentencing and Corrections Issues for the 21st Century, papers from the executive sessions on sentencing and corrections, No. 7. Washington, D.C.: U.S. Department of Justice, National Institute of Justice. (May).
Wexler, D. B. 1999. Relapse prevention planning principles for criminal law practice. Psychology, Public Policy, and Law, 5(4): 1028-1033.
Zamble. E. 1998. Community supervision: Current practices and future directions. Paper presented at the Correctional Service of Canada's Beyond Prisons Symposium, 16-18 March in Kingston, Ontario.
George A. Parks, Ph.D., is associate director of the Addictive Behaviors Research Center, Department of Psychology, University of Washington.
Table 1. RPT Core Components Used In Correctional Programs ** Train significant others in relapse prevention* ** Relapse rehearsal* ** Offense chain analysis* ** Identifying high-risk situations ** Coping skills training ** Booster sessions/aftercare ** Dealing with failure situations * Designates strongest effect on criminal recidivism