Pre-lapse state
High-risk situation. A high-risk situation is any situation that may motivate the individual
to carry out the behaviour. Such situations may be either external cues, such as someone
else smoking or the availability of alcohol, or internal cues, such as anxiety. Research
indicates that the most commonly reported high-risk situations are negative emotions,
interpersonal conflict and social pressure. This is in line with social learning theories,
which predict that internal cues are more problematic than external cues.
Coping behaviour. Once exposed to a high-risk situation the individual engages the
coping strategies. Such strategies may be behavioural, such as avoiding the situation or
using a substitute behaviour (e.g. eating), or cognitive, such as remembering why they
are attempting to abstain.
Positive outcome expectancies. According to previous experience the individual will
either have positive outcome expectancies if the behaviour is carried out (e.g. smoking
will make me feel less anxious) or negative outcome expectancies (e.g. getting drunk will
make me feel sick).No lapse or lapse?
Marlatt and Gordon (1985) argue that when exposed to a high-risk situation, if an
individual can engage good coping mechanisms and also develop negative outcome
expectancies, the chances of a lapse will be reduced and the individual’s self-efficacy
will be increased. However, if the individual engages poor coping strategies and has
positive outcome expectancies, the chances of a lapse will be high and the individual’s
self-efficacy will be reduced. No lapse: good coping strategies and negative outcome expectancies will raise self-
efficacy, causing the period of abstinence to be maintained.
Lapse: poor or no coping strategies and positive outcome expectancies will lower
self-efficacy, causing an initial use of the substance (the cigarette, a drink). This lapse
will either remain an isolated event and the individual will return to abstinence,Fig. 5-6 The relapse process (after Marlatt and Gordon 1985)126 HEALTH PSYCHOLOGY