Relapse Prevention Therapy
Ending an addiction requires more than simply abstaining from drug or alcohol abuse by sheer force of will. In fact, willpower and good intentions are rarely enough to end an addiction in the long-term, according to the National Institute on Drug Abuse. 1 Professional help is almost always needed for successful recovery.
Relapse prevention is the overarching focus of a high-quality addiction treatment program. Any way you look at it, successful recovery is all about preventing a relapse, and that requires developing essential skills and
making positive changes in your life that help you find purpose, meaning and enjoyment in recovery. Relapse prevention is multi-dimensional and occurs via many pathways. A holistic treatment program utilizes a number of different therapies and interventions that help clients develop essential skills, learn a variety of relapse-prevention strategies and make essential lifestyle changes that reduce the risk of relapse.
What is Relapse?
Using drugs or alcohol after a period of recovery is known as a lapse, or slip-up. If the slip-up isn’t addressed quickly, it can lead back to brain changes that cause compulsive use despite negative consequences. When this occurs, the addiction has relapsed, or recurred. Relapse doesn’t happen overnight. Rather, it occurs in three stages over time.
The Three Stages of Relapse
Stage 1: Emotional Relapse
During the emotional relapse stage, you’re not consciously thinking about using again, but your emotions and behaviors are setting you up for a relapse down the road. Because you’re not thinking about using at this point, you may be in denial that you’re headed for a slip-up.
The signs of emotional relapse include:
- Bottling up your emotions
- Feeling isolated or lonely
- Skipping support group meetings
- Focusing on others’ problems and how they affect you rather than on your own problems
- Engaging in poor sleeping or eating habits
- Not taking care of your emotional, physical and psychological well-being
Poor self-care is a major trigger for relapse. An acronym commonly used in treatment is HALT, which stands for Hungry, Angry, Lonely and Tired. These are states that can signal an emotional relapse.
Stage 2: Mental Relapse
Mental relapse is characterized by a war going on inside your head: Part of you wants to use, but part of you doesn’t. The deeper you go into a mental relapse, the less resistance you have to using and the more you want to escape.
Signs of mental relapse include:
- Craving drugs or alcohol
- Reminiscing about the people you used to use with
- Thinking about places and things associated with your past use
- Increasingly frequent and insistent thoughts of using
- Minimizing the consequences of your past use
- Glamorizing past use
- Bargaining or thinking of ways to be able to control using, such as only on Fridays or just on vacation
Mental relapse ends with actively looking for relapse opportunities.
Stage 3: Physical Relapse
Physical relapse is the stage where the slip-up occurs. Physical relapse often begins with “just one” drink or “just one” instance of using drugs. But research shows that when people focus too strongly on how little they used during a lapse, they don’t appreciate the consequences of that one drink or instance of using.
Using just once often leads to obsessive thinking about using again and doing so can quickly snowball into a complete relapse, where you’re once again using compulsively despite negative consequences. Most physical relapses are relapses of opportunity and occur when you feel like you won’t get caught. An important part of relapse prevention is mentally rehearsing these types of situations and developing a plan ahead of time to address them before they lead to a lapse.
What Does Relapse Prevention Include?
Relapse prevention is a holistic endeavor that addresses a wide range of needs and issues to help you gain the skills you need to cope with the many triggers of relapse you’ll encounter in recovery. Combined, these therapies, interventions and services provide a holistic, dynamic and individualized approach to relapse prevention.
Traditional “talk” therapies used in treatment help you address a range of problems and needs. By working through a variety of issues, you will effectively reduce your need to use drugs and alcohol to cope with life’s unpleasantness.
Cognitive-behavioral therapy, or CBT, is the most effective and commonly used therapy in high-quality treatment programs. CBT focuses on negative thought and behavior patterns that keep you in a cycle of addiction and relapse.
CBT helps you identify self-sabotaging ways of thinking, including:
- All-or-nothing thinking, in which things are either utterly terrible or absolutely perfect.
- Disqualifying the positive, or rationalizing why something positive “doesn’t count.”
- Catastrophizing, or regarding all negative events as the worst possible thing that could happen.
- Negative self-labeling, wherein events lead you to attach a negative label to yourself- you regard yourself as hopeless, or a failure, or weak.
- Overgeneralization, or viewing a single negative event, such as a romantic rejection, as a never-ending pattern of defeat by using words like “always” and “never.”
