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Relapse Prevention

Even after people have completed their rehabilitation treatment and returned to regular daily life, addiction is still like any other chronic disease. It requires lifelong management and monitoring. Failure to take this aspect of recovery seriously can result in a relapse that could potentially become a return to drug or alcohol dependency. 

On the other hand, it is important to keep in mind that sometimes relapse does happen. More than sometimes, really, with statistics showing that about 40 to 60 percent of people in recovery from substance abuse disorders will relapse at some point.

A relapse can even occur sometimes as long as months or years into recovery. This can be particularly dangerous for someone who has maintained a lengthy sobriety and lost their tolerance for the substance they previously had been abusing. This means that if they relapse and take the same amount they were accustomed to before, they could easily overdose, potentially fatally. 

However, you can significantly decrease the risks of relapsing if you make creating an effective, realistic relapse prevention plan an essential part of your recovery. 

Understanding Relapse: What Are the 3 Stages?

Relapse prevention is a cognitive-behavioral approach to being able to both identify and prevent situations that make someone vulnerable to relapse. A relapse prevention plan aims to address the problem with techniques and tools to help deal with both the internal and external stressors that can put someone in a high-risk relapse situation. Gaining an understanding of how relapse works and the psychology behind it is critical in being able to prevent it.

Recent relapse prevention studies have concluded that a relapse is not a single event of lapsing back into drug use. Instead, it is a process that can be broken down into three major stages:

Emotional

This is the first stage of relapse. It can occur before someone is even thinking about using again. It is characterized by strong feelings of depression, irritability, and anxiety as well as erratic sleeping and eating habits. These signs are also several of the same symptoms of post-acute-withdrawal syndrome. If these signs can be recognized and dealt with before the next phase, a potential relapse can be stopped dead in its tracks.

Mental

This stage is best described as an internal sort of tug-of-war struggle between the urge to go back to using and the desire to remain sober. A person at this point in the relapse process is especially vulnerable because once they make the decision, they’re going to use again, very little can be done to stop it.

Physical

The physical relapse stage is the part of the process that people typically think of when they hear the word “relapse.” If a mental relapse cannot be stopped, this final stage will quickly follow, and the individual will break their sobriety. All it takes is one use for intense cravings to make a speedy comeback, increasing the odds that they will transition back to consistent substance abuse. The best thing that can be done once a physical relapse has occurred is to get the person back into treatment immediately.

Each of these stages has its warning signs that can alert either the person experiencing them or a friend or family member that something is wrong.

Emotional:

  • Isolating yourself from support systems (friends, family, support meetings)
  • Erratic sleeping and eating
  • Repressing or bottling up emotions
  • Failing to engage in mental and physical self-care
  • No longer following personal recovery rules

Mental:

  • Lying to your support systems
  • Romanticizing/minimizing the impact of your past drug use
  • Attempting to bargain with yourself (“I’ll just use this one time, and then that’s it.”)
  • Actively seeking out a reason or opportunity for relapse

Physical:

  • Using drugs or alcohol “just once”
  • Returning to regular use

A good relapse prevention plan can help bring someone out of a relapse-in-progress in the physical stage. It also prevent situations that can put a person at risk for falling into one at all. 

What Does a Relapse Prevention Plan Look Like?

The idea of having to maintain constant vigilance when it comes to avoiding relapse can feel overwhelming, but it doesn’t have to be that way. A relapse prevention plan doesn’t have to be something huge and complicated. It can be broken down into just five simple rules that help you focus on what’s most important to your continued recovery. 

It is important to note that these are not a “quick fix” guide, but a way to think about relapse prevention that makes the endeavor less intimidating and more achievable, giving you the motivation to stick to your plan.

Rule One: Change Your Life

Admittedly, this can sound like a whole lot all at once. But all it means is looking at the aspects of your life that contributed to your addictive behaviors and working to alter or remove them to create a new life where it is easier to stay sober. This is not an “all or nothing” rule. Try to set an attainable goal of changing one small aspect of your life for the better at a time, even if it’s just getting up earlier, exercising more, or putting more time into self-care.

