Relapse Prevention: What It Is and Why You Need It
In This Article
After overcoming any addiction, experiencing relapse is difficult to recover from. Here are some statistics noting relapse cases in the U.S.:
People in the US are past-month substance users.
People in the US have a substance use disorder
of drug or alcohol treatment patients are expected to relapse at some point.
Whether you or a loved one are experiencing challenges controlling their addictive behaviors, the road toward rebuilding self-control can be overwhelming. This is why understanding relapse prevention is vital.
This blog explores relapse prevention, strategies for avoiding triggers, and coping mechanisms to manage urges of repeat negative habits.
What is Relapse Prevention?
Relapse prevention is an umbrella term that refers to strategies that help reduce the likelihood of relapsing. Most relapse prevention strategies focus on building cognitive-behavioral skills and coping responses.
Cognitive behavioral skills refer to your ability to recognize thought patterns influencing your emotions and determining your behavior. Coping responses are behavioral responses to stressful situations.
Relapse prevention focuses on building the awareness necessary to recognize the early stages of relapse. It also provides the skills to change your behavior and avoid misusing substances again.
Mindfulness-Based Relapse Prevention
Mindfulness-Based Relapse Prevention (MBRP) integrates techniques from Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT).
MBRP aims to increase your acceptance and tolerance of your physical, emotional, and mental states. This will decrease your need to use substances again to feel comfortable.
What Is Relapse?
A trigger is something that causes you to start using again. Because everyday life contains many triggers, relapse is common among people trying to get over their disorder.
Relapse prevention is one of the main goals of drug or alcohol treatment programs. When you become addicted to a substance, your brain functions change, making it challenging to overcome your condition.
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Why Do Relapses Occur?
An estimated two-thirds of people entering substance abuse treatment will relapse weeks or months after completing treatment.10 Although there’s no foolproof way to avoid it, recognizing the stages and avoiding triggers can prevent it.
Common triggers that can lead to relapse include:
- Uncontrolled and severe withdrawal symptoms
- Poor coping skills
- Adverse life events
- Financial stress
- Lack of support system
- Failure to manage cravings
- Pressure to maintain a sober life
- Work stress
- Negative self-image
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What Are The Most Common Relapse Triggers?
Many triggers can come from environmental, mental, and emotional sources. Knowing and understanding them can help you avoid relapses during recovery.
The most common triggers for relapsing are:
- Chronic pain
- H.A.L.T. (hungry, angry, lonely, tired)
- Negative mindset
- Lack of support or aftercare
- Undiagnosed or untreated mental illness
Positive Relapse Triggers
Even positive events in life, like achieving a promotion or attaining sobriety goals, can unexpectedly lead to a relapse. This may occur as a result of overconfidence and a complacent mindset.
For example, celebrating these milestones may provide a tempting excuse to give into old habits. The pressure to maintain success can also contribute to this risk.
What Are The Three Stages of Relapse?
Relapse usually doesn’t happen immediately. Instead, it occurs in stages.
The three stages of relapse are:1
1. Emotional Relapse
In this stage, you may not be actively feeding your addictive behavior. However, you're inadvertently placing yourself at risk for a relapse.
Negative emotions such as anger, anxiety, and restlessness may arise during this stage. Watch out for these behaviors that indicate emotional relapse:
- Mood swings
- Neglecting meetings
- Unhealthy eating or sleeping habits
2. Mental Relapse
In this stage, you'll find yourself torn between the desire to use substances and to resist the urge. This phase’s signs include:
- Reminiscing about old habits
- Glorifying the past
- Daydreaming about using
- Reconnecting with people who enabled your addiction
3. Physical Relapse
The final stage is succumbing to temptation and engaging in drug or alcohol use again. This could involve going to a bar or liquor store, contacting your dealer, or retrieving your old stash.
Physical relapse usually occurs due to a lack of coping strategies during the mental relapse phase. As you begin to obsess more about drug or alcohol use, you find yourself in situations where the opportunity to use arises.
Preventing relapse isn’t as easy as saying no to opportunities to use again. Physical relapse is only preventable if you avoid high-risk situations. You must also develop healthy coping skills and an effective relapse prevention plan.
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What Are Relapse Prevention Strategies?
A relapse prevention plan is essential for recognizing warning signs and ensuring sobriety. With the guidance of experienced professionals, these plans offer strategies for behavioral change.
Therapists and counselors will document, share, and regularly update these strategies throughout your treatment.
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
How Do You Make A Relapse Prevention Plan?
A relapse prevention plan works best when you do it under a therapist or counselor's supervision. That way, you can explore new behaviors and thought patterns to help you stay clean.
They can also help regularly review and update it, especially if you experience significant lifestyle changes. Below are five steps to take while making your relapse prevention plan:
1. Identify Emotions
Various emotions can indicate that a relapse is imminent. If you’ve relapsed before, try to identify the feelings you felt before your relapse.
