What Is Relapse Prevention?
One aspect of treating a client as part of an addiction programme, whether inpatient or outpatient, is the actionable relapse-prevention plan. In treatment, the individual works hard to determine the underlying causes of their drinking or drug use; remaining sober means treating the causes and changing patterns of behaviour. Many relapse prevention plans include coping skills to respond to triggers in one’s environment that typically lead to using.
Relapse prevention lies in understanding the client’s particular cues and helps give them ways to stop the circular thinking that leads to substance abuse. There are several stages of relapse, and relapse prevention acts to identify where in the stage of relapse a client is and how best to interrupt the slide into using again.
It’s essential to identify the early warning signs of relapse, as the process begins well before the individual picks up a drink or begins using drugs. Relapse typically starts with poor self-care and bottling up emotions. In this circumstance, lack of self-care includes poor eating and sleeping habits, as well as not dealing with emotional stressors.
Relapse prevention includes therapy that helps the client change their response to stressors and emotions with positive thinking and self-care.
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Common Causes of Relapse and Relapse Prevention Plans
Emotional relapse mimics the symptoms of post-acute withdrawal syndrome or PAWS. These are anxiety and depression, as well as mood swings, anger and defensiveness. In this stage of relapse, the client may vividly remember just how bad they felt while drinking or using and may choose to avoid the substance. However, recognising that the individual is isolating themselves and not seeking help is critical to preventing relapse in its early stages.
At this point, those in treatment should remember that they’re anxious and need to practice relaxation techniques. If eating and sleeping habits are slipping, they should redirect and practice physical self-care. It’s more challenging to resist temptation when one is hungry, angry, lonely or tired. Relapse prevention plans at this stage of recovery include focusing on positive behaviours and self-care.
The next stage of relapse is mental relapse. At this point, there’s a war going on in our minds. They may be thinking about using again, and as this stage progresses, the thoughts become more intrusive. In addition, their past lifestyle of substance abuse is glamorised, and the individual may begin lying about seeing old friends that they used with or returning to their favourite places to use.
During mental relapse, the individual believes that they can control the use, that they’ll be able to stop before they use to excess or ‘just have one.’ Unfortunately, this is a common lie that addiction tells. Strategies for preventing relapse include talking to a friend and explaining that they have a desire to use.
Stress is a very common trigger for clients in recovery. Many times, the substance is used to help escape or relax after a stressful day at work or to dull the stress of unhappy home life. Stress is a huge trigger for many, as it’s an inflammatory emotion that includes anger, fear and feelings of helplessness.
Using when stressed soothes the pain in the mind of the user. During stressful times, the urge to use can be overwhelming, as the brain has been trained to believe that the substance reduces stress. To prevent relapse at this time, it’s essential to wind down the stress in a healthy manner.
Brisk walking outdoors to clear the mind may be helpful, especially as exercise releases hormones that naturally boost the mood. Using mindful meditation practices — and many guided meditation recordings are explicitly geared toward substance abusers — may be another way to carefully de-stress.
Being the only sober person in a friend group can be a little intimidating if you’re struggling with addiction. Continuing to hang out with old friends may trigger a relapse simply out of habit or due to peer pressure. Changing the responses that lead to using also include abstaining from the environments that made it easy and acceptable to use.
Limiting contact with old social circles at this stage of recovery can help protect the individual during the vulnerable stages of early recovery. Finding new friends may be challenging; this is why many recovery plans include attending group meetings to meet people in similar situations who are not using.
Old hangout locations
The neighbourhood pub is not generally the best place for someone in addiction recovery to spend time at. Addiction is a habitual process, and even just being present in the same environment that the person favoured using in can trigger a habitual repose to use. Nostalgia is powerful, and during the mental relapse stage, the client may glamorize their experiences in old hangout locations and believe that they can control the substance abuse.
The locations themselves may be a trigger during times of stress, anger or loneliness. Treatment plans can include taking alternate paths to and from work if the old hangout was a common stop on the way home.
