Why Relapse Prevention for Addiction Matters

What is relapse prevention?

People who struggle with drug or alcohol use might decide to stop using substances because of the negative effects and consequences.

Many people attempt to do this alone, without professional help, which can be significantly more difficult. In these cases, the individual may not have identified the underlying causes of their harmful substance use and is unlikely to have developed the required skills to cope with triggers. This can mean that they are more at risk of using substances again. ^[1][2]

Even someone who has been abstinent from alcohol and drugs for many years may experience an unexpected relapse. Learning and practicing coping strategies and relapse prevention skills can be crucial in maintaining recovery. Relapse prevention involves learning practical skills to recognize and manage triggers, emotional distress, and thoughts and behaviors relating to substance use to maintain abstinence. ^[1]

Implementing intervention strategies early in these stages can significantly improve outcomes, helping people remain abstinent and prevent a worsening of their emotional state and self-care. ^[3][4]

Some of the most effective relapse prevention strategies include cognitive behavioral therapy (CBT) and mindfulness techniques. These interventions can teach people skills to recognize and manage emotional distress, build resilience to stress, and feel more in control of their sobriety. ^[5][6]

Relapse prevention plans can differ depending on individual needs, triggers, and circumstances, but will often focus on: ^[3]

• Making life changes to avoid harmful temptations and habits and integrate healthy choices
• Being honest with yourself and others
• Asking for help from professionals and loved ones
• Maintaining self-care
• Being consistent and sticking to the rules

How often does substance abuse relapse occur?

Due to the complex nature of addiction, recovery for SUDs will often involve fluctuations, with many people experiencing several triggers and relapses throughout the recovery process. ^[1] The National Institute on Drug Abuse (NIDA) suggests that between 40-60% of people who engage in SUD treatment will return to substance use within the following year. ^[7] Other studies show a higher prevalence of relapse, with some suggesting that 75-95% of people using alcohol or heroin will relapse within one year. ^[1][8]

Many circumstances can trigger a relapse and may occur unexpectedly. As emotional changes often happen gradually and subconsciously preceding a relapse, it can be difficult to recognize an impending relapse without the necessary knowledge and skills. This can contribute to the high prevalence of relapse in addiction recovery. ^[3]

It is important, however, to note that relapse does not indicate failure. Managing addiction recovery is challenging and requires consistent and long-term evaluation, motivation, and decision-making. Various factors and circumstances can impact an individual’s ability to maintain abstinence. These occurrences can be viewed as learning opportunities, to recognize personal triggers and adapt coping strategies. ^[3][7]

Looking out for relapse triggers

Many different situations can trigger a relapse or the stages preceding a return to substance use. Some triggers might generally apply to anyone going through addiction recovery, such as experiencing negative emotions or environmental cues.

As such, it can be a good idea to have a clear understanding of situations you have found triggering in the past. This can remind you to check in with your thoughts and feelings should you encounter a similar situation in the future.

Common relapse triggers include: ^[1][2][9]

• Emotional distress: Strongly felt negative emotions are a common trigger for relapse and can include feelings such as sadness, anxiety, stress, loneliness, anger, and guilt.
• Exposure to substance use: Being around people who are using substances or in places associated with substance use can be triggering.
• Celebrations: Parties, birthdays, holidays, and other celebratory or happy occasions can be an unexpected trigger for people in recovery and may be difficult to avoid.
• Isolation: Spending a lot of time alone can trigger substance use due to boredom, loneliness, or ruminating on negative thought patterns.
• Stress: Stress is a very common trigger for relapse and can be related to any stressful situation, such as work, relationships, finances, or the recovery process.

Stages of relapse

Relapse generally occurs in three stages, beginning with warning signs that can occur many weeks or months before relapse takes place. These stages are emotional relapse, mental relapse, and physical relapse. Awareness of the signs of each stage can help you recognize when early prevention strategies should be implemented. This can form part of your relapse prevention plan and can help you avoid a full relapse. ^[3]

Emotional relapse

During this stage, emotional changes take place subconsciously, while the individual continues with their recovery and abstinence. Often, emotional relapse is triggered by a distressing event or circumstance that leads to the onset or worsening of negative thoughts and feelings.

Signs of emotional relapse can include: ^[3][9]

• Decline in self-care, including sleep, diet, and hygiene
• Avoiding social events and isolating from others
• Bottling up emotions and not sharing with loved ones or professionals
• Not attending support group meetings or treatment appointments

Mental relapse

The second stage is mental relapse. During this stage, the individual might start thinking about returning to substance use, although they may feel conflicted and not want to give up on their recovery.

Signs of mental relapse include: ^[3]

• Glamorizing past use
• Thinking about spending time with people or in places associated with past use
• Making plans to obtain and use substances
• Lying about these thoughts to friends, sponsors, or professionals

Physical relapse

Physical relapse is the final stage and involves the actual use of substances. This stage includes a ‘lapse’, which is characterized by a brief return to substance use followed by recommencing abstinence. A full ‘relapse’ involves returning to consistent or regular substance use and the associated behaviors. ^[1][3]

While a lapse is not as detrimental to health or recovery as a full relapse, it can still cause negative effects, including feelings of guilt and shame and a potential for overdose.^[1]

Does relapse prevention work?

