What is Relapse Prevention?Anna Ciulla
Anyone going through a formal drug or alcohol inpatient rehab program will be exposed to many different treatment modalities. Following the alcohol or drug detoxification process, treatment typically consists of psychotherapy in the form of one-on-one counseling, group therapy, various psychosocial therapies and other treatment options. One area of significant importance for an addict’s recovery process is relapse prevention. But what is relapse prevention, exactly? What’s involved and what can it do for the person undergoing treatment or in recovery for substance abuse?
This article is going to explain what a relapse prevention plan is, how to make one, and how it can benefit an individual overcoming an addiction.
According to research from the Yale Journal of Biology and Medicine, there are four main ideas in relapse prevention. The first is that relapse is a gradual process that involves distinct stages. It is important to help the recovering addict recognize the early stages of relapse so they can prevent these circumstances from occurring when times get difficult.
The second is that recovery is a process that involves personal growth with inherent milestones of development. Each stage of recovery has its own relapse risks.
Third is that the main tools of relapse prevention are cognitive therapy and mind-body relaxation, both of which are instrumental in developing healthy coping skills.
Fourth is that most relapses can be explained by basic rules, and educating those in recovery can help them focus on what is truly important for their ongoing sobriety. These rules to help reduce the risk of relapse include making life changes, being scrupulously honest, asking for help, practicing self-care, and avoiding the temptation to bend the rules.
There are also three stages to relapse: emotional, mental, and physical.
WHAT’S INVOLVED IN RELAPSE PREVENTION?
In simple terms, relapse prevention involves the creation of a personal plan to help the individual in treatment identify and prevent high-risk situations and behaviors that can lead to relapse. It is also important to create effective strategies and techniques to use when times get difficult or when the addict is feeling the temptation. You work on the plan with your therapist in one-on-one sessions, and also during group or other cognitive-behavioral therapy (CBT). When you conclude treatment, you have a plan that will help you prevent relapse that you can take with you or revise later on.
HOW CAN RELAPSE PREVENTION HELP DURING TREATMENT AND RECOVERY?
While in treatment for your drug or alcohol addiction, you may also be wrestling with a co-occurring mental health disorder, such as anxiety or depression. Treating both simultaneously has been shown to strongly help in recovery.
Relapse prevention plans that you create with your therapist take into account the kinds of stresses and triggers you will face as you return to your normal life. Incorporating evidence-based, non-drug therapies and activities into your daily routine can help you realize that there are healthier ways to cope with stress instead of turning to drugs or alcohol.
Harvard Medical School reports that there’s scientific evidence that the practice of yoga reduces “exaggerated stress responses” and may be helpful for those dealing with anxiety and depression to better manage their symptoms. Yoga is a self-soothing technique, like meditation, exercise, and relaxation, that provides mental and physical benefits to the practitioner. Yoga is also considered a low-risk, high-yield approach to improving both mental and physical health.
As an article in Psychology Today explains, depression is likely one of the most common disorders that afflicts addicts when they seek treatment for substance use disorders. The feelings of demoralization and hopelessness they often experience are also exacerbated by the altered brain chemistry resulting from drug and alcohol abuse. Recommendations during and after treatment for dealing with depression include incorporating exercise into a daily regimen, being more realistic about goals, physically grounding yourself, and seeking help when you need it. These are all elements that can be included in a relapse prevention plan.
INCLUDE ELEMENTS TO HELP IN DEVELOPING GOOD COPING SKILLS
Being in recovery doesn’t eliminate stressors and triggers to use. On the contrary, anyone entering recovery will be subjected to an onslaught of temptations, uncertainties, difficulties and challenging situations. Post treatment, an individual is often forced to encounter painful reminders of past drug and alcohol use. By crafting a comprehensive relapse prevention plan prior to leaving drug and alcohol rehab, the newly clean individual has strategies to help cope with such inevitable events at a time when they are most vulnerable to relapse.
Various mindfulness meditation techniques offer recovering individuals research-based help in developing good coping skills. Mindfulness also helps reduce cravings in some recovering addicts. As researchers from the University of Washington found in a study, women undergoing a mindfulness intervention at an outpatient treatment setting while they were also in rehab experienced a noticeable improvement and were less likely to relapse after a year.
The intervention, mindful awareness in body-oriented therapy (MABT), is a combination of manual, mindfulness, and psychoeducational approaches. The therapy helps women understand their body’s physical and emotional signals and teaches them how to engage in self-care activities.
IMPORTANCE OF PEER SUPPORT GROUP PARTICIPATION
Knowing that others who are in recovery from drug or alcohol addiction have experienced relapse and come back from it, or who are currently struggling with overwhelming urges to use can be a compelling part of an overall relapse prevention plan. After all, if you’re surrounded by like-minded individuals who want to live in sobriety, you’re in a proactive network that can bolster you and offer constructive suggestions for commonly occurring challenges. If you start to slip, you have your sponsor and fellow group members to help you regain your footing in sobriety. If you stumble and relapse, they’re ready and willing to encourage your return to abstinence and applaud your progress along the way.
