How to Prevent Relapsing
It is perhaps the greatest accomplishment someone suffering from addiction can achieve – beginning and maintaining his or her recovery journey. However, the reality of the disease of addiction means anyone in recovery should have a well-laid out plan and techniques for relapse prevention.
Many in recovery or considering entering recovery see it as a ‘one time shot.’ They believe that success will be measured in their ability to get sober and stay sober on the first try. Unfortunately, this is an unrealistic standard to hold one's self to. While maintaining complete sobriety for life after entering recovery is not unheard of, 40-60% of individuals treated for substance abuse disorders experience some manner of relapse.
This is further evidence of addiction being a disease – other chronic diseases like hypertension and asthma exhibit similar relapse rates. And like those other diseases, a relapse is not a failure by the patient, nor is it a sign that treatment ‘will not work for them.’ Rather, it is an indication that either the treatment needs to be followed more conscientiously – or if it was, that the treatment may need to be modified or changed to a completely new model. Management of addiction requires both continuous treatment of the disease and the ability to understand and recognize the signs of an oncoming relapse. While millions of brave individuals resume their battle with addiction after a relapse annually, the best case scenario is being able to prevent a relapse entirely.
Recognizing the Signs of Relapse
It is not uncommon to hear a person facing addiction say something along the lines of: “I don’t even want to think about preparing for a relapse because I’m just not going to have one.” While this is an admirable sentiment, not having a relapse prevention plan is one of the worst decisions someone in recovery can make. Learning to recognize an oncoming relapse and having techniques on hand to prevent it does not make it more likely the relapse will happen – but not having these tools certainly does. The fact remains that a relapse is actually a recognized stage of the cycle of addiction.
The Cycle of Addiction
- Initial Use
- Abuse – Using a substance on a recurring, improper basis in a way that is harmful.
- Tolerance – The original dosage no longer produces the same level of desired effect and dosage or frequency is increased.
- Dependence – The brain or body can no longer function properly without the substance.
- Addiction – Referred to as a substance use disorder in the mental disorder diagnostic manual, the DSM-5, diagnosis of this requires displaying at least 2 specific symptoms from a list of 11 which includes “spending a large amount of time using drugs/alcohol, or doing whatever is needed to obtain them,” “continuing the use of a substance despite health problems caused or worsened by it,” and “experiencing withdrawal symptoms after stopping use.”
- Abstinence – This may be achieved by going into a recovery program or attempting to do so on their own.
A relapse prevention plan prevents a person in recovery from entering that last stage of the addiction cycle and going through or partially going through the cycle once again. Before getting into the signs of an oncoming relapse, we should first look at some common triggers that can instigate a relapse.
Common Relapse Triggers
Just like with usage before entering recovering, and arguably any human responsive behavior, relapse triggers (stimuli that push an individual toward using) vary from person to person. Something that is extremely likely to trigger relapse behaviors in one person may have absolutely no effect on another’s sobriety. Triggers can be separated into two kinds – environmental and mental/emotional/physical.
- Environmental – these are triggers associated with previous drug use
- Seeing drugs or alcohol
- Being in an environment where alcohol and/or drugs are being consumed
- Media (a movie, song, picture etc)
- Mental/Emotional/Physiological – these are triggers due to thoughts, emotional states, and physical feelings
- Withdrawal and post-withdrawal symptoms (nausea, anxiety, pain and weakness etc)
- Lack of self-care (lack of sleep, poor eating habits, lack of mindfulness)
- ‘Negative’ or unwanted emotions (anger, loneliness, fear etc)
- General stressors (money, relationship troubles, work etc)
Knowing your triggers allows you to avoid them as much as possible, thus increasing your chances of staying sober. However, despite your best attempts, something may eventually trigger the start of a relapse. To prevent this relapse from occurring, it is necessary to recognize when a relapse is about to happen or happening. Like the overall addiction cycle, there are stages in the relapse process.
