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SUMMARY Relapse is a frequently encountered problem in smoking cessation. With a cognitive-behavioral model of the relapse process, we can describe high-risk situations where smoking first recurs, the process by which people end up in these situations, and typical responses to violations of abstinence. The model posits that individuals are actively coping with situation-specific urges to smoke that result from prior conditioning. Individuals’ beliefs in their ability to cope with urges are critical. Clinical strategies based on the model include assessment of risk profiles, understanding and anticipating high-risk situations, debriefing and reinterpreting lapses in abstinence, and limiting risk through lifestyle changes. These strategies can be incorporated into brief medical office visits. Recommended procedures include systematic but brief assessment, encouragement, goal setting, planning for risk, reinterpreting lapses, recommendations for lifestyle changes, and follow-up appointments.

Treatment of alcohol problems typically focuses on the cessation of drinking. Although cessation is necessary and important to achieving sobriety, this article suggests that maintenance of sobriety is a crucial, but oft ignored, component of effective treatment. Alcohol relapse is discussed in the context of aftercare treatment employing a relapse prevention approach. Within this model, relapse is not automatically defined as a treatment failure but as an opportunity for intervention and the interruption of the relapse process. Determinants and predictors of relapse are discussed, and assessment and intervention strategies provided. A case study illustrates the components of the relapse process and the interventions employed to maintain continued sobriety. [Translations are provided; see the International Abstracts at the end of this issue.]

The study by K. Silverman, D. Svikis, E. Robles, M. L. Stitzer, and G. E. Bigelow (2001) demonstrates the effectiveness of a voucher-based reinforcement intervention in the treatment of pregnant women in treatment for substance abuse. The effects of prolonged initial abstinence as a form of "sobriety sampling" may serve to enhance long-term recovery by providing patients with rewards for maintaining abstinence. Several limitations to the study are addressed, including selection of the treatment sample and the absence of any follow-up data on drug use or relapse following completion of the 24-week treatment program. Recommendations are made to enhance maintenance of abstinence by providing coping-skill training for relapse prevention as an addition to the contingency management approach.

The persistence of drinking behavior in the alcoholic has been described in terms of modern learning theory by a number of investigators (e.g., Kepner, 1964; Kingham, 1958). Although unpleasant and noxious consequences (ranging from hangovers to general disruption in the life of the drinker) are typically associated with prolonged drinking in the alcoholic, it is assumed that the immediate reinforcement effects of alcohol consumption exert greater influence than the delayed punishment effects (Conger, 1956). A basic assumption of aversion therapy procedures in the treatment of alcoholism is that presentation of immediate punishment (emetic drugs, electric shock) in contiguity with alcohol will produce a conditioned fear response leading to the suppression of drinking or the avoidance of alcohol (Rachman & Teasdale, 1969). A question which remains to be studied, however, is the extent to which alcoholics respond to conditions of immediate punishment, compared to nonalcoholics. Any differences which might obtain from such a comparison would have important implications for the use of aversion therapy with alcoholics. In an investigation of the effects of immediate and delayed punishment in alcoholics and normal controls, Vogel-Sprott and Banks