Relapse Prevention: Strategies, Skills & Coping Techniques
Understanding Relapse: Why it Happens and How to Prevent It
Relapse is the return to substance abuse after being drug- or alcohol-free. It’s not uncommon for people who struggle with addictions to relapse after completing treatment, and it doesn’t mean treatment failed. Instead, a relapse signifies that additional and/or a different form of treatment is necessary. Understanding relapse, triggers, and treatment are important steps toward relapse prevention.
Why Does Relapse Happen?
Addiction is a chronic medical condition characterized by an inability to control substance use despite the harms it leads to.1 And addiction, or substance use disorders, affected more than 20 million Americans aged 12 and older according to recent surveying.2
Due to the chronic nature of addiction, relapse—the return to substance abuse after being drug- or alcohol-free—is often part of the disease. In fact, close to half of people who experience drug or alcohol addiction also experience relapses in recovery. Estimated to be 40 to 60 percent, the relapse rate for substance abuse is akin to the rate of relapse for other chronic medical illnesses, such as asthma, hypertension, and diabetes.3
Addiction is a brain disease and, as such, may involve disruptions to certain brain circuits and neural processes as a result of chronic drinking and/or drug use. Pathways involved in how a person feels pleasure and processes rewards, memory, and decision-making can be altered through substance abuse. With repeated use, alterations in brain chemistry and functioning can result in the development of substance dependence. Once a person becomes significantly physically dependent, withdrawal symptoms and drug cravings may be common side effects if drinking or drug use slows or stops suddenly. Someone who has grown dependent on a substance may not feel “normal” without it. Therefore, a return to drug or alcohol use may seem like a good way to get back to feeling OK, curbing withdrawal symptoms, and combating strong cravings.
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When is it Considered Relapse?
A relapse is a return to drinking or drug use after attempts have previously been made to stop. It can be both a single event and a process. Before getting to a full-blown relapse, however, a person may experience a lapse, described as the initial use of a substance after a period of recovery.4 The late addiction researcher G. Alan Marlatt, Ph.D., referred to a lapse as an abstinence violation. According to Marlatt, what matters after a lapse is the person’s emotional response to the violation. This response can be a good indicator of whether the individual will relapse.
Consider this: A recovering alcoholic goes to a party and has one drink. Their response? They’re upset with themselves for giving into temptation and think of ways to better cope in similar high-risk situations, such as bringing their own beverages, next time. This individual is more likely to learn from their mistake and return to sobriety the following day. On the other hand, if that individual feels like a failure who will never be able to stop drinking because of the lapse, their response indicates that they will be more likely to abandon sobriety and return to their unhealthy habits.
Depending on their emotional response, a lapse makes a person more aware of their triggers and helps them develop more effective ways to cope with similar trigger situations in the future, or it can lead them to return to problematic alcohol or drug use.5
Certain internal or external cues can activate the urge to drink or use drugs, increasing the risk of relapse.6 While triggers are unique to individuals, some common ones include:
- Peer Pressure
- Withdrawal symptoms
- Relationship issues
- Drug paraphernalia
- Certain physical settings, sights, and smells
The Stages of Relapse
Steven Melemis, an addiction medicine physician, in his writings about relapse prevention, indicates that relapse tends to be a gradual process with three distinct stages—emotional, mental, and physical—and starts even before the person resumes drinking or using drugs.
- Emotional Relapse: During this stage, the individual is not necessarily thinking about having a drink or using drugs, but they’re neglecting self-care. They might start to bottle up emotions, isolate themselves from others, eat poorly, and not sleep well.
- Mental Relapse: This stage becomes an internal tug-of-war and includes cravings for drugs and alcohol; nostalgic feelings for the people, places, and things associated with alcohol and drug use; and lying to themselves about the consequences that come with it.
- Physical Relapse: At this point, drinking and/or drug use begins and quickly escalates to an uncontrollable level.7
Treatment Programs Reduce Relapse Rates
Relapse can be an indication that treatment needs to be reinstated or adjusted. Sticking with treatment for the entire length of the program is important, too. Research supports a correlation between longer lengths of time in treatment and improved treatment outcomes.8 Adequate lengths of treatment may help to ensure that the full range of a patient’s unique problems and needs are addressed.
Professional treatment can help manage both the psychological and physical factors of addiction to promote recovery. To these ends, comprehensive substance abuse treatment programs often include both therapeutic and pharmacological methods to promote and sustain recovery while working to minimize relapse and manage use triggers.
