ADC 515 Module 7 Implicit Processes in Relapse Example

One Night at the Hospital: Implicit Processes, Stress and a Lapse That Did Not Become a Relapse

Student Name

Psychology and Addiction Studies Program, Aspen University

ADC 515: Psychology of Addiction

Instructor Name

Month Day, Year

One Night at the Hospital: Implicit Processes, Stress and a Lapse That Did Not Become a Relapse

Four months after leaving the residential program near Grand Rapids, Denise received a call that her sister had collapsed and needed emergency surgery. She drove to the hospital, waited for three hours and, while her sister was in surgery, walked to a gas station across the street, bought a bottle of wine and drank three glasses in her car. Then she called her sponsor. Denise, her sister and the program are fictional; the studies cited are not. This paper analyzes the lapse.

Lapse and Relapse

A lapse is a single episode of use after a period of abstinence; a relapse is a return to the previous pattern of use. The distinction matters because most people who achieve abstinence experience lapses, and what happens after the lapse often decides whether it remains one night or becomes a return to daily drinking.

A Dynamic Model

Witkiewitz and Marlatt (2004) described relapse as the outcome of interacting tonic and phasic factors, in a system where small changes can produce sudden shifts. A person with substantial tonic risk, such as years of heavy drinking, may hold steady for months until a phasic change, such as acute stress, tips the system. The model retains an idea from earlier relapse prevention work: the abstinence violation effect, in which a person who lapses interprets it as proof of personal failure and loss of control, feels guilt and hopelessness and continues using because "I've already blown it." Counteracting this effect, by treating a lapse as a mistake to learn from, is a central aim of relapse prevention.

Stress

Sinha (2008) reviewed research on how stress affects addiction. Chronic stress increases vulnerability to drug use, and acute stress increases craving in people with addictions. Stress also impairs functions of the prefrontal cortex that support control, while strengthening habitual and reward-driven responses. In laboratory studies, stress-induced craving predicted later relapse. The review suggests that stressful events are dangerous for two reasons at once: they raise the pull of the substance and weaken the capacity to resist it.

Implicit Associations and Loss of Control

Ostafin et al. (2008) asked whether implicit associations predict not just how much people drink but whether they lose control over their drinking. They measured implicit associations between alcohol and approach using a version of the Implicit Association Test in young adult drinkers, along with explicit measures. Stronger implicit approach associations predicted reports of drinking more than intended and difficulty stopping, even after accounting for explicit measures. The findings fit the dual-process idea that automatic associations matter most when control is compromised.

The Lapse, Moment by Moment

What Prevented a Relapse

After the third glass, Denise said, she heard her counselor's voice: "If you drink, call; don't decide what it means alone." Her plan, made before discharge, had anticipated a lapse and specified a response. Her sponsor met her at the hospital, poured out the rest of the bottle and stayed with her through the surgery. The next morning, Denise went to a meeting and called her outpatient counselor. In Witkiewitz and Marlatt's terms, she avoided the abstinence violation effect: rather than concluding that she had failed completely, she treated the lapse as a dangerous night that she had survived and learned from.

Why the Hospital Was So Dangerous

Hospitals combine nearly every condition the course has identified as tipping the balance toward impulse. Waiting is long and uncertain, food and sleep are disrupted, emotions run high and people are often alone among strangers. Denise's previous high-risk situations were familiar ones, such as her evening drive home, for which she had rehearsed responses. The hospital was unfamiliar, and she had no prepared response for it. Unfamiliar crises are where plans most often run out.

The Role of Her Sponsor

Her sponsor's response mattered as much as Denise's call. Instead of expressing disappointment, the sponsor came, helped remove the alcohol and stayed. That response helped Denise interpret the lapse as a setback rather than a verdict, protecting her against the abstinence violation effect. Support people who understand lapses can be part of relapse prevention, and preparing them in advance is worth considering.

Automatic and Deliberate Elements

The table's last column shows the lapse moving between automatic and deliberate processes. The early steps, attention captured by the sign and feet carrying her across the street, happened with little thought. The decision to buy the wine involved some deliberation, but under heavy stress. The call to her sponsor was fully deliberate and drew on a plan rehearsed in treatment. Relapse prevention aims to insert deliberate steps earlier in the sequence, before automatic processes have carried a person to the point of use.

Lessons for the Plan

The lapse showed gaps the plan had not addressed. It had covered her evenings and her route home but not emergencies in unfamiliar places. Revised, the plan now includes calling her sponsor at the start of any crisis, not after drinking, keeping snacks and a phone charger in her car and, at hospitals or similar places, asking someone to wait with her. Sinha's research suggests that stress management, including brief practices she can use while waiting, deserves more attention. Her counselor also suggested she tell her sponsor in advance about any medical appointments for family members, so that support is arranged before a crisis rather than after a drink.

Conclusion

Denise's lapse combined acute stress, depleted control, a familiar cue and an approach tendency that acted before decision, consistent with Sinha's account of stress and Ostafin and colleagues' findings on implicit associations. Her preparation to respond to a lapse, central to Witkiewitz and Marlatt's model, kept one night from becoming a relapse. The lapse became information that strengthened her plan.

References

Ostafin, B. D., Marlatt, G. A., & Greenwald, A. G. (2008). Drinking without thinking: An implicit measure of alcohol motivation predicts failure to control alcohol use. Behaviour Research and Therapy, 46(11), 1210-1219. https://doi.org/10.1016/j.brat.2008.08.003

Sinha, R. (2008). Chronic stress, drug use, and vulnerability to addiction. Annals of the New York Academy of Sciences, 1141, 105-130. https://doi.org/10.1196/annals.1441.030

Witkiewitz, K., & Marlatt, G. A. (2004). Relapse prevention for alcohol and drug problems: That was Zen, this is Tao. American Psychologist, 59(4), 224-235. https://doi.org/10.1037/0003-066X.59.4.224