Some emotions that can lead to a relapse include:
- Feeling overwhelmed
Everyone will have different emotions that cause their substance use. Ask your therapist for additional guidance if you need help identifying these emotions. Recognizing these emotions can help you seek other therapy or a recovery meeting if necessary.
2. Identify Triggers
Different life stressors can lead to people using substances. Events, specific people (such as friends who are also using), and certain places can put you at a higher risk of relapsing. Identify these triggers so you can avoid them.
3. Write Down Coping Mechanisms
Write down things that have helped you stay sober on your recovery journey. Positive coping skills include attending support groups, exercising, journaling, and eating healthy foods to minimize intense cravings.
4. Use Support Groups
If you’re a support group member, keep trusted group members or leaders’ information in your prevention plan. If you fear you are at imminent risk of relapsing, contact them immediately.
Write down a schedule of your favorite support groups and attend a meeting for additional guidance. Commit to talking with one or more of the support group members regularly. You can also reach out to them whenever you experience triggers or cravings.
5. Create an Action Plan
Keep a note of your therapist's phone number, emergency contacts, and a concrete action plan in case you relapse. This plan might include asking your therapist for an emergency therapy session, visiting the emergency room, or enrolling in inpatient treatment again.
Note: If you’re experiencing intense thoughts of suicide or hopelessness, call 911 immediately.
10 Relapse Prevention Skills
There are different models and techniques to include in your relapse prevention plan. They’re based on building your knowledge and skills to combat substance use.
The essential relapse prevention skills are:
1. Identifying Triggers
Triggers can be anything from people, places, or objects that remind you of substance use. It’s important to know which triggers might cause you to relapse and come up with strategies for managing them.
Doing so will help you quickly identify and deal with them before they become too overwhelming. You can also find ways to replace old habits with healthier activities.
2. Promoting Self-Care
Self-care is essential for relapse prevention. It involves taking the time to tend to your mental and physical health, such as getting enough sleep, eating healthy food, and exercising regularly.
Self-care means being mindful of negative or unhelpful thoughts that could incite relapse. It also helps train your body to reduce post-acute withdrawal symptoms in the weeks or months after getting sober.
3. Emphasizing Emotional Awareness (HALT)
One of the most widely used relapse prevention techniques is the HALT model. The acronym “HALT” stands for Hungry, Angry, Lonely, and Tired—four common conditions that can trigger a relapse.
Emotional awareness encourages you to check in with yourself before taking action, reminding you to stay mindful of your current state. Pause first when you experience these states and find ways to deal with them without turning to substances.
4. Encouraging Mindfulness
Mindfulness is a practice that involves being present in the moment and being aware of your thoughts without judgment. It helps you recognize triggers and cravings more quickly.
Mindfulness activities include:
- Tai chi
- Nature walks
Practicing mindfulness also aids in dealing with triggers without using substances. It helps you break free from unhelpful thought patterns and focus on healthier alternatives for managing stress.
5. Leveraging Grounding Techniques
Grounding techniques help you stay calm, destress, and reduce anxiety. They can be especially beneficial when cravings feel overpowering.
Grounding techniques redirect your thoughts from using substances again and help you regain control of your emotions. The 5-4-3-2-1 coping technique is one of the most helpful grounding methods:
- Identify five things you can see around you
- Identify four things you can touch around you
- Identify three things you can hear around you
- Identify two things you can smell around you
- Identify one thing you can taste around you
6. “Playing the Tape Through”
This technique involves running "a mental videotape” of the entire relapse process. It involves going through the process from start to finish and noting all the changes that would occur if you give into the temptation.
To “play the tape through,” imagine short-term and long-term consequences. You also have to picture how far back you would have to go to get back on track.
7. Accepting Help
No matter how strong your willpower is, you can’t fight relapse alone. You must accept help from supportive family and friends when you need it.
Setting up a system to reach out if they sense you may be heading toward a relapse might also be helpful. This way, you can ensure that someone will be there to remind you of the benefits of sobriety and provide support.
8. Finding Support
No one should face sobriety alone. Surround yourself with a strong support system of friends, family, and sober acquaintances. Additionally, join local recovery meetings to interact with peers in similar situations.
Importance of Support Groups
Groups like Alcoholics Anonymous, Narcotics Anonymous, and SMART Recovery provide invaluable help, resources, and substance abuse group activities. They also offer a safe space for group members to talk about their struggles and learn to cope without substances.
Relapse prevention group activities can be a cornerstone in the journey to recovery. These activities allow you and other group members to share experiences and foster camaraderie.
Support groups also let participants collectively learn from substance abuse group topics. They offer a sense of belonging and understanding, often missing from other social circles.
