Relapse Prevention

 Relapse prevention describes the process of developing skills to continue health-promoting behaviours and avoiding old patterns of harmful behaviour. Relapse prevention includes a range of goals about making choices to reduce the harmful consequences of substance use.

Stages of Relapse:

1. Something happens
Sometimes referred to as a “trigger,” it can be an event, feeling, situation, or person. It can be anything—good or bad, inside or outside you. A bad day at work, running into an old friend who uses, or achieving a goal and feeling proud and hopeful are all examples of triggering events.
2. You interpret it
The triggering event elicits a core belief that you hold about yourself. This often comes in the form of a message that you say to yourself, consciously or subconsciously. Each person has a unique message, but examples are statements such as “I am a complete failure,” “I don’t deserve success,” or “I deserve to celebrate.”
3. Cravings
Your interpretation leads to cravings. Cravings are the psychological and physical desire to engage in your old, harmful behaviour. (This may be smoking a cigarette, having a drink, going to the casino or any other harmful behaviour you want to avoid).
4. Permission-giving thoughts
Your cravings could lead to ”allowing thoughts” where you give yourself permission to engage in the old behaviour. These thoughts can take many forms. A few examples might be: “I need to smoke a joint to calm down,” “I’ve been exercising pretty well. This weekend I’ll just sit in front of the TV,” “I deserve to treat myself, I’ve had a bad day,” or “I have not been drunk for three months. I’m strong enough to handle going to that party.”
5. Action
At this point in the process you take the steps necessary to engage in the old pattern, or give yourself an excuse for not engaging in your new pattern. Examples could be calling your old dealer, stocking up on beer for the weekend, “dropping in” on a friend you know is always supplied, or inviting a friend over so you cannot make it to your exercise class.
6. Harmful behaviour
You finally engage in the old pattern, such as using a drug you had been abstaining from, getting drunk at a party, or wasting the weekend in front of the TV.

Avoiding Relapse

The most important thing you can do to avoid relapse is to develop a plan so you can achieve your health goals. A significant part of this plan, particularly early in the recovery process, is minimizing your risks for relapse.
Address high-risk situations
Just about anything can create risk of relapse. Areas of highest risk will differ from person to person. The first step in developing your relapse prevention plan is to begin identifying situations or circumstances that hold the highest risk factors for you.
High-risk situations can be internal or external in origin.
Examples of internal risk situations:

• feeling depressed, bored, lonely or tired
• being excited at the end of the day on payday
• feeling proud of an accomplishment achieved

Examples of external risk factors are:

• an argument with your partner
• a call from an old “using” friend
• money stress
• hearing a radio commercial
• a sporting or social event

As you reflect on your own life, it is a good idea to make a list of situations that increase your risk of relapse. Ask yourself these questions:

• What things are most likely to happen in your life?
• What circumstances or events have been associated with your harmful behaviour?

Your risky situation list doesn’t need to be inclusive at this point; listing the first five or 10 that come to mind is a good place to start.
Next you develop a plan for each of your personal risk factors. Your plan should be very specific, and can consist of more than one response to each situation you have identified. Here is an example of how this might look:

• Phone call from Bob: I will state my abstinence commitment, and tell Bob I cannot see him any longer; I will take a clean friend with me and meet Bob for 30 minutes only.
• Feeling depressed: I will go for a 30-minute walk; I will call people on my phone list, until I reach someone to talk to; I will write a list of 10 things that I am grateful for.

Developing a written plan helps you reach your health goals in several ways. It gives you an opportunity to commit your actions in writing to yourself. It allows you to be prepared, thus increasing your sense of control over your own life. It also minimizes the likelihood that you will be caught off-guard, which can be the most dangerous time for a relapse to occur.

Quick tips for relapse prevention: Handle day-to-day feelings and problems as they happen. This way, pressure and stress don’t build up. Keep your life in balance. This reduces stress and helps you find enjoyment again with friends and family, without alcohol or drugs. Try new activities, reward yourself for small successes, and eat nutritious food. Gain support and trust. Family, friends, coworkers and counsellors can help you watch for warning signs, handle stress and support your goals. Identify and plan for high-risk situations. Plan ahead what you will say and do and have several back-up strategies in case one doesn’t work. Realize that the most effective coping strategies will often be the ones you think of yourself, and that they will change over time.

Ways to Support Your Recovery

While relapse prevention work is critical to changing unhealthy behaviours, it is also important to build positive skills and patterns of behaviour that support your healing process. Here are some simple suggestions:

• Healthy eating. If you eat well-balanced, nourishing meals, your body will be better prepared to deal with daily stresses.
• Get enough sleep. Sleep gives your body time to strengthen and rebuild and allows you to be clear-headed and functioning at your best.
• Exercise regularly. Exercise has many health benefits including building strength, increasing stamina, and lowering the risks for many health conditions. Exercise also helps to flush out toxins and increases levels of endorphins, or “feel-good” hormones, both of which are beneficial to relapse prevention.

• Stay connected. It is important to have positive social contacts in your life, both on the phone and in person. Work at building a network of people who support your recovery goals, and include them in your recovery plans.
• Practice meditation or relaxation skills. Stress, anger, frustration or boredom are all potential risk experiences. Relaxation skills are great ways to combat negative feelings.
• Journaling. Writing down your thoughts, experiences and discoveries can be a powerful practice. • Self-monitor. It can be useful at the end of each day to evaluate how you are doing. What went well? What would you have liked to have done differently? What did you accomplish today? What feelings did you experience throughout the day? These kinds of questions can be useful to continue to shape your plan for recovery.
• Understand cravings. It is important to understand that when you experience physical cravings, the chemicals in your brain are involved. These chemicals can change in the same way they do when you use your drug of choice. Therefore, you may feel like you do either right before, or during substance use. It is important to understand this, and to know that these feelings will pass in a short period of time. When you experience cravings, it is most important (as with high-risk situations) that you have a clear plan for response.
• Reward yourself! It is crucial that you recognize the hard work it takes to make changes in your life. You need to honour your efforts. A nice meal out, a new CD, a bubble bath or an hour at your favorite hobby are examples of rewards you can provide for yourself.
• Keep slips in perspective. If you do succumb to old patterns, make the most of this experience. While it is important to recognize the serious impact this can have on your recovery, it can be used as a valuable opportunity to evaluate where you may not have planned or acted carefully enough. You can use this experience to strengthen your recovery, if you choose to do so.

In case of relapse, remember:

• swift admission of relapse should be looked upon with respect
• relapse indicates a need for stepped-up support and possibly increased intensity of treatment
• relapse always indicates a need to review and revise the relapse prevention plan to see what triggers, warning signs, and key people were missed