Relapse Prevention Plan: Tips to Help You Stay Sober
In This Article
Why Do Relapses Occur?
An estimated two-thirds of people entering substance abuse treatment will relapse weeks or months after completing treatment.1 Although there is no fool-proof way to avoid relapse, recognizing the stages and avoiding triggers can prevent it from occurring.
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
Relapse occurs in gradual stages:2
1. Emotional Relapse
Emotional relapse is the first stage of substance abuse relapse. During this stage, people typically lack self-care and experience denial about their addiction.
They might isolate themselves, which makes it difficult to adjust to sobriety. They might also focus on other people’s problems rather than their own.
An acronym that can help users and family members identify this stage is HALT, which stands for hungry, angry, lonely, and tired.
During emotional relapse, overcoming poor self-care habits becomes critical. Improving sleeping habits, attending a support group, and practicing self compassion can all help during emotional relapse.
2. Mental Relapse
During mental relapse, thoughts of using again amplify. These thoughts and cravings are a normal part of addiction recovery, but might cause people to put themselves in high-risk situations. Some examples include visiting a bar where substances will be involved or spending time with old friends who drink.
People might not realize they are at higher risk for relapse during this stage, and therefore continue to think of opportunities where they can use again. They might also bargain or justify a future relapse, such as using during a holiday or birthday.
3. Physical Relapse
This is the final and most serious of the three relapse stages. During physical relapse, people start by having one drink or using substances. This can quickly lead to a snowball effect and cause recurring drug and alcohol abuse.
Physical relapse usually occurs due to a lack of coping strategies during the mental relapse phase. As people begin to obsess more about their drug or alcohol use, they find themselves in situations where the opportunity to use arises.
Contrary to popular belief, preventing relapse isn’t as easy as saying no to opportunities to use again.
Physical relapse is only preventable if the person takes steps to avoid high-risk situations. They must also develop healthy coping skills and an effective relapse prevention plan.
What is a Relapse Prevention Plan?
A relapse prevention plan is an important tool that helps recovering users recognize early warning signs of a relapse.
Relapse prevention plans usually incorporate information such as:
- A person’s drug(s) of choice
- Emotions or feelings that can lead to a relapse
- Factors that protect against a relapse (family, friends, sober living)
- Contact information of who they can reach out to for help
- Support groups they can attend
- Coping strategies that have helped in the past, such as listening to music, writing, and exercise
- Ideas on how to manage cravings
Types of Relapse Prevention Models
Relapse prevention (RP) models use behavioral therapy treatments and eliminate high-risk scenarios to improve lifestyle factors.3 RP models utilize a variety of proven psychotherapies that enhance the effects of medications and help people stay in treatment longer.4
These resources include:
Cognitive Behavioral Therapy (CBT)
CBT is a form of psychotherapy that can help people identify negative thoughts that lead to substance abuse. CBT is effective at reducing 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.5
Contingency management is a relapse prevention strategy that utilizes positive reinforcement to encourage people to stay sober. It has been shown to increase retention in substance use programs and help people maintain sobriety.6
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 people safely manage thoughts about using again. Discussions often revolve around how to deal with common life situations without turning to substances.
Steps for Making a Relapse Prevention Plan
A relapse prevention plan helps people recognize relapse warning signs. It allows them to seek help before they physically relapse.
Below are five steps to take while making your relapse prevention plan:
1. Identify Emotions
Various emotions can indicate relapse is imminent. If you’ve relapsed before, try to identify the emotions you felt before your relapse.
Some emotions that can lead to a relapse include:
- Feeling overwhelmed
Everyone will have different emotions that precipitate their substance use. Ask your therapist for additional guidance if you need help identifying these emotions. Learning to identify these emotions can help you seek additional 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 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 can include attending support groups, exercising, journaling, and eating healthy foods. Healthy coping skills can help you minimize intense cravings.
4. Use Support Groups
If you’re a member of a support group, keep their information on hand in your prevention plan. If you fear you are at imminent risk of relapsing, contact a trusted group member 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 on a regular basis. 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.
Relapse Prevention Workbooks and Worksheets
- Relapse Prevention Plan Worksheet to help you create coping skills.
- ASI-MV Worksheet to identify negative emotions about treatment, educate yourself on the stages of relapse, and identify risk factors.
- The Oxford Clinical Psychology Worksheets include ideas for positive activities, weekly schedules, and lapse and relapse plans.
Call to find out how much your insurance will cover
- Sinha, Rajita.(2011, October). New Findings on Biological Factors Predicting Addiction Relapse Vulnerability. Current Psychiatry Reports.
- Melemis, S. M. (2015, September 3). Relapse prevention and the five rules of recovery. The Yale journal of biology and medicine.
- GA;, L. M. E. P. R. S. M. (n.d.). Relapse prevention. an overview of Marlatt's cognitive-behavioral model. Alcohol research & health : the journal of the National Institute on Alcohol Abuse and Alcoholism.
- U.S. Department of Health and Human Services. (2020, July 10). Treatment and recovery. National Institutes of Health.
- McHugh, R. K., Hearon, B. A., & Otto, M. W. (2010, September). Cognitive behavioral therapy for Substance Use Disorders. The Psychiatric clinics of North America.
- U.S. Department of Health and Human Services. (2020, June 1). Contingency management interventions/motivational incentives (alcohol, stimulants, opioids, marijuana, nicotine). National Institutes of Health.