Relapse is a common concern for individuals in recovery from a substance use disorder and for their friends and family members. While relapse is a part of the recovery process for some people, it doesn’t have to be. Here are some tips for avoiding relapse as well as information on how to approach the situation if a relapse has occurred.
A Relapse May Not Be What You Think It Is
Many individuals are bit confused about what relapse really is. In terms of what a relapse actually represents, it is important to understand that a relapse is a return to the behaviors that would qualify an individual who is in recovery to be re-diagnosed with a substance use disorder. The individual must have an extended period of abstinence in order to actually relapse, and their behavior must be severe enough to qualify them to be re-diagnosed with a substance use disorder.
What most people often label as a relapse is actually a lapse, which is a very brief slip from abstinence that is self-corrected by the individual. A relapse represents a prolonged return to substance use, whereas a lapse is a very brief slip that is corrected by the individual and the individual gets back on their recovery program.
Both lapses and relapses can be serious, and they can result in an individual in recovery losing confidence in their recovery program. However, an individual who has experienced a lapse has already made the change and moved back into the recovery program, whereas a relapse represents a situation where the individual is continuing to engage in prior behaviors. While both situations should be considered serious, relapse is obviously the far more serious of the two situations.
Both situations require that the individual rethink their approach to recovery. Individuals who suffer multiple lapses or relapses need to re-examine their approach to addressing their substance use disorder.
Lapses and Relapses Are Not as Uncommon as You May Think
Individuals recovering from substance use disorders are often under the impression that having a lapse or relapse represents a failure. As it turns out, lapses and relapses are quite common and occur in similar proportions as relapses do for certain types of medical disorders that have a significant behavioral component to them. According to the National Institute of Drug Abuse, relapse rates for individuals who attempt to recover from substance use disorders are similar to relapse rates for common medical conditions, such as asthma, hypertension, and diabetes. Relapse rates for substance use disorders occur in 40-60 percent of individuals who attempt to recover from them, and this is consistent with relapse rates for these other disorders.
This is not an excuse to lapse or relapse, but it should be a sign to individuals that lapses and relapses represent a part of the recovery process for many, but not all, individuals. Individuals who can learn from their mistakes and move on will eventually be successful in their recovery program, whereas individuals who do not learn or attempt to adjust the recovery program are often doomed to a long, painful, and even continuous cycle of substance abuse, recovery, relapse, recovery, etc.
Tips to Avoid Lapses and Relapses
Just because relapse is not uncommon in recovery from substance use disorders does not mean that it is inevitable. The late addiction specialist Dr. G. Alan Marlatt published extensively on relapse prevention. In one of his classic works, Relapse Prevention: Maintenance Strategies in the Treatment of Addictive Behaviors, he offers a number of tips and strategies to avoid lapses and relapses. Some of the major points and suggestions from his writings are summarized here.
- Get into treatment. Individuals who address their issues in formal substance use disorder treatment programs and receive social support will stand a better chance of avoiding lapses and relapses than individuals who attempt to address their issues without professional help. If you are not in a formal treatment program, you should get into one. If you are in a formal treatment program, you should follow the program. If you are in a formal treatment program and having significant issues with certain treatment providers, it is permissible to seek different treatment providers; however, do not drop out of treatment altogether.
- Get a change of scenery. Continuing to associate with individuals who use drugs, or continuing to frequent places where alcohol or drugs are used, is a sure path to lapsing and/or relapsing. When you choose to enter recovery, you must also choose to make some very significant changes in behavior, associations, and habits. Many times, this means letting go of old friends, places, and things that are associated with substance use. Just as an extremely obese person who is attempting to lose a large amount of weight will most likely experience difficulty if they work in an ice cream parlor dishing out ice cream, an individual attempting to become abstinent from drugs or alcohol should not expose themselves to situations where the use of drugs and alcohol is common.
