Maintaining sobriety and meeting treatment goals after completing a drug and alcohol rehabilitation program can be the most difficult part of recovery. However, many people with a substance use disorder do recover from addiction and enjoy a lasting and satisfying sober lifestyle.
A number of those in recovery could relapse after treatment. Preventing or reducing the incidence of relapse by following a comprehensive relapse planning guide has helped many to enjoy drug and alcohol free lives in spite of potential relapses.
Planning and mastering the art of relapse prevention begins while you’re still in treatment. Relapse is not an out-of-the-blue event. Rather, it’s a process with a beginning, a middle and an end. As such, it can be monitored. If necessary, adjustments can be made to your relapse prevention planning to help you avoid relapse in the future.
What Is Substance Use Disorder?
A 2014 survey conducted by the National Survey on Drug Use and Health revealed that 21.5 million Americans suffer from a substance use disorder. According to the American Society of Addiction Medicine, a substance use disorder is “a chronic brain disease, with behavioral, biological, social, emotional and physical aspects, that is characterized by an inability to control substance abuse.”
What Is Relapse?
A substance use disorder relapse occurs when someone resumes using substances after a period of abstinence. A return to active substance use can vary in duration and intensity from one person to another.
According to the Substance Abuse Treatment, Prevention and Policy journal, relapse is “a setback that occurs during the behavior change process, such that progress toward the initiation or maintenance of a behavior change goal (e.g., abstinence from drug use) is interrupted by a reversion to the target behavior.”
Relapse Is Not Failure
Relapse doesn’t mean that treatment didn’t work. For many with a substance use disorder, relapse is considered a stepping stone instead of an end point. When relapse happens, it simply indicates that treatment goals must be revisited and revised in some way.
Relapse prevention can include increased attendance at support group meetings. It can mean trying new types of therapy. It might involve that improvements in diet and nutrition or additional inpatient or outpatient treatment is necessary.
Relapse Can Be Part of the Recovery Process
With chronic addiction, relapse can be considered part of the disease. According to the National Institute on Drug Abuse, substance abuse relapse rates are between 40 and 60 percent. Those percentage rates are similar to those seen in other chronic diseases like hypertension, asthma and type 1 diabetes.
Common Relapse Triggers
Although everyone in recovery is unique, there are some common situations, also called triggers, that seem to be especially difficult for those recovering from a substance use disorder:
- Negative emotional states
- Physical withdrawal symptoms like nausea and weakness
- Emotional withdrawal symptoms like anxiety, boredom, depression, frustration and irritability
- Time spent with friends who use
- Poor eating and sleeping habits
- Visitation of places where you’ve used
- Relationships that become stressful if something goes wrong
- Isolating behavior
- Complacency and letting down your guard
- Interpersonal conflict
- Peer pressure to use
- Positive and celebratory emotional states
- Commercials and advertisements
- The use of will power or trying to recover by yourself
- Behavior that tries to control your using
Negative emotional states correlate with the highest relapse rates according to a study by Marlatt and Gordon in 1985. Interpersonal conflict and negative emotional states taken together triggered half of all relapses. Being in social situations where people were using accounted for 20 percent of relapses.
Concurrent Mental Health Conditions
According to the Substance Abuse and Mental Health Services Administration, as many as 7.9 million Americans with a substance use disorder have a concurrent mental health condition.
Untreated mental health conditions can trigger relapse. Treating the substance use disorder as well as the mental health condition can increase the probability of maintaining abstinence. Although substances like drugs and alcohol provide temporary relief from the symptoms of a mental health condition, they actually increase the unpleasant symptoms that those conditions generate.
Phases of Relapse
When you view relapse as a process rather than an event, it has three distinct stages. These stages are emotional, mental and physical relapse.
Emotional Relapse
You might not be thinking of using. However, if you’re harboring negative emotions and participating in high-risk behaviors, you’re creating the groundwork for relapse in the future. The emotional stage of relapse is the easiest to overcome. The later stages get progressively harder to resist.
The trick is to recognize that you’re currently in a state of emotional relapse and change your thoughts and behaviors accordingly. If you remain for too long in a state of emotional relapse, you’ll progress to a state of exhaustion. This exhausted state is called mental relapse, and it will make you want to escape.
Mental Relapse
Once you reach a state of exhaustion, you’re likely to stop taking care of yourself. You could develop poor eating and sleeping habits. You might start to feel resentful and anxious or uncomfortable in your own skin.
In a state of mental relapse, you’re likely to isolate and not ask for help. Your mind is fighting with itself about whether or not to use. You might be thinking about using even though you haven’t picked up. In the mental relapse stage, it’s common to romanticize your using days and to wonder whether you have a substance use disorder after all.
You might think that you can now control your using. You could start hanging out with friends from your using days and fantasize about picking up. You might think you can get away with using because no one will know. The longer you continue to think along those lines, the greater the likelihood that you will pick up.
Coping With the Desire to Use
When you feel like using, here are some tips to reduce the possibility of relapse:
- Tell someone that you’re thinking of picking up.