This is the earliest relapse stage. At this point, you are most likely not even consciously thinking about abusing drugs or alcohol, at least not more than you usually would. Instead, your emotional state and habits will begin to change. These include:
- Mood swings
- Not asking for help
- Not going to meetings
- Poor eating habits
- Poor sleep hygiene
At this stage, you are now consciously thinking about using. At the beginning stage, the thoughts may be fleeting and you may be able to dismiss them with relative ease. However, as this stage progresses, the thoughts can become overwhelming. Signs of mental relapse include:
- Repeatedly thinking about people and things associated with past use
- Glamorizing your past use
- Fantasizing about using
- Obsessively thinking about relapsing
- Denying and lying about these thoughts
- Pathologically lying unnecessarily about mundane things
- Socializing with friends you used to use with
- Planning out how you would use without anyone knowing
An individual in recovery should immediately begin taking the appropriate steps (outlined below in ‘Relapse Prevention Techniques’) when any of these signs are noticed. The signs of emotional relapse may be missed in the chaos of everyday life, but persistent thoughts of using, no matter how brief, should always be addressed right away.
This is the final stage of a relapse, and in most cases, results in the actual occurrence of relapse. It is incredibly hard to prevent at this point, with real-world behaviors occurring including:
- Going to the bar or a liquor store to get a drink
- Contacting a dealer
- Approaching friends that use about using yourself
With the extremely low probability that a relapse will not occur at this stage, it is all the more important that the individual has techniques ready and implements them at the earliest possible time during the first or second stages of a potential relapse.
Relapse Prevention Techniques
Now that you have recognized that you are in danger of relapsing, you can institute the techniques that are part of your relapse prevention plan. There are techniques to deal with the specific stages of a relapse, but to prevent even getting to a relapse's beginning, there are some general guidelines an individual in recovery should adhere to.
- Understand why you used to begin with: Knowing that your drug use began to help you fit in socially, to deal with stress or because of a trauma suffered early in life is an important tool in preventing relapse. The likelihood of staying away from specific triggers is greatly increased when you are aware of the overreaching issue many of them will be associated with.
- Learn your triggers and how to recognize them: Getting more specific and being aware of the triggers that may put you at danger of relapse protects you against situations that may be triggering even though they are dissimilar to events around your original drug use.
- Discuss your disease with your employer and loved ones: While this can be difficult, it is also an important and effective safety net. Work can be extremely stressful, and most employers will be willing to make concessions (within reason) to help you avoid extreme stress. If they are aware of the disease, they are also likely to be willing to adjust your schedule so you can attend meetings. There are times you may miss possible triggers and warning signs. Employers, co-workers and loved ones who are aware of the situation can provide additional sets of eyes and ears.
- Live a healthy, positive lifestyle: Feeling tired, unwell, or despondent due to not taking care of your physical and mental health creates a fertile ground for relapsing. Engage in proper nutrition, get plenty of rest and exercise, and engage in activities that bring you joy and satisfaction.
- Have a clear plan in place: As always, have a well laid out, actionable plan in place should you begin to experience a relapse. While certain specifics will vary from person to person as you gradually learn your own needs and processes, below are some of the basic techniques to deal with the different stages of a potential oncoming relapse.
- Incorporate Contingency Management and Protective Triggers: In the simplest of terms, Contingency Management (CM) refers to the use of positive reinforcement in the context of recovery. When someone in recovery adheres to the rules of their program or exhibits otherwise healthy and productive behavior, they are rewarded. This can be a token of some kind, something more palpable like taking the person out for dinner, or simply heartfelt praise. These positive experiences, combined with actions such as attending group meetings, seeking out the help of a sponsor or loved one, and seeing a therapist create ‘protective triggers,’ which help combat the effects relapse triggers.
Techniques to Deal with the Emotional Relapse Stage
- Be Vigilant and Mindful –The beginning signs of the emotional relapse are subtle so to catch them as early as possible, you should at all times be mindful of your feelings and behaviors. After some time, it will become second nature and your chances of not progressing beyond this stage will hopefully increase.
- Practice Self Care, Increasing Focus Where Necessary –Taking proper care of yourself not only prevents but helps satiate feelings of anxiety, agitation, and hopelessness. As you notice trouble sleeping or poor eating habits, zero in on these and focus on correcting them.