- Mental filter, wherein you obsess about a single negative detail to the point where it obscures the positive.
- Jumping to conclusions, or interpreting things as negative even when there’s no evidence to back up this conclusion.
- Magnification, wherein you exaggerate the importance of your problems and minimize the importance of your good qualities.
- Personalization, or holding yourself personally responsible for events that aren’t completely in your control, leading to feelings of guilt, shame and inadequacy.
CBT helps you identify these patterns of “stinking thinking” and develop healthier ways of thinking and behaving.
Dialectical Behavior Therapy
Dialectical behavior therapy, or DBT, helps you develop emotional coping skills and reduce conflicts in your interpersonal relationships. DBT helps clients understand that dysfunctional thought and behavior patterns arise from a lack of coping skills. DBT is effective for treating trauma survivors who may feel a lack of control over their thoughts and behaviors. It helps clients learn to cope through:
- Mindfulness of emotional states and physical sensations.
- Emotional regulation.
- Interpersonal skills to improve relationships.
- Developing a tolerance for distress.
DBT helps people let go of anger, and it reduces suicidal thoughts, self-harm behaviors and substance abuse that may result from trauma.
Acceptance and Commitment Therapy
Acceptance and commitment therapy, or ACT, is a mindfulness intervention that helps you develop psychological flexibility. It addresses the challenges that are present in attempts to control and suppress negative experiences and emotions. ACT helps people learn to make healthy decisions that support their personal values and promote physical and mental wellbeing. ACT involves six core foundations:
- Acceptance, rather than avoidance, of negative emotions and experiences.
- Techniques that improve the way you interact with your thoughts.
- Developing mindfulness and learning not to judge yourself for your thoughts.
- Being aware of negative experiences without being attached to them.
- Defining your personal values, or what’s important to you in life.
- Developing thought and behavior patterns that align with your personal values.
ACT is effective for treating chronic stress, anxiety, depression, chronic pain and obsessive-compulsive disorder that may underlie an addiction.
Motivational Enhancement Therapy
Motivational enhancement therapy, or MET, helps people resolve any ambivalence they have toward recovery. Finding your own intrinsic motivation and personal reasons for wanting to recover is essential for preventing relapse in early recovery. During MET, the therapist opens a discussion about the client’s substance abuse to foster self-motivational statements. MET consists of two to four sessions that effectively increase the client’s readiness to change.
Family dysfunction is a major trigger for relapse. Problematic family relationships often develop as the result of an addiction. Family members often develop unhealthy coping skills as a result of the chaos and uncertainty addiction brings to the household. They may unwittingly engage in enabling and co-dependent behaviors that further perpetuate the substance abuse. Resentments build up, and fear and anger can boil over. Family therapy helps families in recovery learn healthy communication skills, develop healthy coping skills, repair damaged relationships and restore trust. Family therapy helps family members understand how to best support their loved one in recovery.
A high-quality treatment program is holistic in nature. A holistic approach to treatment and relapse prevention encompasses body, mind and spirit for whole-person healing. Complementary therapies in treatment are effective for relapse prevention when they’re used along with traditional therapies.
Art or Music Therapy
Art and music therapy are experiential therapies that involve hands-on activities to help you make sense of unhappy experiences and express difficult emotions. Both of these therapies involve making, viewing and talking about art or music. Art and music therapy help improve self-awareness, self-esteem and communication skills. They reduce stress and ease feelings of guilt and shame.
Yoga is known to be effective for reducing stress, improving self-awareness and increasing mindfulness. Regular yoga practice helps you evaluate your state of mind, and it relieves feelings of anxiety and depression. It promotes physical and mental strength, endurance and flexibility and fosters emotional healing.
Daily meditation helps you accept your experiences and emotions rather than try to suppress or avoid them. Meditation puts you in an alpha brainwave state where you’re relaxed, focused and open to creative ideas.
Mindfulness-Based Stress Reduction, or MBSR, is a type of meditation practice commonly used in treatment. MBSR reduces anxiety and depression, increases self-awareness, produces feelings of inner peace and improves immune function.
According to a Harvard University and MIT study, participants who meditated every day for eight weeks enjoyed overall stress reduction, and it improved the way external events affected them moving forward.