As one of the mainstays of modern addiction treatment, cognitive behavioral therapy (CBT) is an effective tool for promoting relapse prevention and increased abstinence.9 CBT explores the way a person’s thoughts are related to actions, and the therapy can help modify negative thought patterns, thus positively affecting behavior.
Many successful treatment plans are specifically tailored to each individual. Relapse prevention and other treatment strategies may consider the person’s environment, level of motivation, severity of their addiction, co-occurring medical and mental health conditions, and other factors, too.
A person’s support system may also play an important role in recovery and the avoidance of relapse. Family counseling and therapy sessions may help loved ones to better understand the disease of addiction and learn to recognize potential relapse triggers and ways they can support in those instances. Communication skills and the overall family dynamic may improve through family therapy as well.
See if your insurance provider may be able to cover all or at least part of the cost of rehab.
Tips for Minimizing the Risk of Relapse
Outside of treatment, relapse prevention is not out of an individual’s control. Relapse prevention may benefit from each individual in recovery practicing self-care, seeking help, being honest, adhering to rules, and modifying potentially maladaptive habits.7 Here are some strategies to try:
- Eat a healthy diet.
- Get some quality sleep. Insomnia, sleep disturbances, and fatigue are commonly associated with both substance use and withdrawal. Not getting enough shuteye can be a potential trigger for relapse, too.10
- Exercise regularly. Though studies that have evaluated the impact of physical activity on the prevention and reduction of drinking and drug use behavior have netted somewhat mixed results, few would argue against exercise being a healthy outlet for stress reduction and overall wellness.11
- Consider other complementary and holistic methods for managing stress naturally, like yoga and meditation.
- Join a self-help group, attend meetings regularly, and actively participate. Studies have shown that individuals who received help and participated in a peer support group such as Alcoholics Anonymous (AA) were less likely to relapse.12
- Surround yourself with positive and supportive people.
- Ask for help when needed.
- Be completely honest with those in your recovery circle, including family members, doctors, counselors, self-help group participants, and sponsors.7
- Attend all therapy and counseling sessions.
- Take any prescribed medications or supplements as directed.
- Avoid people, places, or things that are tied to previous drug or alcohol use.
- Take up a creative endeavor, like painting, sculpting, writing, dancing, or playing an instrument.
- Keep the mind occupied.
Finding the Right Help for You
The path to sobriety is a long and difficult journey, and the process is different for everyone. While some may never relapse, others may relapse several times at some point during recovery. At American Addiction Centers, we offer a 90-Day Promise that gives you 30 additional days of complimentary treatment if you relapse after 90 consecutive days at one of our facilities. Whether you are going to rehab for the first time, or have relapsed in the past, we will work with you to find the best treatment plan for you.
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- American Society of Addiction Medicine. Addiction is a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences.
- Substance Abuse and Mental Health Services Administration. (2019). Key Substance Use and Mental Health Indicators in the United States: Results from the 2019 National Survey on Drug Use and Health.
- National Institute on Drug Abuse. Drugs, Brains, and Behavior: The Science of Addiction Treatment and Recovery.
- U.S, Department of Veterans Affairs. Reducing Relapse Risk.
- Larimer, Mary E., Ph.D., Palmer, Rebekka S., and Marlatt, G. Alan, Ph.D. (1999). Relapse Prevention: An Overview of Marlatt’s Cognitive-Behavioral Model. Alcohol Research and Health, 23(2), 151-160.
- Melemis, Steven M. (2015). Relapse Prevention and the Five Rules of Recovery. Yale Journal of Biology and Medicine, 88(3), 325-332.
- National Institute on Drug Abuse. Principles of Drug Addiction Treatment: A Research-Based Guide Principles of Effective Treatment.
- McHugh, R. Kathryn, Hearon, Bridget A., and Otto, Michael W. (2010). Cognitive-Behavioral Therapy for Substance Use Disorders. Psychiatric Clinics of North America, 33(3), 511-525.
- Brower, Kirk J., M.D. and Perron, Brian E., Ph.D. (2011). Sleep Disturbance as a Universal Risk Factor for Relapse in Addictions to Psychoactive Substances. Medical Hypotheses, 74(5), 928-933.
- Moos, Rudolf H. and Moos, Bernice S. (2006). Rates and predictors of relapse after natural and treated remission from alcohol use disorders. Addiction, 101(2), 212-222.