Substance use treatment will typically involve teaching relapse prevention strategies, which can have a significantly positive impact on your recovery. ^[4]

Many studies have investigated the outcomes of people in recovery with and without the utilization of strategies like mindfulness-based relapse prevention (MBRP) and showed that those who utilized MBRP had significantly fewer heavy drinking days and reduced drug use compared to those who did not. A systematic review of MBRP also showed that these interventions help maintain abstinence by reducing substance cravings and impulsivity and improving symptoms of depression. ^[5][6]

Similarly, studies have found that CBT-based relapse prevention significantly improves recovery outcomes as compared with those who did not receive CBT. This model of relapse prevention teaches coping strategies, including positive thinking and avoidance or distraction techniques, which have been found to improve abstinence outcomes. ^[5][10][11]

Relapse prevention strategies

Many techniques and interventions can be utilized to help prevent relapse and can be implemented during the emotional and mental relapse stages when warning signs begin to emerge.

1. Check-in with HALT

The acronym HALT (hungry, angry, lonely, tired) can be a useful tool to help you check in with yourself and recognize early warning signs of potential relapse. These four aspects of well-being can be a good indication of overall emotional and physical health.^[3]

It can be a good idea to regularly check in with these aspects and notice if there are any changes or impairments in these areas. This can be a helpful strategy to prevent relapse stages from worsening and allow the early implementation of strategies to improve self-care. ^[2]

2. Practice mindfulness

Mindfulness techniques, such as meditation and yoga, can provide many physical and mental health benefits that can help reduce the risk of relapse. Mindfulness practices allow individuals to focus on their breathing and sensations in the body, helping to increase awareness and regulation of current thoughts and feelings.^[5]

By using these techniques, individuals can become more aware of any physical and mental changes, helping to recognize triggers and warning signs of relapse. This can increase self-efficacy and control over abstinence, improving the ability to make healthy choices and prevent relapse.^[6]

3. Practice self-care

Maintaining healthy habits and good self-care techniques is an important aspect of general well-being and especially impacts an individual’s ability to prevent relapse. Often, self-care declines in the early stages of relapse, which can be an easily recognizable warning sign.

Declining self-care can occur due to withdrawal symptoms, emotional changes, or pre-existing mental health conditions. Implementing and maintaining healthy habits such as structured sleep patterns, eating a healthy diet, and engaging in physical exercise can all improve general well-being and reduce the impact of triggers that can contribute to relapse.^[2][3]

4. Attend support groups

Attending support groups is an important part of relapse prevention for many people throughout their recovery. Groups such as Alcoholics Anonymous, Narcotics Anonymous, and SMART Recovery can provide a safe space for individuals to talk about past use, recognize and manage cravings and triggers, access peer support and advice, and provide accountability.^[2]

These groups can also help reduce feelings of loneliness, providing a sense of community amongst others going through a similar process. Many people also find someone to act as their sponsor through these groups, who can be contacted during challenging moments and when extra support is required.^[3]

5. Assign spotters

Having friends or family who can act as spotters can help you manage temptations and triggers. Trusted loved ones can help you recognize and manage challenging situations, supporting you through cravings and triggers. This can also help you hold yourself accountable, allowing you to be honest with yourself and others about relapse warning signs.^[1]

6. Seek treatment

Therapeutic interventions can help you manage underlying trauma and emotional distress that contribute to substance use, learn and adapt coping strategies to manage triggers and cravings, and recognize and alter negative thought patterns.^[2][3] 

Inpatient rehabs or outpatient treatment facilities can provide extensive support during relapse, which can help you through withdrawal, returning to abstinence, and learning relapse prevention skills.^[2]

What is a relapse prevention plan?

A relapse prevention plan is a set of tools, techniques, and skills that can be used in the stages leading up to a relapse, during a relapse, or immediately following a relapse, to guide the individual back to their recovery process.^[4]

While the general principles of relapse prevention can apply to all, each prevention plan will be tailored to the individual. It will aim to address their specific triggers and include any coping strategies that have been helpful in the past. It might also include aspects relating to any pre-existing mental or physical health conditions, the severity and duration of their substance use disorder, and environmental or social conditions.^[2]

Some common aspects of a relapse prevention plan include:^{[1][2][3][11]}

• Identifying triggers: Analyze past situations that led to substance use and identify the thoughts, feelings, and circumstances that preceded it. Once triggers are recognized, specific plans can be made to help avoid or manage these situations.
• Coping strategies: Different coping strategies can be effective for different people. Some useful techniques include mindfulness exercises, physical exercise, positive self-talk, assertive communication, and distractions.
• Support networks: Identifying who can be contacted in times of crisis or for compassionate support. This can include friends or family, sponsors, or peers from group meetings.
• Checking in: The acronym HALT (hungry, angry, lonely, tired) can be a useful tool for checking in with yourself and recognizing aspects of self-care that need improving.
• Lapse planning: In the event of a lapse, knowing how to limit the quantity or duration of substance use and return to recovery.
• Life changes: Removing unhelpful people, places, or items from your life and making healthy changes such as improvements in sleep, diet, and exercise.

The role of treatment in reducing relapse risk

Treatment programs for substance use disorders will often involve relapse prevention strategies to teach individuals important skills to use throughout their recovery process. This is often part of the treatment provided by rehab or outpatient facilities, therapy sessions, or group meetings.^[2]

The recovery process involves more than just avoiding substances and often requires consistent management of emotions and thoughts, utilization of coping strategies and skills, and awareness of temptations and triggers. As such, any addiction treatment program will involve these aspects, so individuals are better equipped to manage any challenges they face during recovery.^[3]

Various treatment options are available to help with addiction recovery and relapse prevention. You can learn more about these options and find available facilities through Recovered.