Biofeedback therapy helps you learn to reduce your body’s stress on the spot. Stress makes it difficult to make good decisions and leads to negative emotions, irritability and unhealthy coping behaviors. During biofeedback therapy, sensors attached to your body record the body’s stress response and display the body’s functions on a monitor. As you practice stress-reduction techniques like deep breathing, progressive relaxation and visualization, you watch your heart rate, blood pressure, body temperature and other stress markers improve on the monitor. This valuable therapy helps you reduce acute stress and learn to better respond to stressors.
Psychoeducational groups educate clients about addiction and recovery. The better you understand addiction, how it develops and how to sustain lifelong recovery, the slimmer your chances of relapse.
- How relapse occurs
- Common relapse triggers and how to identify personal triggers
- Specific techniques and strategies for preventing relapse
- Co-occurring mental illnesses and how they’re treated
- Trust issues
- Reducing stress
- Medications that can promote long-term recovery
Psychoeducational groups typically involve a short lecture followed by hands-on activities and group discussions that engage and inform.
Life Skills Classes
Many people who have an addiction lack essential life skills that are central to successful recovery. Life skills classes help improve functioning across many areas of an individual’s life and teach skills related to:
- Self-care, such as good nutrition and coping with emotions.
- Domestic life, including organization, routines, meal-planning and grocery shopping skills.
- Relationships, including communication and social skills.
- Finances, including budgeting and saving.
- Employment, such as job-search and workplace skills.
Life skills classes help clients keep stress at bay by teaching them how to perform essential tasks and stay motivated to get things done.
Self-Care for Relapse Prevention
The importance of self-care in recovery can’t be overstated. When you stop taking care of yourself, everything else falls apart. Self-care is an important focus of many therapies and covers a broad range of essential skills.
Good nutrition in recovery helps you maintain a stable mood and adequate energy, and it improves your overall health. Nutritional therapy helps you identify any nutritional deficiencies and use good nutrition to repair the damage done to your body by addiction. It teaches you about essential nutrients and what healthy eating looks like. It often includes practical skills like reading nutritional labels, shopping for healthy food, and preparing healthy meals.
A lack of sleep takes a toll on your energy levels, brain function, mood and overall health. Healthy sleep requires good sleep hygiene, which is the collection of conditions that promote a good night’s sleep. These include a safe, comfortable sleeping environment, going to bed and getting up at the same time every day and developing a bedtime routine that helps you fall asleep more easily.
Managing your emotions helps you maintain mental clarity and a stable mood. Emotional regulation is taught through cognitive-behavioral therapy, dialectical behavior therapy, acceptance and commitment therapy and a variety of other therapies and interventions.
Fun and Relaxation
Spending time every day relaxing and having fun is an important aspect of good self-care. It lets you blow off steam and fills the time with enjoyable pursuits. Developing healthy hobbies in treatment and learning to have fun without drugs or alcohol is an important relapse prevention skill.
Participating in a support group is an integral part of treatment and recovery. Support groups stave off feelings of isolation and loneliness, and they promote a high level of personal accountability.
They offer a non-judgmental place to express emotions and synthesize experiences. They provide support, advice and resources for people in recovery.
According to a literature review published in the journal Substance Abuse and Rehabilitation, evidence points to support groups as helpful for: 3 Joining a support group is a crucial relapse prevention strategy. A variety of support groups can effectively help prevent relapse
Alcoholics Anonymous and Narcotics Anonymous
Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) are the most popular and widespread support groups in the U.S., with numerous meetings taking place in most towns and cities. These 12-step programs are based on spirituality and turning your life over to a higher power, whatever that may be for you. Working through the 12 steps involves admitting to having a problem, working to repair the damage done to your life, making amends and carrying the message of recovery forward.
A support group based on four points:
- Building and maintaining motivation to recover
- Coping with cravings and urges
- Managing your thoughts, emotions and behaviors
- Living a balanced, enjoyable life
SMART Recovery offers tools, techniques and strategies for achieving long-term sobriety.
Secular Organizations for Sobriety
Secular Organizations for Sobriety, or SOS, is a support group that takes a scientific approach to recovery. It focuses on self-empowerment rather than a belief in a higher power. SOS meetings are typically found in larger cities but are also offered in online groups where you can find daily support and inspiration.
HAMS: Harm Reduction for Alcohol
HAMS is an acronym for Harm reduction, Abstinence and Moderation Support. It’s based on 17 elements that lead to positive change based on your life goals. You can pick and choose the elements you wish to focus on. The elements include:
- Setting goals
- Making action plans
- Learning to cope without alcohol
- Developing self-confidence
HAMS offers in-person meetings, chat rooms, email support and a Facebook group.
