Relapse Prevention 101

MANAGE STRESS EFFECTIVELY

Over three-fourths of relapses are triggered by stress or stress-related issues. While it’s impossible to eliminate all stress, much can be done. The key aspects of stress management are:

• Good general health practices. The healthier the body, the stronger the brain and the greater the self-control.
• A “relaxed” approach to life. It’s no coincidence that many treatments for insomnia—cognitive behavioral therapy, progressive relaxation, meditative prayer—are also effective in reducing waking-hours stress.
• Awareness and acceptance. Both reduce relapse triggers connected to worry, denial and false guilt. Try mindfulness meditation for preventing relapse.
• Healthy relationships. Positive, encouraging people are always less stressful to be around than complaining, controlling types.
• A sense of purpose. People who enjoy creative hobbies, find meaning in their work, and believe in a Higher Power are less stressed even in challenging times.

KNOW YOUR TRIGGERS

Stress management alone doesn’t make anyone relapse-proof: sometimes, the most dangerous triggers come when people lower their guard to enjoy themselves. (Rates of alcohol relapse may run as high as 90 percent, partly because alcohol is a socially accepted part of celebration and relaxation.) Staying sober around the holidays is a challenge for many people, and may necessitate tough measures such as declining an annual invitation and instead volunteering at a food pantry.

Celebration- or stress-related, the most common triggers for relapse are:

• Locations (or places that resemble locations) where drugs were used or bought
• Drug-using acquaintances (including social drinkers)
• Times of heavy responsibility
• Pay day (which the brain associates with buying drugs)
• Strong emotions such as guilt, anxiety or even euphoria
• Sights, sounds or smells associated with drug experiences

Not everyone is tempted by all the above. Know what’s a trigger for you, and do everything possible to avoid it.

HAVE A RELAPSE PREVENTION PLAN

Knowing personal triggers also plays a key role in relapse prevention plans, which no one should leave treatment without. Every plan should be written out and answer the following questions as specifically as possible:

• How will I keep aware of my sobriety motivations?
• What locations and people will I avoid? What will replace them?
• What triggers will I meet? How will I defuse them?
• What self-care skills will I practice regularly?
• What support groups will I attend, and when?
• Whom will I call in case of temptation?
• Do I know the early warning signs of potential relapse (depression, irritability, getting slack on relapse prevention, reminiscing about “good old days” of drug use)? How will I nip them in the bud?
• In case of a slip, what immediate actions will I take to keep it from becoming full-blown relapse?
• Who will hold me accountable for sticking to all the above?

CONSULT A DOCTOR

Support networks should include professional as well as personal contacts. Just as the success rates of addiction treatment are improved by opting for real treatment—seeking professional help instead of toughing out withdrawal alone—the best ally against relapse is often a primary care provider.

• A doctor provides patient-specific advice on insomnia, dietary needs and other general-health issues.
• A doctor can diagnose and treat mental illnesses that might increase relapse risks.
• If the addiction involved prescription medications and the original health issue still exists, a doctor can recommend alternate medications.
• A doctor brings professional perspective to controversial issues such as whether to provide methadone or naltrexone for opiate cravings. (Opiate relapse dangers present special concerns because some treatments can lead to new addictions, and because many opiate addictions originate with legitimate prescriptions.)

That said, some doctors would rather throw pills at symptoms than make time to discuss concerns in depth. Choose your provider carefully (the addiction treatment center may have recommendations).

KEEP A POSITIVE ATTITUDE

The most important points to remember are:

• Addiction is not destiny.
• Relapse is neither inevitable nor irreversible.
• A happier, healthier future is always

For related information on relapse prevention, see the following articles:

• Addiction Relapse Rates Compared to Those for Other Chronic Illnesses
• Addiction Triggers: How to Prevent a Relapse
• Coping with Negative Emotions in Addiction Recovery
• How Mindfulness Can Prevent Relapse
• How to Celebrate the Holidays While in Recovery
• How to Make a Relapse Prevention Plan with Your Loved One in Recovery
• Key Elements of Relapse Prevention

SOURCES

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Hosseini, Somaye, Abbas Moghimbeigi, Ghodratollah Roshanaei, and Farzaneh Momeniarbat (2014, February 28). “Evaluation of Drug Relapse Event Rate Over Time in Frailty Model.” Osong Public Health and Research Perspectives (2014, April, Vol. 5, No. 2, pp. 92–95). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4064647/

Kassani, Aziz, Mohsen Niazi, Jafar Hassanzadeh, and Rostam Menati (2015, September 1). “Survival Analysis of Drug Abuse Relapse in Addiction Treatment Centers.” International Journal of High Risk Behaviors & Addiction (2015, September, Vol. 4, No. 3, p. e23402). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4609495/

Mayo Foundation for Medical Education and Research. “Insomnia.” Retrieved from https://www.mayoclinic.org/diseases-conditions/insomnia/diagnosis-treatment/drc-20355173

National Institute on Drug Abuse (2016, October). “The Science of Drug Abuse and Addiction: The Basics.” Retrieved from https://www.drugabuse.gov/publications/media-guide/science-drug-abuse-addiction-basics

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

National Institute on Drug Abuse (2018, June). “Understanding Drug Use and Addiction.” Retrieved from https://www.drugabuse.gov/publications/drugfacts/understanding-drug-use-addiction

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

U.S. Department of Health and Human Services (2000, October). “Relapse and Craving.” National Institute on Alcohol Abuse and Alcoholism, Alcohol Alert (1989, October, No. 6, p. 277). Retrieved from https://pubs.niaaa.nih.gov/publications/aa06.htm

U.S. Department of Health and Human Services (2018, June 30). “Drug Abuse and Addiction.” National Institutes of Health. Retrieved from https://www.report.nih.gov/nihfactsheets/ViewFactSheet.aspx?csid=38