9. Seeking Professional Help
If the temptation to use again becomes too overwhelming, don’t hesitate to seek professional help. Certified addiction specialists can guide your recovery and relapse prevention journey.
They can help identify and treat any underlying issues that could increase your risk of relapse. They also provide counseling services to teach healthier coping strategies for stress and negative emotions.
10. Following Through with Treatment
The ultimate goal of relapse prevention is to stay sober for life. This requires long-term treatment and daily work on your behalf.
It’s essential to stick with your aftercare program and follow-up appointments. It’s also important to know when to ask for help again if you need it. After all, relapse doesn’t mean you have failed; it means you need more support and treatment.
How to Fight Relapse Through Treatment Options
Contact a healthcare professional if you or someone you know suffers from a substance use disorder. You can learn about the best relapse-prevention treatment options for your needs.
You can beat relapse by signing up for one or more of the following addiction treatment options:
- Inpatient Treatment
- Partial Hospitalization Treatment
- Outpatient Treatment
- Medication-Assisted Therapy
- Support Groups
Relapse Prevention Workbooks
Besides signing up for recovery programs, keeping track of your progress is also integral to maintaining sobriety. Relapse prevention workbooks provide convenient ways for you to perform self-evaluations and assessments.
Here are a few workbooks you can fill out for free:
- The Mission Consumer Workbook
- Relapse Prevention Workbook
- My Relapse Prevention Workbook
- Cognitive Behavioral Relapse Strategies
- Relapse Prevention Tool Worksheets
- Make Your Last Relapse The Last
- Relapse Prevention Basics
- ASI-MV Worksheet
- Oxford Clinical Psychology Worksheets
Types of Relapse Prevention Models
Relapse prevention (RP) models use behavioral therapy treatments and eliminate high-risk scenarios to improve lifestyle factors. RP models utilize a variety of proven psychotherapies that enhance the effects of medications and help people stay in treatment longer.11
These resources include:
Cognitive Behavioral Therapy (CBT)
CBT is a form of psychotherapy that helps identify negative thoughts that lead to substance abuse. CBT effectively reduces the risk of relapse and is an integral component of the recovery process.
One study showed that CBT helped a majority of cocaine users stay clean after 52 weeks.12
Contingency management is a relapse prevention strategy that utilizes positive reinforcement to encourage you to stay sober. It has increased retention in substance use programs and helped people maintain sobriety.14
12-step programs, such as Alcoholics Anonymous (AA), Cocaine Anonymous (CA), and Narcotics Anonymous (NA), provide additional guidance and support for people in recovery.
These programs offer support from a sponsor and peers. This helps you safely manage thoughts about using substances again. Discussions often revolve around dealing with everyday situations without turning to substances.
Relapse prevention is a skill that takes dedication and following relapse prevention strategies. You can achieve this by recognizing your triggers and developing healthy coping skills.
Other than joining therapy groups and treatment programs, accessing relapse prevention workbooks can help immensely.
Remember, reaching out for help and support is vital if you ever feel overwhelmed or struggling. Long-term sobriety is possible and starts with taking that first step.
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- Melemis, S. “Relapse Prevention and the Five Rules of Recovery.” The Yale Journal of Biology And Medicine, 2015.
- Hendershot et al. “Relapse prevention for addictive behaviors.” Substance Abuse Treatment Prevention and Policy, 2011.
- Marquez-Arrico 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, 2019.
- Chauhan et al. “To identify predictors of relapse in cases of alcohol dependence syndrome in relation to life events.” Industrial Psychiatry Journal, 2018.
- "Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition)." National Institute on Drug Abuse, 2018.
- Bowen et al. “Mindfulness-based relapse prevention for substance use disorders: a pilot efficacy trial.” Substance Abuse, 2012.
- “Key Substance Use and Mental Health Indicators in the United States: Results from the 2018 National Survey on Drug Use and Health.” Substance Abuse and Mental Health Services Administration, 2019.
- "Drugs, Brains, and Behavior: The Science of Addiction." National Institute on Drug Abuse, 2023.
- Asensio et al. “What Is the "Trigger" of Addiction?.” Frontiers in Behavioral Neuroscience, 2020.
- Sinha, R. “New Findings on Biological Factors Predicting Addiction Relapse Vulnerability.” Current Psychiatry Reports, 2013.
- U.S. Department of Health and Human Services. (2020, July 10). “Treatment and Recovery.” National Institutes of Health, 2023.
- McHugh et al. “Cognitive behavioral therapy for Substance Use Disorders.” The Psychiatric Clinics of North America, 2010.
- Stranger et al. “Contingency Management: Using Incentives to Improve Outcomes for Adolescent Substance Use Disorders.” Pediatric Clinics of North America, 2020.
- Bowen et al. “Mindfulness-Based Relapse Prevention for Substance Use Disorders: A Pilot Efficacy Trial” Substance Abuse, 2012.