Negative or challenging emotions
Negative emotions leave us feeling empty and unrewarded. The most common ones are feeling hungry, angry, lonely or tired — the HALT acronym. When these feelings are running high in our minds, it’s more difficult to reverse the thought process and change course to more positive behaviours.
Negative emotions create an imbalance in the mind that creates yearnings for the emotions to go away, and for many people struggling with addiction, that’s the reason they began using in the first place: to numb or escape from these negative feelings.
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Seeing or sensing the object of your addiction
While much of the battle with addiction is mental, there is a physical component, as well. Seeing, smelling or sensing the addictive substance can trigger a primal physical reaction. During the mental stage of relapse, you may begin to believe a regained control you’re your drinking or drug usage. At this point, seeing the object may reinforce the belief that you can stop when you choose to, but it’s not often the case.
While seeing a frosty mug of beer or a syringe may not always trigger the urge to use, you must have a strategy in place before a trigger actually appears. This is where the relapse=prevention techniques you would learn during your treatment will come in action. For example, understanding the sudden urge to drink when you’re walking through the beverage aisle of the nearby store may help you be ready to use certain coping strategies or to wait out the cravings. The techniques you will learn are strictly personal; feel free to discuss any concerns with your therapist.
Big parties and celebrations
Substance use and celebrations go hand-in-hand for many. For a client newly in recovery, avoiding these special events may be the best bet. However, if they cannot avoid the event, having strategies in place beforehand to reduce the temptation to use and stop glamorising their old lifestyle are essential.
Bringing non-alcoholic beverages is a step that many take. Spending a little extra money on artisanal soft drinks or making lemonade from scratch give many clients something that tastes good and still feels like a special treat. Leaving the event early can help, as over time, the urge to use may become stronger.
Taking a date or a friend that also doesn’t use, can give support and encouragement. We all need someone to talk to who isn’t using, especially when we’ve just successfully completed our rehab treatment.
Types/Stages of Relapse
Addiction is very much a mental challenge, and the stages of relapse begin well before we take a sip of alcohol. Understanding where one is in the relapse process is critical to using prevention strategies to reduce the urge to use and employ proper self-care.
Support and connections with other individuals who are battling addiction are essential in all phases of recovery. Also, many people can spot relapse behaviours in others and can be a valuable tool to help those struggling with relapse.
There are three distinct stages of relapse. Understanding the aspects of each and having pre-planned coping mechanisms for each can help the client redirect their thoughts and behaviour.
Withdrawal from alcohol or drugs has a physical effect on the brain and emotions, including feelings of anxiety and depression. As the brain heals, these feelings gradually dissipate. However, the strong negative emotions that led clients to drink can trigger a relapse at this stage.
Poor self-care during the emotional phase of relapse can quickly lead to mental relapse. During the emotional relapse stage, therapy can help the individual understand the triggers for negative emotions and help guide them to ways to deal with these emotions that don’t include using. Journaling, exercising and cognitive behavioural therapy are all good relapse prevention strategies.
Mental relapse involves the individual’s battle with themselves. In this stage, the client begins casually thinking about using again. These thoughts become more intrusive and include believing that they can control the drinking or using.
During mental relapse, it’s critical to maintain self-care and therapy as well as journaling the results after a night of substance abuse, which the client can use to remind themselves why they quit in the first place. Cravings may intensify at this stage, and the client may reminisce fondly about people they once used with and places they used to go.
Physical relapse is the act of picking up a drink or calling a dealer for drugs. There may be a lapse in which the individual has a brief slip-up or a full relapse in which the individual returns to their old patterns of using.
Physical relapse prevention isn’t as simple as just saying no when the opportunity arises. It’s the culmination of the emotional and mental relapsing that put the client in a place where they are too overwhelmed to say no.
Physical relapse may also occur when the individual thinks they won’t get caught. It’s essential to have strategies in place and recognise when one is in a vulnerable situation in order to avoid physically using again.