- Learn to deal with triggers and cravings. Triggers represent conditions or situations, either general or very personal, that elicit feelings of wanting to use the substance of choice. Cravings represent the actual desire to use again. Obviously, a number of different triggers can elicit cravings in different situations. Cravings may also just seem to come out of nowhere at times. Individuals in recovery need to learn to identify their specific triggers and either avoid them (although this may not always be possible) or implement a plan of action to deal with them. Individuals in recovery also need to develop an action plan to put in place when they experience cravings. These strategies are learned in therapy, support groups, and in actual practice and experience. In some instances, the strategies may involve the use of medications to decrease cravings. In other instances, they may involve certain behavioral strategies. At a minimum, the individual should:
- Understand that cravings are normal experiences in recovery
- Realize that cravings do not represent weakness or failure of one’s program
- Thoroughly outline their own specific triggers and develop a plan to address them
- Understand the general cues that elicit substance use in individuals
- Develop a specific plan of action to avoid or deal with triggers/cravings
- Emphasize the negative. A pitfall that occurs in the thinking of recovering individuals who lapse or relapse is that they begin to fantasize about the positive aspects associated with their former substance use while totally ignoring or even forgetting all the discomfort, pain, and difficulty that their substance abuse produced. Individuals should understand that when they begin to fantasize about the positive aspects of their past substance use, they are potentially setting themselves up to lapse or relapse. In recovery individuals should be trained that when they begin to do this, they should immediately start reflecting on all the negative aspects of their substance use (part of a technique that Marlatt referred to as “urge surfing”). Some individuals can actually benefit from writing these down on a sheet of paper, listing all the positive aspects of their substance use on the left and all the negative aspects of their substance use on the right. When they do this, they can immediately see that returning to substance use is a losing proposition.
- Learn and practice stress management techniques. A major trigger for lapses and relapses is stress. Individuals who experience significant stress in recovery often begin craving their substance of choice and may begin using again. It is extremely important for individuals in recovery to learn behavioral methods to cope with stress, such as meditation, systematic relaxation, breathing techniques, and other methods. In addition, individuals who are under the treatment of an addiction medicine physician or psychiatrist may benefit from certain medications.
- Treat co-occurring disorders. In line with the above recommendations, it is also important that individuals who enter recovery for substance use disorders ensure that they have professional support that includes a thorough assessment of their biopsychosocial functioning in order to identify the presence of any co-occurring psychological disorders. If individuals who have a co-occurring disorder, such as depression, attempt to only address the substance abuse aspect of their co-occurring disorders, the potential for a successful recovery is significantly reduced. A full recovery program should treat the entire individual.
- Embrace a healthy lifestyle. Individuals in recovery can enhance their chances of success by getting plenty of rest, eating a relatively healthy and nutritious diet, and getting exercise. You don’t need to become a health guru or fanatic; however, establishing healthy living habits can assist in recovery.
- Develop a strong social support group. Individuals in recovery will benefit from having a strong support group that is committed to their recovery. This can come from family members, friends in recovery, or social support groups, such as 12-Step groups. You can utilize your support group when you are having a particularly difficult time with cravings or a desire to reuse. Contact these people, confide in them, and socialize with them as often as possible.
- Stay busy. Boredom is a general trigger for relapse in recovering individuals. While you should be careful not to overdo it, you should also be careful to make sure that you have enough to do so you do not become overly bored. Staying busy can involve just interacting with one support group, or developing a list of goals and aspirations and working toward them, such as returning to school, getting the job, joining a book reading group, etc.
If You Have a Lapse a Relapse…
If you have lapsed or relapsed, it is important to remember not to catastrophize the situation. The first thing to do is to immediately stop any drug or alcohol use, and if able, remove yourself from the situation. Contact your therapist or support group members, and meet with them as soon as possible to discuss the situation.
Instead of viewing the lapse or relapse as a failure, attempt to analyze the situation, identify any knowledge of how and why the relapse occurred, and take steps to avoid similar situations in the future. This way you can utilize a lapse or relapse as a learning experience and turn it into a positive.