Rule Two: Be Honest

Lying is a huge component of addiction. People struggling with substance dependence are constantly in situations that require lying.  Not just to family, friends, or on the job. But also to yourself. You will lie about how much harm your addiction is causing. Making an effort toward complete honesty can also feel like a big task, but you just need to approach it the same way as change. Keep it small and stay consistent. Be honest about needing help with something or someone. Be honest about how you might be feeling. Make it a habit, and it will eventually come easier to you.

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Rule Three: If You Need Help, Ask for It

As previously mentioned, a big part of learning to be honest is being open about needing help. People often want to prove they can get through recovery on their own, that they’re in control. But without a solid support system, you’re setting yourself up to fail and relapse. Something as simple as joining a self-help or support group where you can safely express feelings and ask for help from people who have experienced the same things as you make long-term recovery much more likely.

Rule Four: Exercise Self-Care

It should be apparent now that these rules blend and overlap with each other, which makes it easier to stick to them, as following one will naturally help you follow others. Self-care is essential to avoid creating negative internal emotions that can drive you back to using. It also works to create a new rewards system to replace drugs or alcohol. It can be as simple as a relaxing bath, a special dessert, or a bit of shopping to acknowledge and celebrate your work toward recovery.

Rule Five: Stick to the Rules

This might seem redundant, but the rules of your relapse prevention plan aren’t going to work if you try to bend them. The first stage of relapse involves letting these good habits lapse. It doesn’t matter how much time has passed since you’ve been sober. If you want to prevent relapse, you have to work at it  actively.

Techniques for Dealing With Mental Urges    

Relapse triggers are going to stick with you when you are put in an environment that you once used drugs. It can be as simple as returning from treatment and going to a grocery store where you placed yourself in high-risk situations. As time lingers on, however, you are going to become better equipped to deal with these mental urges for substance abuse. Below we will discuss some techniques that you can apply to your life that will help your coping skills.

When you fantasize about drugs or alcohol, you’ll likely believe you can control your substance use disorder this time around. You will only have one drink, one pill, or maybe just one puff, but you need to play the tape past your favorite scene. One drink typically leads to two drinks, and you’ll wake up the next day filled with embarrassment and disappointment.

At this point, you may not be able to stop yourself the next day, and you will get stuck in the cycle of addiction. When you move past your favorite scene, the thought of using becomes less appealing. 

The most common mental urge is that you will get away with it this time if no one knows you relapsed. Maybe your wife is away for the weekend, or you’re on a trip. That’s when the voice will convince you that it’s ok and you can only have one drink. If you play the tape until the end, you’ll remind yourself of the adverse consequences that are waiting for you if you follow through.

Another technique is to reach out to a friend or peer in recovery. You must let them know what you’re going through. They can make you feel less alone in recovery and help you overcome these urges. On that same note, you must distract yourself when you think about using. Go for a walk, play a game of pool, and enjoy the outdoors. If you sit there and drown in your urges, it’s a possibility you’ll give in and use. 

If none of these are working, wait 30 minutes. Urges tend to last anywhere from 15 to 30 minutes, and if you can keep yourself busy for that short duration, you can get over your thoughts. 

You have to remember to take recovery one day at a time. When you think about long-term abstinence, it may be overwhelming. Focus on the now and what you need to get through this moment in time. If you can find ways to overcome these thoughts and relax, you are going to do well in preventing relapse. 

Sources

(January, 2018).Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition). National Institute on Drug Abuse. Retrieved from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/how-effective-drug-addiction-treatment

(July, 2018).Drugs, Brains, and Behavior: The Science of Addiction. National Institute on Drug Abuse. Retrieved from https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery

Melemis, S, (September, 2015).Relapse Prevention and the Five Rules of Recovery. US National Library of Medicine. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4553654/

National Institute on Drug Abuse. (n.d.). Treatment and Recovery. Retrieved from https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery

(n.d.). American Society of Addiction Medicine. Retrieved from https://www.asam.org/resources/definition-of-addiction

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