Drug Relapse Prevention

Addiction can be an ongoing struggle for many people, even after they complete an intensive treatment program; periodic relapses are not uncommon.  Relapse-prevention planning is crucial, then, for maintaining long-term sobriety.  Addiction can be an ongoing struggle for many people, even after they complete an intensive treatment program; periodic relapses are not uncommon.  Relapse-prevention planning is crucial, then, for maintaining long-term sobriety.
In its simplest terms, relapse occurs when you have abstained from using drugs for any period of time and then use again. This use may be a brief, one-time lapse in abstinence, which is often called a slip, or it may be a binge that involves using drugs in large amounts or repeatedly. In either situation, relapse does not mean you cannot get back on the road to recovery. However, it may indicate that underlying issues are not being managed effectively or that you could benefit from recommitting yourself to your sobriety.
The first six months of recovery is when a large percentage of relapses occur—studies demonstrate that between 66% to 80% of relapses occur in the first 6 months after treatment.  Relapses can be motivated or influenced by changes made previously to the brain during active drug use, or by the experience of uncomfortable feelings, pain, stress, or a combination of these factors. With this in mind, creating a solid drug relapse-prevention plan before you leave inpatient treatment is a great proactive step to protect your sobriety.

CONTRIBUTING FACTORS TO RELAPSE
Any number of factors may play a contributing role in a relapse, so part of a successful drug relapse-prevention plan is knowing and recognizing the signs of specific high-risk situations and applying effective relapse-prevention skills to maintain sobriety. Common contributing factors to relapse may include:
Emotional or mental health issues: Negative emotional states such as depression, anger, anxiety—or even boredom—often create high-risk situations associated with relapse. You may use drugs to avoid experiencing these uncomfortable emotions. An unmanaged mental health issue can be one of the highest risk factors for relapse.

Conflict: Situations involving conflict with other people can leave you feeling anxious and upset, which could eventually lead to relapse. Social pressure: Social pressure includes both verbal and nonverbal pressure from friends or people in your social circles. This pressure may seem harmless, such as being around people who are using drugs, or it may be direct, such as a friend teasing you about not using. Any social situation where drugs are being used makes it easy for you to relapse—avoid them at all costs.

Celebrations or other positive events: Weddings, sporting events, graduations, and other special events— generally viewed as positive activities, yet ones that are often associated with alcohol or other substance use and may therefore play a large role in relapse. You may have used drugs to celebrate or to enhance positive feelings, so be aware of this as another risk factor in relapse.

In many cases, the path to relapse occurs long before you actually use drugs, so a vital component of relapse prevention is to learn how to detect the early warning signs of potential problems that might steer you toward relapse. By identifying these factors, you can take positive steps to remain on your path to recovery. And the better you are at spotting the signs of possible relapse, the earlier you can take action to ensure long-term sobriety.
Many people identify the following warning signs as issues that will challenge their sobriety:

  • Frequenting old using grounds or hanging around drug-using friends – Keeping drugs in your home for any reason
  • Isolating yourself from friends or support groups – Constantly thinking about using drugs
  • Quitting therapy, skipping scheduled appointments, or veering away from your addiction treatment program
  • Overconfidence or feeling as though you no longer need support – Relationship conflicts
  • Being too hard on yourself or setting impossible goals
  •  Abrupt or sudden changes in eating or sleeping habits, personal hygiene, or energy levels
  • Feelings of confusion, depression, uselessness, anxiety, stress, or being overwhelmed
  • Boredom or irritability, usually stemming from a lack of structure
  •  Refusing to deal with personal problems related to daily life events
  • Replacing drugs with other obsessive behaviors such as gambling
  • Major life changes that cause intense emotion such as grief, trauma, or extreme elation
  • Thinking that “just one time” won’t hurt – Physical illness or pain

It is not uncommon for you to relapse at least once during recovery. It may happen when thoughts of using drugs resurface in the early stages of recovery. Changes in your attitude, behavior, thoughts, feelings, or disruption to routine can be early warning signs of an impending relapse. Developing and following an effective relapse-prevention plan can help stay ahead of a relapse.

TIPS FOR SUCCESSFUL RELAPSE PREVENTION
While in early recovery, you may experience warning signs of relapse. However, relapse is not inevitable. There are many effective ways to prevent relapse, such as: Since drug use can alter brain pathways and impair your ability to regulate emotions and deal with stressful situations, to prevent relapse, it is important to learn how to deal with all of your emotions, both positive and negative.

