Relapse Prevention

Up to 60 percent of people in substance use disorder treatment will experience relapse at some point during their recovery. This is why relapse prevention is one of the most important elements of all treatment programs.
Evidence Based
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What is Relapse?

Relapse is when someone begins using a substance again, after a period of sobriety. A trigger is something that causes a person to start using again. Because everyday life contains many triggers, relapse is not uncommon among people trying to get over their disorder.

Relapse prevention is one of the main goals of all drug or alcohol treatment. When a person becomes addicted to a substance, their brain functions change. These changes make it very challenging for them to overcome their disorder.

165

Million

People in the US are past-month substance users.

20

Million

People in the US have a substance use disorder

60

Percent

Of drug or alcohol treatment patients are expected to relapse at some point.

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What is Relapse Prevention?

Relapse prevention is an umbrella term that refers to strategies that help reduce the likelihood and severity of relapse when someone is trying to remain sober.

Most types of relapse prevention strategies focus on building cognitive-behavioral skills and coping responses. Cognitive behavioral skills refer to a person’s ability to recognize their thought patterns, which influence their emotions, which determine their behavior. Coping responses are behavioral responses to stressful situations.

One of the most important things to understand about relapse is that it usually does not happen impulsively. Instead, it occurs in stages.

The three stages of relapse are:

  • Emotional relapse — During this stage, you’re not thinking of using yet, but you are setting yourself up for a relapse. You may be feeling negative emotions like anger, anxiety, or restlessness. Self-isolation, mood swings, missing meetings, and poor eating or sleeping habits are signs of emotional relapse.
  • Mental relapse — In this stage, there is a battle going on inside of you. Part of you wants to use, and part of you doesn’t. Thinking about people and places you used, glamorizing your past, fantasizing about using, lying, and hanging out with old friends are signs of mental relapse.
  • Physical relapse — This is when you finally give in and go through the motions of using again. Driving to the bar or liquor store, calling your dealer, or finding your old stash is cons begin using again is considered physical relapse.

Relapse prevention focuses on building the awareness necessary to recognize the early stages of relapse, and providing you with the skills to change your behavior and avoid using again.

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Relapse Prevention Plans

A relapse prevention plan helps you recognize your own personal warning signs and outlines ways to change your behaviors and remain sober. Therapists, counselors, and other professionals with relapse prevention experience will help patients create their plans. They are often written down and shared in group counseling settings, and updated as treatment continues.

There are three steps to take when creating a relapse prevention plan:

  1. Record and assess your history of substance use
  2. Create a list of warning signs that could lead to relapse
  3. Establish a plan of action for each warning sign

Your relapse prevention plan should include the following:

  • A list of your triggers
  • Techniques for managing triggers and cravings
  • Preventative tools you can utilize
  • Available support groups and programs
  • Lifestyle changes you should make
Icon of transparent brain showing mental health.

Relapse Prevention Skills

There are many different models and techniques for relapse prevention plans. However, they are all based on building patients’ knowledge and skills.

The most essential relapse prevention skills are:

Identifying Your Triggers

Triggers may be internal or external. Knowing what emotions, people, places, and things lead you to relapse can help you avoid them or take an alternative course of action when you’re confronted by a trigger.

Self-Care

A healthy diet, sleeping pattern, and exercise routine can help train your body to reduce post-acute withdrawal symptoms that occur in the weeks or months after getting sober.

Emotional Awareness (HALT)

HALT stands for Hungry, Angry, Lonely, Tired. These emotions are some of the most common triggers for people in recovery. Learning to identify these emotions can help you reduce the chances of relapse.

Mindfulness

Meditation, breathing techniques, yoga, and other mindfulness practices help increase self-awareness and provide healthy alternative courses of action.

Grounding Techniques

Grounding techniques can help you destress and reduce anxiety.

The 5-4-3-2-1 coping technique is one of the most helpful grounding methods:

  • Identify 5 things you can see around you
  • Identify 4 things you can touch around you
  • Identify 3 things you can hear around you
  • Identify 2 things you can smell around you
  • Identify 1 thing you can taste around you
Play the Tape Through

If you find yourself wanting to use again, a good technique is to “play the tape through.” This involves playing out the scenario of using all the way to the end, and visualizing the negative consequences that will come after relapse.

Finding Support

Joining a support group such as Alcoholics Anonymous, Narcotics Anonymous, SMART Recovery, or any other local organization can provide you with a network of people who are in similar situations as you. You'll also meet people who are further along in their recovery and want to help you.

Accepting Help

Making sure that you have a peer support group and a support system of friends and family will give you plenty of options if you feel a relapse coming.

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Mindfulness-Based Relapse Prevention

Mindfulness-Based Relapse Prevention (MBRP) integrates techniques from Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT). The goal is to increase a person’s acceptance and tolerance of their physical, emotional, and mental states. In turn, this will decrease their need to use again to feel comfortable.

If you or someone you know is suffering from a substance use disorder, it’s important for them to begin their road to recovery. Contact a healthcare professional to learn about your best relapse prevention treatment options.


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Resources

Melemis, Steven M. “Relapse Prevention and the Five Rules of Recovery.” The Yale Journal Of Biology And Medicine vol. 88,3 325-32. 3 Sep. 2015

Hendershot, Christian S et al. “Relapse prevention for addictive behaviors.” Substance Abuse Treatment, Prevention, And Policy vol. 6 17. 19 Jul. 2011, doi:10.1186/1747-597X-6-17

Marquez-Arrico, Julia E et al. “Coping Strategies in Male Patients under Treatment for Substance Use Disorders and/or Severe Mental Illness: Influence in Clinical Course at One-Year Follow-Up.” Journal Of Clinical Medicine vol. 8,11 1972. 14 Nov. 2019, doi:10.3390/jcm8111972

Chauhan, Vinay Singh et al. “To identify predictors of relapse in cases of alcohol dependence syndrome in relation to life events.” Industrial Psychiatry Journal vol. 27,1 (2018): 73-79. doi:10.4103/ipj.ipj_27_18

NIDA. "Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition)." National Institute on Drug Abuse, 17 Jan. 2018, https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition.

Bowen, Sarah et al. “Mindfulness-based relapse prevention for substance use disorders: a pilot efficacy trial.” Substance Abuse vol. 30,4 (2009): 295-305. doi:10.1080/08897070903250084

“Key Substance Use and Mental Health Indicators in the ...” Substance Abuse and Mental Health Services Administration, 2018, www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHNationalFindingsReport2018/NSDUHNationalFindingsReport2018.pdf.

NIDA. "Drugs, Brains, and Behavior: The Science of Addiction." National Institute on Drug Abuse, 20 Jul. 2018, https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction.

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Updated on: August 7, 2020
Author
Michael Bayba
About
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Medically Reviewed: March 18, 2020
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Annamarie Coy,
BA, CADACII/ICADC, ICPR, MATS
About
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