Avoiding Relapse


Relapse is a common concern for individuals in recovery from a substance use disorder. While relapse, or multiple relapses, are recognized as an almost expected or inevitable setback in the recovery journeys of many people, they don’t have to be. Here are some tips for avoiding relapse as well as information on how to move forward with your recovery goals if a relapse has occurred.

A Relapse May Not Be What You Think It Is

Relapse is a sustained return to problematic substance use behavior. What many people label as a relapse could actually be viewed as a lapse—an isolated slip from sobriety from which the individual may be able to get back on track with their previously mapped out course of recovery. A lapse isn’t an insignificant event, however, and could be more likely to lead to a full-blown relapse if the individual considers it a point of no return or total recovery failure.1

Both lapses and relapses can lead to some shaken confidence in an individual’s recovery program. Though relapse may be potentially more serious and/or immediately dangerous, both situations should signal to the individual that a rethinking or refocusing of their recovery approach may be in order, and could indicate that additional treatment measures are needed.2

Lapses and Relapses Are Not as Uncommon as You May Think

Relapses are common in the world of recovery, which might not be too surprising given the chronic nature of substance use disorders. Substance use relapse rates are comparable to those associated with certain other types of chronic medical conditions. Relapse rates in people treated for substance use disorders have been estimated to be in the range of 40-60%, which is similar to the relapse rates for other treatable chronic conditions like asthma and high blood pressure.3

While they are common, relapses should not be taken lightly. As they can be quite dangerous, and even deadly with certain drugs, relapses should obviously be avoided. When they do occur, a relapse should be a sign to individuals that changes need to be made. Individuals who can learn from what led up to a lapse or relapse may be more successful in working their recovery program in the future, whereas individuals who do not adjust in the wake of a relapse may be more likely to experience additional setbacks.

Tips to Avoid Relapses

Just because relapse is not uncommon in recovery from substance use disorders does not mean that it is inevitable.  The late addiction treatment specialist Dr. G. Alan Marlatt published extensively on relapse prevention, including the 1985 book, Relapse Prevention: Maintenance Strategies in the Treatment of Addictive Behaviors.

As part of his relapse prevention model, Marlatt offered a number of tips and strategies to help people avoid lapses and relapses. Relapse prevention suggestions that draw from Marlatt and others in the field of addiction treatment include:4,5

  • Get into treatment. Individuals who utilize formal substance use disorder treatment—with exposure to cognitive-behavioral relapse prevention-based approaches and the inherent social supports of such a program—can help themselves to avoid lapses and relapses.
  • Get a change of scenery. Continuing to associate with individuals who use drugs, or continuing to frequent places where alcohol or drugs are used, can increase the risk of lapsing and/or relapsing. When you choose to enter recovery, you must also choose to make some very significant changes in previously maladaptive behaviors, associations, and routines. In some instances, this could mean letting go of old friends, places, and things that are associated with substance use.
  • Learn to deal with triggers and cravings. Urges and cravings may arise as a result of certain psychological and environmental triggers. These triggers may comprise conditions or situations that elicit feelings of wanting to drink or use drugs. 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 can be 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. An 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.
  • Don’t discount or ignore the negative. A pitfall that occurs in the thinking of recovering individuals who lapse or relapse is that they begin to emphasize 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 expectations about the positive aspects of their past substance use outweigh the negative consequences, 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. 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.
  • 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. Marlatt referred to certain negative emotional states—including anger, anxiety, and depression—as intrapersonal high-risk situations that could greatly increase relapse likelihood. Comprehensive recovery programs should integrate treatment of both the substance use disorder and co-occurring mental health issues to improve treatment outcomes.
  • 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 Relapse…

If you have lapsed or relapsed, it is important to remember that it doesn’t mean your recovery goals are no longer attainable. If possible, remove yourself from any situation that may have contributed to your relapse and begin to make plans to reinitiate your recovery efforts. Contact your therapist or support group members, and meet with them as soon as possible to discuss the situation. For help detoxing and getting back to the foundation of your recovery, give us a call at 972-848-0221.

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.

References

  1. Miller, S. C., Fiellin, D. A., Rosenthal, R. N., & Saitz, R. (2019). The ASAM Principles of Addiction Medicine, Sixth Edition. Philadelphia: Wolters Kluwer.
  2. National Institute on Alcohol Abuse and Alcoholism. (2014). Treatment for Alcohol Problems: Finding and Getting Help.
  3. National Institute on Drug Abuse. (2020). Treatment and Recovery.
  4. Larimer, M. E., Palmer, R. S., & Marlatt, G. A. (1999). Relapse prevention. An overview of Marlatt’s cognitive-behavioral model. Alcohol research & health : the journal of the National Institute on Alcohol Abuse and Alcoholism, 23(2), 151–160.
  5. Melemis S. M. (2015). Relapse Prevention and the Five Rules of Recovery. The Yale journal of biology and medicine, 88(3), 325–332.


About The Contributor

Scot Thomas, M.D.
Scot Thomas, M.D.

Senior Medical Editor, American Addiction Centers

Dr. Thomas received his medical degree from the University of California, San Diego School of Medicine. During his medical studies, Dr. Thomas saw firsthand the multitude of lives impacted by struggles with substance abuse and addiction, motivating... Read More


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