Ignoring day-to-day problems can create a buildup of stress, which can increase the likelihood of relapse. Because stress is a huge relapse trigger, it is important to learn how to maintain a balance in your life. An essential component of drug-relapse prevention, then, is to find ways to balance work and relaxation. This can include incorporating hobbies, exercise, socialization, or other enjoyable activities that can help you lower your stress levels and discover that life in recovery can be fun.

Learn how to manage high-risk situations. Weddings, holidays, or even spending time with family and friends can be triggering. Avoiding high-risk situations isn’t always possible, so it is important to plan ahead for how you will deal with them. Urges will occur, so part of a relapse-prevention plan is learning how to ride out the urge until it passes.

Urge-surfing focuses the mind on experiencing the feelings of the urge, both physical and mental, and allowing you to distract yourself from thoughts of using. Building a sober support group is vital to your recovery. Friends, family, addiction professionals, and sober peers can all become part of your support group to help you maintain sobriety.

HIGH-RISK SITUATIONS
As we discussed before, identifying high-risk situations and mapping out a plan to deal with them is an essential component to your relapse-prevention plan. This is a great task to work on with your therapist as you work through all the potential landmines on your road to long-term recovery.

Begin by asking yourself several key questions to identify your personal high-risk situations:

  •  Are there specific days you used drugs, such as holidays or weekends, or were you a daily user?
  • Are there specific times of day when you experience cravings most often? –
  • What specific locations are associated with your drug use?
  • Who have you used drugs with in the past?
  • Have you ever used because of your emotions? Which ones?
  • What positive effects have you experienced from using drugs?
  • What negative consequences have you experienced from using drugs?

The best relapse-prevention strategy is to identify these situations in your life, then make sure to have a specific plan in place to deal with each one. Ask a supportive friend or family member to role-play ways to refuse or avoid drugs, so that it feels comfortable and natural. Many recovering individuals find that bringing a member of their sober support group to what they know will be a challenging situation can make it easier to stay abstinent. Having an escape plan from one of your identified triggering situations (parties, a specific person’s house, a neighborhood restaurant) is also helpful so that you can leave if others start using or you start to feel a strong urge to use. Offering to be a designated driver can also help you stay sober and maintain control of the situation.

NEGATIVE FEELINGS AND CRAVINGS
People in early recovery are often taught that they are more likely to relapse when they are hungry, angry, lonely, or tired—otherwise known as the acronym, HALT. Stress and other negative emotions can also increase your cravings to use.
Experiencing uncomfortable feelings, such as fear, boredom, anxiety, stress, anger, frustration, or sadness are especially difficult when you are in early recovery, making it appealing to turn to your drug of choice to manage these feelings.
So learning how to regulate your emotions appropriately is another essential feature of an effective relapse-prevention plan. A few ways to help you regulate your emotions is speaking to a support group, exercising, or practicing other distraction techniques, such as reading, watching television, or listening to music while the feelings pass. Following a healthy daily routine can also help you reduce stress, so focus on managing your small daily stressors, eating a healthy diet, and getting adequate amounts of rest.

SPECIFIC ACTIONS TO COPE WITH CRAVINGS After identifying situations where problematic cravings may arise, list the specific steps you will take to manage them, including:

  • Listing the names and phone numbers of supportive friends or family who you can speak to about your cravings. Ideally, choose people who won’t judge you for experiencing a craving but can be encouraging and supportive. Speaking to others in recovery can help you gain insight into how others successfully manage cravings.
  • Reaching out to a member of your support group. They can help change your perspective and talk you through the craving, or just keep you company until is passes.
  • Preparing to distract yourself so that you aren’t focused on the craving. Healthy distractions may include cleaning, exercising, meditation, or anything else that will take your mind off the craving. While it feels interminable, cravings will eventually pass.
  • Keeping a record of the successful ways you’ve coped with past cravings, and referring to this often.
  • Switching your focus from the craving and thinking about all the positive experiences or growth you have made. List all the things you are grateful for.
  • Writing down a list of all of the negative consequences you have experienced due to your drug use, and if you have an urge, referring to this list to help remind you why you no longer use.
  • Planning out each step you need to take to reach these goals is worth the time you invest in doing it  because reaching these goals means actively building up safeguards for your recovery, rather than just hoping that challenges won’t arise. Celebrate your small milestones too. Self-help meetings are great at helping you do this and providing incentives to stay clean, such as coins or key tags earned for increments of sobriety. Surround yourself with people who celebrate with you.