Relapse Prevention Therapy (RPT)
This is a skill-based cognitive behavioural therapy programme that seeks to untwist the client’s way of thinking and coping with life stressors that don’t include alcohol or drugs. Addiction causes different pathways to form in the brain, and taking the time to deliberately halt the destructive thought patterns and realign them more healthily is part of RPT.
The client and the therapist work together to deal with internal addiction cues and external triggers that may create a heightened desire to drink or use. The cognitive strategies are related to the client’s way of thinking, while the behavioural aspects help the client make better choices when stressed or upset.
As the client’s coping skills improve, they exhibit a greater sense of self-worth and confidence to handle difficult situations. These newly learned behaviours make preventing relapse more effective. In therapy, the client and therapist work together to identify the particular situations in the client’s life that create the urge to use. Once these situations are defined, then the emotions that are associated with them are explored.
Coping skills training
Coping skills training includes finding other ways to relax during high-stress times. Each individual is different — some people may find relaxation easier to achieve through meditation, exploring their emotions and allowing themselves to fully feel their feelings. Other individuals may find exercise or a hobby relaxing. Redirecting the response to stress is part of the coping skills that the therapist teaches.
This helps the client redirect circular thinking and discover new ways to deal with their emotions. Many addicts have negative thinking that worsens underlying anxiety and depression. Working through the root causes of anxiety and depression can help the client redirect their thoughts, making it easier to deal with their emotions and not turn to substances to numb them.
Cognitive therapy allows the client to re-frame their way of thinking. This includes identifying at what point in a negative thought pattern the urge to use occurs. When a client is in a high-risk situation, they may react without thinking. Slowing down the thought process and redirecting reactions into a more productive way of thinking can be beneficial to helping clients mitigate stressors in a healthier way.
When you successfully create a new lifestyle that doesn’t include abusing substances, then it becomes easier to make healthy choices. If nothing changes when you complete your rehabilitation, then it’s rather easy to fall back into old habits and thinking.
Lifestyle changes typically include removing the triggers that cause substance abuse. With different surroundings and different influencers, it’s easier to make better choices. Removing things from the old life that caused stress and using allows the client to practice the behaviour and cognitive changes that help prevent relapse.
What Are the Biggest Triggers for Relapse?
Several common triggers are fairly universal. Triggers are identified as internal thoughts and external situations that cause those in recovery to crave drinking or drugs and eventually relapse. It’s essential to work with a therapist to determine personal triggers to develop strategies to cope with the trigger that don’t include alcohol or drugs.
External triggers include people, places, activities or even objects that the client associated with using. Part of relapse prevention includes substituting old routines with new ones, instead of simply removing the external triggers.
Internal triggers are a response to stressful situations. These may be more difficult for the individual to remove, as they’re emotional responses that trigger the desire to use. These emotions are an instinctive response, although the individual may learn different ways to work through their emotions in therapy.
Common internal triggers include fear, anxiety, guilt or shame. Often, the client has deep trauma in the past that caused negative emotions to arise. Avoiding the pain of negative emotions is typically the reason that people begin drinking and using drugs. Dealing with the pain in a healthy manner can make it easier for the client to choose other ways of working through emotional situations without using.
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Which addictions have the highest relapse rates?
Overall, substance abuse relapse rates average 40%-60%. (1) However, three substances have the highest relapse rates, due to the physically addictive nature of them and the ease at which users can acquire them. Many people use more than one substance or have an addiction to several things. This makes gathering statistics a little more difficult
Other times, users switch addictions, moving from drinking to drugs or from drugs to drinking. Other times, the addiction to the substance becomes an addiction to risky behaviours, such as sex or gambling. However, generally speaking, the drugs with the highest rates of relapse are opioids, alcohol and cocaine/crack cocaine.
These three substances alter the brain’s ability to produce dopamine, the high that these substances create. However, through abstinence, the brain can recover and begin producing the dopamine and serotonin without drinking or using drugs.
