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3 Steps for Relapse Prevention and Long-Term Treatment Success
Research shows that 65% of people who receive treatment for substance use disorder experience relapse within 1 year (Appiah, et al., 2018). Although relapse is common, there are steps you can take toward prevention. Recognizing relapse triggers, minimizing high-risk situations, and developing an individualized relapse prevention plan are important to maintain progress in recovery. Every person has their own set of internal and external triggers, and unaddressed, all can increase a person’s vulnerability to relapse, so prevention is key.
Recognizing Triggers
Triggers are things that lead to cravings or “trigger” substance use. Triggers are broadly classified as either external or internal. External triggers are things in the environment that lead a person to think about using drugs or alcohol. Simply put, these are people, places, and things that a person associates with substance use. People might be people with whom they used drugs or alcohol in the past. Places might be places where a person used drugs or alcohol, or places where drugs and alcohol are available. Things might be items that remind someone of their substance use, such as drug paraphernalia or alcohol advertisements. Internal triggers might be harder to identify. These are triggers that come from inside a person. Negative emotions, such as anger or grief, are internal triggers, as are stress and physical pain. Experiencing any of these triggers while in a high-risk situation (an environment where drugs or alcohol are available) can easily lead to relapse. Therefore, it is important to recognize triggers and high-risk situations along the path of recovery (Menon & Kandasamy, 2018).
Long before a person relapses into drug or alcohol use, most experience progressive and predictable symptoms. If warning signs remain unaddressed, they often lead to progressive problems with cognition, emotional regulation and judgment. The symptoms build over time, creating an overwhelming desire for the drug or alcohol. Learning to identify early warning signs is important because the sooner someone recognizes symptoms of relapse, the easier it is to address those symptoms and regain stability in recovery.
Terrence Gorski identified and ordered 37 common warning signs of relapse. These warning signs include a progression from relapse warning sign No. 1—apprehension about one’s well-being—to relapse warning sign No. 37—return to active substance use and loss of control. These warning signs describe a progressive worsening of symptoms, including elevated stress, negative changes in behavior, breakdown of social support, loss of daily structure and impaired judgment. Unaddressed, these progressive symptoms leave a person believing the best way to get relief is to return to active substance use. Given the progressive nature of substance use disorder, most people experience worse problems with their addiction than before (Gorski & Miller, 1982).
Research shows that general demoralization is the strongest predictor of relapse within 2 months of onset. This demoralization may manifest as depression, anxiety, anger, or lack of a sense of purpose in life. However, low relapse risk is predicted by recovery stability. Those at lower risk for relapse tend to have stable eating and sleeping patterns. They think clearly and practice honesty. They have a sense of meaning in life, are hopeful about the future, and feel a sense of peace and stability (Miller & Harris, 2000). Everyone in recovery may experience triggers and high-risk situations, but learning how to manage them effectively can reduce the relapse risk.
Managing Triggers and High-Risk Situations
The first step in successfully managing triggers and high-risk situations is recognizing them. It may be helpful to carefully review use history and write down a list of external and internal triggers associated with past use. Next, look ahead a few months to identify any high-risk situations someone might be facing. Holidays and special events are often high-risk situations, so it is helpful to plan and practice strategies to minimize risks. Whenever possible, it is best to avoid triggers and high-risk situations, but when they cannot be avoided, the following strategies can help.
- Relaxation or meditation can help reduce the risks associated with internal stress triggers.
- Practicing positive self-talk, self-affirmations or making a gratitude list can combat negative emotional states.
- To prepare for unavoidable high-risk situations, people in recovery should practice drug refusal skills and assertive communication in advance through role-play.
- Creating a “relapse road map,” thinking through the likely consequences of various choices, also reduces relapse risk (Menon & Kandasamy, 2018).
- Rather than focusing on the immediate desire, considering the “relapse road map” helps an individual make healthy choices and address relapse warning signs early when they are easier to manage.
Relapse warning signs build over time, but making healthy choices early in the process can stop relapse in its tracks.
Developing an Individualized Plan for Relapse Prevention
Every person’s recovery journey is unique, so having a personalized plan for relapse prevention is key to individual success. Learning from peers in addiction group counseling and consulting with an experienced substance use disorder treatment professional can help an individual design a relapse prevention plan that addresses their personal risk factors. It is also helpful to periodically revisit and review the relapse prevention plan as circumstances change throughout recovery. Relapse is preventable, and an individualized, ever-evolving relapse prevention plan can help.
If a person does relapse, it is important to remind them that relapse is a part of many recovery journeys and should never be perceived as a failure or sign that recovery is impossible. Every recovery journey looks different, and healing is available to those who continue to choose recovery.
Wendy Insalaco, MS, LGPC, LGADC, ICCDPD, ACRPS, ICCS, is director of quality and model of care at Ashley Addiction Treatment.
The views expressed in Perspectives are solely those of the author and do not necessarily reflect the views of Behavioral Healthcare Executive, the Psychiatry & Behavioral Health Learning Network, or other Network authors. Perspectives entries are not medical advice.
References
Appiah, R., Boakye, K. E., Ndaa, P., & Aziato, L. (2018). “Tougher than ever”: An exploration of relapse prevention strategies among patients recovering from poly-substance use disorders in Ghana. Drugs: Education, Prevention & Policy, 25(6), 467–474.
Gorski, T. T., & Miller, M. (1982). Counseling for relapse prevention. Independence Press.