While some individuals in recovery may eventually decide to stop going to support group meetings once they feel better, that often proves to be a mistake. Relapse can and does occur after months and even years of sobriety. That’s why it’s so important to continue going to 12-step support groups like Alcoholics Anonymous and Narcotics Anonymous. Maintaining your connections to like-minded individuals will help you stay accountable and on track for a substance free life.
GETTING INVOLVED IN MEANINGFUL ACTIVITIES
Another crucial aspect of an effective relapse prevention plan is involvement in meaningful activities. Whether this includes taking up a hobby, traveling, going back to school, learning a new skill, or pursuing a different career or job, having goals will add a powerful dimension to your ongoing recovery. Having interests and goals will help you interact with new people and give you the opportunity to make friends outside of your old circle.
KNOW THE WARNING SIGNS OF RELAPSE
While it is not inevitable, relapse is quite high during recovery. A study in Systematic Reviews reported that relapse rates for substance and alcohol use disorders are as high as 60-90 percent (60 percent for SUDs and 90 percent for AUDs). The most critical time is the first 90 days to 6 months following treatment, as this is when you are still most vulnerable and perhaps unable or unwilling to do what’s best for your continuing sobriety. The following warning signs may mean you’re about to relapse:
- You start romanticizing past drug use
- You get in touch with past drug-using friends
- Your attitude or behavior suddenly changes
- You experience the onset of withdrawal symptoms
- You start making excuses and stop going to self-help or support group meetings
- You no longer have any interest in once enjoyable activities or hobbies
- Your self-care begins to deteriorate
What if you feel you’re in danger of relapse? Get in touch with your sponsor, if you have one, right away, either by phone or meeting in person. If that’s not possible, go to a support meeting without delay. Your sobriety may depend on it. It’s also wise to contact your therapist and schedule an appointment for further counseling. If treatment is over, check into continuing care and aftercare programs, along with alumni services. If these are available to you, they can help you recommit to your sobriety and help you get back on track.
RELAPSE PREVENTION: A KEY TOOL TO HELP ONGOING SOBRIETY
One of the biggest challenges in treatment and recovery is recognizing that you need help on an ongoing basis. While in treatment, developing a relapse prevention plan can help keep you focused on the larger picture: living your life without drugs or alcohol. This was more than just an exercise to keep you busy while you learned how to overcome your addiction and tend to underlying emotional, psychological and/or other substance use disorders. Indeed, as research shows, relapse prevention is a key tool for anyone in treatment recovery to help with their ongoing sobriety.
While you may relapse, keep in mind that recover is a process. The journey may involve some slips and relapses, just as it will involve much self-discovery and a renewed sense of purpose and meaning in life. With the help of your support network, along with participation in aftercare and alumni programs, you can get past relapse and become stronger and more confident in your ability to live a life of sobriety.
- Harvard Medical Health. “Yoga for anxiety and depression.” Retrieved from https://www.health.harvard.edu/mind-and-mood/yoga-for-anxiety-and-depression
- Journal of Substance Abuse Treatment. “Continuing Care Research: What We’ve Learned and Where We’re Going.” Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2670779/
- Journal of Substance Abuse Treatment. “Promoting recovery in an evolving policy context: What do we know and what do we need to know about recovery support services?” Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3642237/#R75
- National Institute on Drug Abuse. “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
- National Institute on Drug Abuse (NIDA). “What is a relapse?” Retrieved from https://easyread.drugabuse.gov/sites/default/files/node_pdf/61-what-is-a-relapse.pdf
- Psychology of Addictive Behavior. “Classes of substance abuse relapse situations: A comparison of adolescents and adults.” Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3031179/
- Psychology Today. “Addiction and Depression.” Retrieved from https://www.psychologytoday.com/us/blog//ending-addiction-good/201301/addiction-and-depression
- Systematic Reviews. “Physical activity and the prevention, reduction, and treatment of alcohol and/or substance use across the lifespan (The PHASE review): protocol for a systematic review.” Retrieved from https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-018-0674-0
- University of Washington. “Mindful body awareness training during treatment for drug addiction helps prevent relapse.” Retrieved from https://www.washington.edu/news/2019/04/16/mindful-body-awareness-training-during-treatment-for-drug-addiction-helps-prevent-relapse/?utm_source=UW%20News&utm_medium=tile&utm_campaign=UW%20NEWS
- Yale Journal of Biology and Medicine. “Relapse Prevention and the Five Rules of Recovery.” Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4553654/