Knowing and Understanding Your Triggers
Many relapse prevention strategies stress the importance of honesty. This includes the addicted individual being honest with others around them, letting people know when they feel triggered or stressed or are thinking about drinking or using drugs. It’s also important to be honest with themselves.
Being honest with themselves helps clients discover their triggers. This can include a spouse, employer or old friend. Personal triggers may also include stressful situation or even times of fun and enjoyment. For example, not every person has the urge to use when angry
And other people may look at their drug of choice as a reward and so may be triggered when happy.
Understanding their triggers helps clients work with their therapist to find better options to tackle triggering situations. Catching themselves when personal triggers occur is part of the healing process from addiction and a solid foundation for a relapse prevention plan.
What Do I Do if I Have Relapsed?
Relapse is common. Treating addiction and rewiring the way that individuals react, as well as the difficult life changes that sobriety requires, means that over 50% of drinkers or drug users relapse. Many people may have multiple relapses before making a full recovery. (2)
Being prepared for the guilt and shame that is associated with breaking sobriety is the first step towards relapse recovery. The next step is to seek help. This may mean clinical therapy, addiction counselling, or going to meetings with other addicts in recovery.
Often, the addict may feel too embarrassed to admit that they slipped up and may not reach out for support. Depending on the length of the relapse — one day versus several weeks — more treatment may be in order. For individuals who relapse from alcohol or benzos, supervised medical detox may be necessary as withdrawals from these substances can be deadly.
What Is a Relapse Prevention Plan?
A relapse prevention plan is developed in treatment to identify personal triggers that start the slide from emotional through mental and bargaining relapse to the physical act of drinking or using the drug of choice. Having this plan in place before leaving treatment allows the client to explore their own emotions that trigger the desire to use.
A relapse prevention plan (RPP) includes brainstorming scenarios that may trigger the individual to use. There are five key components to a successful RPP. It starts with taking time for reflection and self-awareness as to why the individual chose to use. It could escape from stress, to relax and have fun or to deal with the pain of past trauma.
Next, the RPP includes personal triggers and warning signs. Once these are identified, then the client should develop a worst-case scenario plan and strategies to work through the situation without using. The fourth step includes involving others in relapse prevention, as having support decreases the feeling of isolation many clients experience. Finally, setting goals for a healthy lifestyle gives us purpose and meaning.
A solid foundation on which to build long-term recovery
When people descend into addiction, they often describe that time as a struggle because they had no foundation. This often means they feel like they have nothing to live for, no foundation to build upon and a deep loss of self-worth.
Essentially, a you may feel like life doesn’t matter anymore, and when you finally decide to begin the journey of recovery, you would have to first start on solidifying your own foundation. And like building any structure, the foundation is the first thing you and your therapists will put down.
How to develop a relapse prevention plan
Developing the relapse prevention plan may be best to do in partnership with a therapist. The most important thing is to honestly identify the triggers that led to drinking or using drugs. The client and therapist discuss things that trigger the client and specific situations where the desire to drink or use drugs increases.
RPPs vary with each individual, but more successful ones include actionable plans for stressful situations and an honest look at your personal emotions, including guilt and shame, that accompany triggering situations.
What You Will Learn about Relapse Prevention in Rehab
One thing that many clients discover in recovery is to take each day one at a time, focusing on mindfulness and choosing healthy behaviours. Clients in recovery learn about the three stages of relapse: emotional, mental and physical. They’re encouraged to journal when they feel triggered, including acknowledging their feelings and struggles.
Those who don’t continue with aftercare upon leaving rehab run a greater risk of relapsing. Each day is a series of small decisions that add up to sobriety, and many clients will learn how to make small changes to develop a sober lifestyle.
Properly Managing Your Sober Time
Using drugs and drinking takes up a lot of time. For many newly sober people, the empty hours may lead them to boredom and loneliness. These emotions can trigger the desire to drink or use drugs, to pass the time.