- Do something to turn your thoughts in another direction.
- Go to a support group meeting and tell the group what you’re feeling.
- Hold off on using for 30 minutes. Most urges to use will pass after half an hour.
- Don’t use until tomorrow. By tomorrow, you probably won’t want to.
- Stay in the now. Don’t tell yourself that you can never use again. Just don’t use today.
- Do something that you enjoy to help you relax and unwind.
- Go out for dinner with friends. Putting food in your stomach can take the edge off cravings.
Physical Relapse
If you don’t take preventative action while in the mental relapse mode, you’re headed for physical relapse. At that point, you’ll feel so uncomfortable that you’ll have very little defense against picking up. Relapse can still be prevented, but when you already feel an intense level of mental and emotional distress that could be eliminated by picking up, it’s very difficult to shift your train of thought and change your course of action.
What If You Relapse?
If you resume using, don’t waste time beating yourself up. Instead, seek help as soon as possible. The important thing now is to keep the relapse from progressing. If you act quickly, you can lessen the duration and severity of the experience.
Substance Use Disorder and Brain Chemistry
Substances like heroin, alcohol, cocaine and prescription painkillers all disrupt the neural pathways in the brain. These pathways affect things like impulse control, decision-making, feelings of well-being and how you experience pleasure and pain.
With regular use, you’ll need more and more of a substance to feel okay. When your brain no longer functions properly without substances, you’ll have what’s called a physical dependence.
With physical dependence, withdrawal symptoms and cravings will develop if you try to stop using. You’ll no longer feel normal if the drug is not present in your brain in sufficiently high concentrations.
When you reach this level of discomfort, it’s very easy to convince yourself that using would be a good idea. It would eliminate the cravings and withdrawal symptoms so that you can get back on track. With this mindset, it’s easy to view using as a reasonable form of self-medication instead of a relapse.
Cognitive Behavioral Therapy and Thinking Positive in Recovery
Physical detox clears substances out of your body, but that alone won’t keep you sober. After physical dependence has been addressed, treatment focuses on how to maintain a sober lifestyle while living substance-free. Sober living requires attention to the mental, emotional and behavioral aspects of a substance use disorder.
A form of behavioral therapy called CBT is often used to treat those recovering from addiction. According to the journal of the Psychiatric Clinics of North America, “abstinence rates may be increased with the use of CBT methods.”
Your habitual thoughts affect your health, your mental state, your emotional well-being and your behavior. CBT is used to explore the various ways that your thoughts affect your recovery. CBT can help you to replace the old, negative thought patterns so common in active addiction with positive thought patterns that support a healthy and satisfying sober lifestyle.
CBT and Learning Healthy Ways to Cope With Stress
Everyday stress is one of the most common causes of relapse. CBT can teach you new coping skills that will help you deal with stress in a healthy and effective manner.
CBT can also help you cope with the anxiety, depression, anger and emotional mood swings that make recovery so difficult. Studies published in the Psychiatric Times journal suggest that “CBT may actually help to improve a person’s neurobiological circuits in the brain.”
Length of Time in Treatment
It you’re in treatment for a substance use disorder, you can reduce the potential for relapse by completing your full course of treatment. The longer you remain in treatment, the more opportunity you’ll have to learn and establish new coping mechanisms before resuming a normal life in the real world. According to Psych Central, the length of time spent in treatment correlates with how long a recovering person is able to maintain abstinence.
The Role of Medication
Medication can help to regulate moods and reduce cravings. In many programs, medication is an essential element of a comprehensive substance use disorder treatment approach that combines pharmacological therapy with behavioral therapy.
Activities That Support the Recovery Process
Here are some examples of basic holistic activities that can help you to avoid relapse by improving your overall feelings of well-being:
- Regular exercise
- Eight hours of sleep
- Healthy eating habits
- Good nutrition
- Yoga
- Acupuncture
- Mindful meditation
- Massage therapy
Effects of the Environment on Recovery From a Substance Use Disorder
Some environments are more supportive of long-term recovery than others. Relationships with family members can help or hinder the recovery process. Family counseling and therapy for those who have loved ones in treatment can be helpful for family members as well as for the recovering person.
Counseling sessions can help family members to develop good communication skills. Clear communication makes it easier to support the treatment goals of the family member with a substance use disorder.
During counseling, loved ones are educated about how the disease of addiction works. When family members understand what the recovering person is going through, they are better equipped to help that person cope with stress more effectively. They can also help the recovering person to avoid triggers that could lead to relapse.
The Importance of a Strong Support System
Studies show that those in recovery who have received treatment and participate in twelve-step groups like Alcoholics Anonymous are more likely to stay sober and remain abstinent.
Recovering people who surround themselves with others who are also in recovery receive regular healthy peer pressure and experience a sense of connection and fellowship with others. That ongoing support helps them to maintain a clean and sober lifestyle. Being part of a recovering community also helps those with a substance use disorder to avoid relapse.