SPECIFIC THOUGHTS TO COPE WITH CRAVINGS

Training your mind to think positive thoughts is an important step in managing cravings and drug relapse prevention. A few ways to do this include:

  • Remembering how bleak things seemed when you were using drugs.
  • Thinking about the reasons you stopped using drugs and referring to the list of negative consequences that your drug use has caused.
  • Reminding yourself that your cravings are a normal part of recovery and that you do not have to give into them.
  • Visualizing the cravings as waves that you have to ride out. Urge-surfing is a technique that focuses your mind on the physical and mental experience of the craving, rather than giving in to the urge to use.
  • Being positive. Encourage yourself by remembering your successes each time your cravings become intense.

Planning out each step you need to take to reach these goals is worth the time you invest in doing it because reaching these goals means actively building up safeguards for your recovery, rather than just hoping that challenges won’t arise. Celebrate your small milestones too. Self-help meetings are great at helping you do this and providing incentives to stay clean, such as coins or key tags earned for increments of sobriety. Surround yourself with people who celebrate with you.

COPING WITH RELAPSE

While having a relapse prevention plan in place is important, it does not guarantee sobriety. In fact, relapse is often considered a natural part of recovery. Even though you may know this, when you do relapse, you may be overwhelmed by feelings of guilt, shame, frustration, anger, or fear. If these emotions are not dealt with properly, the relapse can become a full-blown reversal into regular drug use.

Instead, try to view a relapse as a signal that you could use additional treatment to support your recovery efforts. You may also discover that an underlying mental health issue is affecting your sobriety and can work toward treating it. Either way, don’t try to manage alone. Reach out and ask for the help you need.

With your therapist, sponsor, and support group, recommit to your sobriety, talk through your struggles, and if needed, seek a treatment program. Managing the aftermath of a relapse is difficult, but support is available to help you normalize your experience and encourage you to get and stay sober.

It helps to remind yourself that no matter how stressful things get, or how bad your life may seem, the benefits of abstaining from using drugs outweigh the short-term relief you might gain from using again. Recovery is a long-term process, and the cravings, risk of relapse, and uncertainty will fade with time. Relapse-prevention planning means finding new ways to deal with life and all that it brings.

Your Complete Guide to Relapse Prevention

The risk for relapse is so high that it is often considered an intrinsic part of the addiction recovery process. But, after a full-blown relapse, going back to treatment a second (or third or fourth) time can be even more difficult than the first time. Some may never give themselves a second chance at sobriety, which is why relapse prevention is a critical aspect of recovery from drug addiction.

But relapse is a scary thought. How can you go from fearing relapse to actively preventing it? First, you must take time to understand what a relapse is, the warning signs that you are headed for relapse, and actions you can take in your daily life to stay healthy and addiction free.

What is a Relapse?

As a chronic disease, addiction is prone to relapse. Addiction relapse is the return to actively using your substance (or process) of choice after a period of abstinence and improved health. Relapse occurs when old patterns of thinking, behavior, and ultimately drug use completely take over.

A relapse occurs in stages — it is not simply the event of taking that first drink or drug after time in recovery. Changes in thinking, emotions, and behavior occur days, weeks, or even months before a physical relapse. That is where relapse prevention comes in. Recognizing and taking action against early symptoms of relapse will help you minimize their impact on your recovery and prevent a full-blown relapse from happening.

Relapse Warning Signs

Before active drug seeking behavior occurs there are emotional and mental warning signs that you should train yourself to recognize. If you’re not aware of the early warning signs and symptoms they can quickly become a slippery slope back to addictive behavior.

Emotional warning signs:

  • Feeling unhappy or depressed
  • Feeling anxious or restless
  • Feeling resentful or angry
  • Poor eating and sleeping habits
  • Isolating self from groups and activities
  • Not asking for help
  • Difficulty concentrating
  • Neglecting healthy habits

Mental warning signs:

  • Thinking about people, places, and things associated with past addiction
  • Missing old “friends”
  • Feeling resentful or angry
  • Reminiscing about past use
  • Lying
  • Fantasizing about using
  • Returning to old hangouts

Catching yourself early on and utilizing your relapse prevention plan as soon as you experience warning signs is imperative for your continued recovery.

Creating a Relapse Prevention Plan

Change requires time and practice. Creating a sober lifestyle for yourself will not just happen on its own; it takes planning and action. A relapse prevention plan is your personal guide to how you will recognize symptoms of relapse when they occur and actively prevent relapse from happening.