Choosing an engaging hobby or taking time for self-improvement is an important part of relapse prevention. Managing sober time means putting new habits into place. Planning their day can help clients feel a sense of control and security, taking ownership of their sober life.
Part of addiction is avoidance, including avoiding uncomfortable emotions and numbing feelings of anger and boredom. Part of building a healthy, sober life includes learning the art of mindfulness. This means that the individual is present in each moment, enjoying times of happiness and activities that give them pleasure as well as consciously working through times of anger, fear and unpleasant emotions.
Mindfulness practice can help with relapse prevention by teaching individual strategies to relax without using drugs or drinking. These include breathing exercises and encouraging stillness, noting each moment and being aware of our surroundings. Making mindfulness a habit can give you a safe, healthy way to take time for yourself if you feel you have to take on a challenge.
Physical Therapy and Healthy Eating Habits
Eating well and drinking plenty of water can help the body rebuild after drug and alcohol rehab. By making time for exercise, as well as nourishing the body, it’s easier for the brain to heal from the effects of alcohol and drug use.
Regular exercise is shown to boost feelings of well-being and help decrease stress, both of which may make it easier for clients to stick to their RPP. Typically, a healthy diet can also help the client feel good about taking care of themselves. Cooking healthy food from scratch instead of eating junk or take-away may also help fill the client’s sober time.
The Role of Counselling in Relapse Prevention
Aftercare and counselling, after the client leaves rehab, are critical to their overall success in sobriety. Regular counselling sessions can help clients pinpoint stressful situations as well as safely tweak their RPP as needed. They may find that there are unforeseen triggers in their life. Working with a counsellor to address these issues and incorporate better ways to handle the emotions that the situations bring up is part of an honest RPP.
Counsellors also give the client a safe space to talk about their emotions and provide support when the person feels like drinking or using drugs again.
Choosing a Treatment Centre for a Safe Relapse Prevention Plan
Selecting the right place for treatment depends on the individual. Some people do well with an inpatient centre, while others prefer ongoing intensive therapy as outpatients. Better treatment centres don’t simply detox the individual from their drug of choice but help each person build a sober, enjoyable lifestyle that reduces the triggers that cause a relapse.
For clients who have a dual diagnosis, such as addiction and depression, treating depression and anxiety may help the relapse prevention plan succeed. Other clients may have mental illnesses and are self-medicating with alcohol or drugs.
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Residential treatment centres vs outpatient services
Some clients may feel more secure with residential treatment centres, detoxing under medical supervision and getting through the early stages of sobriety safely tucked away from triggers in their regular life. These treatment centres include group and individual therapy as well as a safe, drug-free environment.
Outpatient services include intensive therapy, where clients attend meetings and counselling sessions. Often, the clients are tested once or twice a week to ensure that they’re maintaining their sobriety. This may be a better option for those with children or other obligations in their lives, where they can’t simply pack up and stay in a treatment centre for days or weeks.
Private medical detox centres and confidentiality
Private medical detox from alcohol and drugs is covered under patient privacy acts. Private centres may cost more money and not be covered by the client’s insurance. Confidentiality includes protecting the client’s privacy and dignity, working through addiction issues without shame or judgment.
For many people, seeking professional treatment may make them feel like their relationships or employment may suffer. Many individuals think that there is a stigma attached to being addicted to drugs or alcohol and that it’s a personal weakness. Seeking private, confidential treatment can help clients get the therapy and treatment they need in a safe space.
Treatment near home vs different city or county
Each individual may choose to seek treatment in their own community or to travel farther away. Some rehabilitation centres offer outpatient services for those who cannot leave their current situations. Other clients may find that going far away for treatment is better, as they’re farther away from triggering situations on their life.
Part of relapse prevention includes dealing with feelings of guilt and shame. For those in recovery, it can be hard to let others know that they’re working through addiction and that they were in rehab. For the clients who wish to refrain from making their treatment public, getting help farther away from home may be a better option.
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