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Relapse Prevention

We have come to understand the nature of a relapse better over the past few decades. It was once treated as a single event that marked the end of recovery and a failure of addiction treatment. However, relapse happens to about half of the people who achieve sobriety. Those seem like steep odds until you realize that other chronic diseases like hypertension and asthma have similar relapse rates.

However, after a period of diet, exercise, and blood thinners, if you start eating a little too much salt and your blood pressure goes back up, you wouldn’t say treatment failed. Instead, you would just need to reinstate treatment and make new relapse prevention strategies.

Addiction is the same way. A relapse doesn’t mean that treatment has failed; it means that it needs to be revisited and that you should reexamine your relapse prevention strategies. Still, the high relapse rates for addiction highlight the fact that relapse prevention is an important part of effective treatment.

Throughout your time in an addiction treatment program, you will go through therapies that are designed to prepare you for the challenges that you will experience in your real life. High-risk situations where you feel strong compulsions to use again may occur, and it’s important for you to be prepared to safeguard your sobriety in those moments.

Learn more about relapse prevention, treatment, and how to develop strategies that can help you stay on the path to recovery. 

Why Relapse Prevention Is Important 

Relapse doesn’t just threaten your sobriety; it threatens your health. People who relapse after a period of abstinence risk a potentially dangerous overdose. Fatal overdoses happen for a variety of reasons and in many different circumstances. However, a relapse puts you at risk for several reasons.

After being sober for a period, you will have lost most if not all of the tolerance you built up over time. People who relapse sometimes take their usual amount without realizing that that is an extremely high dose for them currently. Plus, you may have lost contact with dealers and friends you knew during active addiction, so you may no longer have your usual connections to your drug of choice. The drugs you do find may be contaminated with other dangerous additives such as fentanyl.

Alcohol and prescription depressants can also be dangerous after a relapse period. Central nervous system depressants cause a phenomenon called kindling, which is when withdrawal symptoms become worse after more than one detox period. If you have gone through alcohol withdrawal before, going through it a second or multiple times can increase your risk for deadly symptoms.

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3 Stages of Relapse

When you think of a relapse, you might be envisioning a single event that happens during a moment of weakness. However, a relapse doesn’t start with action; it starts in the mind.

According to psychologists, relapse is a process more than a single event. According to psychologist and researcher Alan Marlatt, Ph.D., relapse is a transitional process that’s caused by a series of events that happen over time. If you do take that drink or start using drugs again, it’s because of a mindset shift that may have been caused by triggers or stress. According to Marlatt, a relapse can follow a cascading effect that includes several problems that happen before you even start using again.

The road to relapse may look something like this:

  • A lifestyle imbalance causes stress in your life.
  • You have a desire for an indulgence to help cope with stress.
  • You experience urges and cravings.
  • You rationalize potential drug use or deny you are struggling.
  • You experience a high-risk situation where you have a strong urge and ability to use.
  • You don’t have a coping response to help overcome your compulsions.
  • Your self-efficacy decreases, and you believe relapse may be inevitable.
  • You lapse and take the drug, causing you to experience shame.
  • You continue using.

This process can happen slowly over time or quickly. However, according to Marlatt, dozens of coping strategies can be applied at each of those nine steps to help avoid continuing on the path to relapse. However, even though a wide variety of events can lead to a relapse, the recurrence of symptoms takes place in three stages: emotional relapse, mental relapse, and physical relapse. 

Emotional Relapse

The first stage of relapse involves your emotional stages. At this point, you aren’t even consciously thinking about using again. Instead, you’re experiencing negative emotional responses to stress, high-risk situations, or inborn anxieties. Because emotional relapse is so far beneath the surface, it can be incredibly difficult to recognize. It’s marked by feelings of depression, anxiety, loneliness, and irritability. Of course, everyone experiences negative emotions at one point or another. These natural emotions don’t necessarily cause emotional relapse but how you cope with them.

Denial, isolation, and ignoring the problem can cause an emotional relapse that can escalate.

In some cases, negative emotional symptoms like anxiety and depression are products of post-acute withdrawal symptoms that need to be addressed before they can be resolved.

Staying connected to a recovery community is a good way to help avoid emotional relapse.

Solemn Woman with head against a wall

Processing emotional challenges in support groups can be a way to cope with this stage of relapse.

Mental Relapse

A mental relapse involves consciously thinking about using drugs or alcohol again. You may begin to experience an internal struggle between resisting thoughts about drugs and compulsions to use. You may start rationalizing why you might be able to use without experiencing the same consequences that you did before.

You may have thoughts like, “I deserve this after staying sober for so long,” or “I need this to cope with what I’ve been going through.” Cravings cause you to work through mental plans to use that seem plausible to you at the time. This is often a critical moment to recognize your impending relapse because once you decide to use, it’s extremely difficult to stop. 

Physical Relapse

Physical relapse is what you might be imagining when you think about a relapse; it’s taking your first drug or drink after achieving sobriety. According to Marlatt, there is a difference between the first initial lapse and complete abandonment of abstinence as a goal. And the progression from a lapse to uncontrolled active addiction isn’t always inevitable if you seek help in time.

However, a single lapse leads to what he calls the abstinence violation effect, which is the emotional response to a lapse.

People who respond to a lapse with feelings of personal failure and shame are likely to continue using. Others may see their lapse as the product of external factors beyond their control and believe there is no point in resisting addiction.

However, the abstinence violation effect can be combated by realizing that the lapse is a mistake that can be learned from. Thinking about a lapse in that way can help you to avoid a return to active addiction and the need to reinstate treatment.

Sources

Becker, H. C., Ph.D. (1998). Kindling in Alcohol Withdrawal – Brochures and Fact Sheets. Retrieved from https://pubs.niaaa.nih.gov/publications/arh22-1/25-34.pdf

Larimer, M. E., Ph.D., Palmer, R. S., & Marlatt, G. A., Ph.D. (1999). Relapse Prevention – National Institutes of Health. Retrieved from https://pubs.niaaa.nih.gov/publications/arh23-2/151-160.pdf

Marlatt, G. A., & Witkiewitz, K. (2005). Relapse Prevention for Alcohol and Drug Problems. Retrieved from http://adai.washington.edu/confederation/2008readings/Marlatt_Relapse prevention.pdf

National Institute on Drug Abuse. (2018, July). Treatment and Recovery. Retrieved from https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery

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