5.2.2 The 5 Most Common Causes of Relapse

Address cognitive distortions using motivational interviewing and CBT integration

The 'just this once' rationalization typically emerges during high-stress periods when executive function is depleted.¹² Integrated MI-CBT approaches address this by pre-building counter-responses during low-stress sessions and rehearsing them through imaginal exposure. The clinician's role is to help the patient separate legitimate emotional suffering from the addiction's opportunistic use of that suffering as justification. This distinction - 'your pain is real, but nicotine is not the answer to it' - is the therapeutic crux.