- Reach Out/Resume Meetings –While you may not be in crisis, it doesn’t hurt to reach out to a trusted person and express that you have noticed these minor signs and are taking steps to stay on track. Saying it aloud helps you be mindful and accountable, while their positive reinforcement will be motivating. And if one of your telltale signs has been not attending meetings or going less often, immediately resume your previous schedule – it will be more difficult to do so further down the line.
Techniques to Deal with the Mental Relapse Stage
- Play the Tape Through –This is a technique widely used in recovery programs and by those in the recovery process. Put simply, it directs you to ‘play the tape through’ from that first drink or usage of the drug all the way through the consequences later that day to the next day, week and beyond to the inevitable terrible conclusion – be it back in the throes of painful addiction or worse. Often, we will not think beyond ‘having that one drink’, so actually doing so and being truthful that there is no such thing can help pull us back from the edge. It also forces us to admit other lies, like “no one will ever know” or “it’s not going to hurt anybody.”
- Tell Someone You Are in Crisis –And make no mistake, at this stage you are in a situation that must be taken seriously. As we have mentioned, when you get to the physical stage of seeking out a drug, it is often too late. So it is absolutely reasonable at this point to contact your sponsor, loved one, or fellow person in recovery and let them know about what is happening. Even if they do nothing but listen, it will begin to take away some of the power of the urges – which often seem much larger when you are in a vacuum with them alone.
- Stay Busy –While by itself this may not be sufficient, in tandem with these other techniques it is a necessity. Like talking about your urges, it is a technique designed to prevent the mental urge from growing within your isolated mind. You can call another friend to talk about anything, engage in an activity you enjoy, or simply go for a walk.
- Go to a Meeting –This combines the previous two techniques, and as a result, can be a very effective tool. Not only are you doing something and no longer alone with your thoughts, but you are also talking with people who understand completely what you are going through.
- Use the ’30 Minute Rule’ –It is estimated that individual cravings last around 15 to 30 minutes at most. Similar to, say, running on a treadmill, it can seem far longer. But keeping this goal in mind, you can string together activities to get you to that point. More often than not, you will suddenly realize that far more than 30 minutes have passed – and so has your urge that initially felt insurmountable.
- Use the ‘One Day at a Time’ Rule –This has unfortunately become a clichéd term due to its constant use, but it is a real and effective technique to be used during recovery and relapse prevention. When attempting to achieve any task, it is recommended you separate the whole into manageable parts. The more you may be struggling or looking at a potential relapse, the harder it is to look forward to a month, year or lifetime of sobriety. And that’s okay. Begin with the 30-minute rule – then an hour. Then until dinnertime. Eventually, you will have successfully gotten through the day.
Be Indulgent in Your Self Care –There is nothing more important than your sobriety and your health. Nothing. Therefore if you find yourself thinking about using and progressing toward a possible relapse, do everything in your power (short of harming yourself or others of course) to prevent this. If you feel sleeping in and canceling brunch plans is what you need to do, politely do so. If spending some extra money to buy yourself a luxurious spa day or your favorite meal will help, then go right ahead.
Techniques to Deal with the Physical Relapse Stage
- Consider Sober Living or Inpatient Treatment –At this stage, you are so close to a relapse, taking extreme action is your best bet. Many individuals do pull themselves back from the brink of relapse in this way. Contact your recovery center if you have one, track down the one nearest you if you do not, or call a helpline and get the necessary information. Once there, you and an addiction counselor can decide whether this is the correct step at the time.
Experienced and Caring Recovery Services and Relapse Prevention
Recovery from addiction is far from easy – in fact, it may be the hardest thing you ever do. Once you enter recovery, staying sober is a daily challenge as well.
At Clean & Sober Recovery Services, our mission is to help you succeed in this process through affordable, dignified and confidential care. Located in beautiful Sacramento, California, we help those in need through the entire process, from intervention and detox to residential inpatient treatment, intensive outpatient treatment, and even transitional housing when initial treatment is complete. If you or a loved one needs help overcoming an addiction, contact us today for a free and confidential assessment.
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