It is normal to experience cravings, as well periods of confusion, sadness, and loneliness in recovery. A major part of recovery is learning how to cope with life without using drugs, alcohol, or addictive behaviors. If you do not have a plan in place to deal with stress, emotions, and triggering situations it will be all too easy to revert to old coping mechanisms.

With a relapse prevention plan you are planning for success. Each individual’s relapse prevention plan will be tailored to his or her specific needs, but can generally include three major categories: recognizing warning signs and managing triggers, adopting healthy lifestyle habits, and seeking support.

Step One: Avoiding triggers and recognizing warning signs.

riggers are the thoughts, feelings, and situations that bring back an urge to use, or remind you of your addiction.

First make a comprehensive list of the people, places, sights, sounds, smells, or behaviors that may be triggers for you. These could include driving past an old neighborhood, hearing a song you used to listen to while drunk or high, running into an old using friend, or even staying up too late.

Sometimes triggers are not so obvious — like getting a promotion at work, which could trigger an urge to celebrate with alcohol, drug use, or gambling. Triggers do not have to be external events — feeling stressed, exhausted, sad, or lonely can also trigger a desire to use.

In all cases, once you have a list of possible triggers for you make a plan for what you will do when you encounter them. You can actively avoid some triggers like driving past your old hangout, while others – such as seeing an ad on television – are unavoidable. If you are having trouble coming up with a list on your own, ask your sponsor or someone close to you to help. Once you’ve got your list, you must learn how to deal with these triggers.

Things you can do to avoid or manage triggers:

  • Change your route to avoid passing locations that could trigger you
  • Keep a list of phone numbers of people you can call if feeling triggered
  • Keep a written reminder of why recovery is important to you in your wallet
  • Avoid high risk situations such as becoming tired, hungry, and lonely
  • Practice relaxation techniques
  • Practice healthy distraction: take a walk, read a book, call a friend
  • Practice self-care by keeping healthy eating and sleeping habits a priority
  • List at least three people you can talk to if you slip into old patterns of thinking, start feeling anxious and depressed, or are struggling to keep up with your recovery plan

While external triggers are important to plan for, internal warning signs — that is the changes in thoughts feelings and behavior listed above; are equally important to take note of and plan what you will do when they occur.

For each trigger and warning sign list how you will know you are feeling triggered and what you will do right away to avoid succumbing to relapse. Make a detailed written plan — having vague ideas about what you will do is often not enough.

Step Two: Create healthy habits.

You can use your diet and lifestyle to keep your life in balance and prevent yourself from slipping into the early stages of relapse. Filling your schedule with healthy activities will keep you from becoming bored which can trigger drug seeking behavior.
Stress prevention is one of the main goals of keeping healthy diet and lifestyle habits.

Your relapse prevention plan should include what lifestyle changes you need to stick to in order to be successful in recovery. Some ideas include:

  • Eat 3 meals a day. Plan meals and snacks in advance to avoid becoming too hungry.
  • Avoid consuming too much sugar and caffeine
  • Drink lots of water
  • Make getting enough sleep a priority. If you struggle with sleep talk to your doctor.
  • Incorporate exercise into your day
  • Practice mindfulness meditation
  • Keep a journal: this will help you track your thoughts and mood and notice changes
  • Practice gratitude
  • Start a new hobby

In order for your plan to be effective you have to follow it. Keeping a written reminder of why recovery is your number one priority can help motivate you to stick to your healthy lifestyle choices.

Step Three: Having a support system.

You cannot beat your disease alone. Having a solid support network is crucial for relapse prevention. When you neglect having a sober support network you can be sure that your recovery is in danger. For many, the support of AA or another recovery — based group provides a lifeline when life gets difficult and recovery seems impossible. You may need to attend several groups to find one that resonates with you.

Your relapse prevention plan should also include a list of people you can call when you feel triggered or start to slip into old patterns, and people who support and participate in healthy activities with you.

Ways to build a good support network:

  • Join a recovery group and attend often
  • Get a sponsor
  • See an addiction or mental health counselor
  • Get an exercise partner
  • Share your recovery with close friends and family and enlist their support

Be specific with people you know about how they can support you. Tell them when you start to feel down or ask them to call you out on behaviors you know are not healthy for you — Such as not getting enough sleep or neglecting meetings.

In order to stay sober, actively preventing relapse is imperative. Talk to an addiction counselor, family, or friends about your plan so they can help you in preventing relapse.

If you do find yourself struggling with symptoms of relapse, or moving into a full – blown relapse – you are not a failure, but you may need to visit an addiction treatment center to get the support and help you need to get back on track with your recovery.