LifeRing Secular Recovery
LifeRing Secular Recovery focuses on self-empowerment and personal growth. It promotes developing, refining and sharing strategies for maintaining abstinence and living a purposeful life. LifeRing offers in-person meetings, one-on-one email support, online meetings and online forums.
Additional Interventions and Services
Treatment involves a variety of interventions and services that specifically address your unique needs and issues. These interventions are designed to mitigate relapse triggers and promote whole-person healing.
For people who have a co-occurring mental illness like anxiety and depression, medications may be needed along with therapy to get the issue under control.
Medical problems like chronic pain, malnutrition and diseases can get in the way of successful recovery, and they need to be addressed in treatment.
Employment in recovery is an important aspect of relapse prevention. According to an article published in the Journal of Psychoactive Drugs 4 , having a job:
- Fills the time with productive activities
- Reduces financial stress
- Gives your life purpose
- Offers opportunities to develop healthy relationships
- Improves self-esteem and self-confidence
Vocational assistance in treatment covers a wide range of skills, from resume writing and job searching to good workplace habits and interview practice.
If you wish to return to school to improve your life, educational assistance services can help you with the school application and registration processes and identify sources of financial aid.
Legal issues cause a great deal of stress and can derail a recovery. Legal assistance offers help in navigating the legal system, finding an attorney and resolving legal issues like DUI, custody issues and other legal problems that often result from an addiction.
An unsafe or unstable living environment reduces the chances of successful recovery. Housing assistance helps you find a safe living environment that will promote personal safety and a healthy lifestyle. Safe housing options may include sober living facilities where you live with other people in recovery. Sober living provides a high level of support in early recovery.
Relapse Prevention: The Five Rules of Recovery
In an article published in the Yale Journal of Biology and Medicine, addiction expert Steven Melemis identifies five essential rules for relapse prevention. 5 Following these rules promotes long-term successful recovery.
Change your lif
Recovery is about more than simply not using drugs or alcohol. It involves creating a life for yourself that makes it easy not to use. This includes making essential lifestyle changes to promote good physical and mental health; cutting toxic people out of your life; and finding purpose and meaning in your life through school, employment, volunteering or engaging in healthy hobbies.
Be completely honest
Addiction requires lying, even to yourself. In recovery, being honest with yourself and others in your recovery circle is central to successful recovery. Your recovery circle includes supportive friends and family, healthcare providers, therapists, your support group and your sponsor.
Ask for help
Many people in recovery want to do it all on their own to prove they have control over the addiction. But everyone needs help. Support at home and in the community is one of the four pillars of successful recovery, according to the Substance Abuse and Mental Health Services Administration. 6 Asking for help when you need it removes obstacles to recovery. A support group that you attend daily is one of the best sources of help.
Making self-care a major priority in recovery helps prevent relapse. People who are addicted typically put a low priority on self-care, becoming exhausted, resentful and physically incapable of sustaining the mindfulness and attention recovery requires.
Don’t bend the rules
Looking for ways around changing your life, being honest, asking for help and taking care of yourself is a recipe for relapse. Staying focused on recovery requires making the first four rules non-negotiable and incorporating them into your lifestyle and your identity so that they become second nature.
Relapse is Not the End of Recovery
Despite the heavy focus on relapse prevention in treatment, some people in recovery will relapse. How you approach a lapse or relapse dictates how quickly you’ll get back on track with recovery. One of the most important things to understand about relapse is that it’s a natural -and even expected- part of recovery.
According to an article published in the journal Substance Abuse Treatment, Prevention and Policy, relapse is considered an opportunity to evaluate what went wrong, identify missing skills and develop those skills to prevent another similar relapse.7
People who regard relapse as a personal failure or the end of recovery will take longer to get back on track, and some will abandon recovery altogether. But those who view a lapse or relapse as an opportunity for growth and focus on the progress they’ve made so far are more likely to get back to recovery more quickly and more motivated than ever to make it work.
Relapse prevention is all about transforming your life and finding authentic happiness in sobriety so that you no longer have the need or desire to slip back to drinking or abusing drugs. It’s about improving all corners of your life and developing a strong foundation for sobriety that leads to mental clarity, a positive outlook and a higher quality of life for the long-haul.