In the world of addiction treatment, relapse prevention is one of those areas where the only way to stay on top of it is through constant diligence and work. Unlike other diseases where the illness is gone once you have taken the appropriate medicine, addiction is a chronic disease; the threat of relapse is always something that will be with a person once they become afflicted. This has to do with the way addiction affects the brain and also how the brain is affected by outside triggers. These triggers can come from anxiety, anger, interpersonal situations and a whole host of other factors. If you aren’t constantly working in a recovery program of some sort, then the odds of relapsing jump upward.
The Disease of Addiction
In order to fully understand why relapse prevention is not only a vital but also an ongoing process in dealing with addiction, it is important to know exactly what the disease is. Addiction is defined by the American Society of Addiction Medicine as a chronic brain disease that primarily affects the reward, memory, motivation and related areas. The dysfunction that occurs in these areas leads to characteristic biological markers as well as shifts in a person’s psychological, social and spiritual bent. This change in tendency is displayed in a person’s pathological pursuit of triggering their reward center through the consistent use of certain chemical substances.
The main symptoms of addiction are the inability to abstain on a regular basis, behavioral problems, inability to recognize intrapersonal and interpersonal problems stemming from use, cravings and emotional dysfunction. Addiction is a chronic disease, meaning that there will be periods of relapse and remission. Without proper treatment, including relapse prevention programs, the disease can progress and possibly result in disability.
If you are suffering from addiction or a substance use disorder, then the first step is to seek help from a treatment center. Depending on how far the disease has progressed and how it has affected your everyday life, you might need a high level of initial care as can be found with an inpatient program or a lesser level of care from an outpatient program. Here is a comprehensive list of options:
- Long-term inpatient programs are designed for people who have severe addiction problems and require 24/7 care in a medical facility. These programs focus on detoxification and medically assisted withdrawal, group counseling as well as individual therapy, resocialization including employment training and household management and coming up with strategies and coping mechanisms to prevent relapse. People stay at the facilities on average between 6 and 12 months.
- Short-term inpatient programs are intensive programs based around a revised 12-step approach. There are individual and group counseling sessions as well as health and wellness training. The average stay is three to six months.
- Intensive day treatment programs are designed to give a level of care compatible with an inpatient program while still allowing the patient to live at home. There are two to four-hour meetings multiple times weekly focusing on both group and individual counseling sessions.
- Outpatient treatment programs are for people who have addiction or substance abuse issues but can still function in the world by going to work and taking care of their family. A meeting takes place one to two times weekly for two hours each time and entails both group and individual counseling.
- Individual treatment options work well for people who are in the beginning stages of addiction and do not require a high level of care. Usually, the approach used will involve Cognitive Behavioral Therapy and address the issues that led to the initial substance abuse. Meeting frequency and duration vary.
The Struggle of Relapse
Once you have completed the course of recovery through one or more of the various programs that are available, the focus of treatment shifts toward a model of preventative care. For many people, by the time they reach the end of their treatment program, they will have already had a relapse. Relapse simply means returning to substance abuse after a period of sobriety. People suffering from addiction have a 40 to 60 percent chance of relapsing at some point according to the National Institute of Health. Those numbers are on par with other chronic diseases like hypertension and asthma and are significant to point out because of the shame and regret that are often associated with relapsing. Relapse is considered a common part of recovery and is actually a useful tool for signaling the need to reenter treatment or modify a treatment plan.
Triggers and Early Warning Signs
An important aspect in recognizing that a relapse is likely is understanding what might be triggering it. A trigger is something that prompts a person to feel upset and scared because they are made to remember something bad that has happened in the past. In the world of addiction, triggers can very easily lead people to relapse and possibly spiral downward if not addressed in a timely manner. Here is a list of some of the more common triggers that can spark a relapse:
- Withdrawal symptoms that come about from the discontinued use of a substance are a huge trigger for relapse. Not only are these symptoms a major cause of relapse, but they are often a major obstacle to people seeking treatment in the first place. Symptoms of withdrawal are varied depending on the substance, length of use and amount ingested. Symptoms include anxiety, nausea, physical weakness, stroke, accelerated heart rate, irregular bowel, blood pressure problems, mood swings and sleep problems.
- Everyday life can be full of stressors that can wear people down and possibly become triggering.
- Poor self-care in the form of stress management, eating and sleeping habits or leisure time can all weigh a person down mentally and physically, which can result in relapse.
- Seeing old friends they formerly used with is a big trigger for many people. The old friend doesn’t even have to be using anymore for the trigger to still be present. Many times, friends who use together develop a co-dependency that will still be present even in the face of abstinence.
- Old hangouts like bars, drug houses or anywhere that use commonly occurred can trigger the urge to pick up again.
- Anything that was a part of a drug-using life can become a trigger to use again. Old habits become etched into memories as do the memories of using that are tied to them.
- Uncomfortable emotions are difficult to deal with under normal circumstances, and for someone suffering from addiction, negative emotions can definitely trigger the urge to use. When people experience feelings of hunger, anger, loneliness, fatigue or sadness, it’s natural to want to shut them down as quickly as possible.
- Relationships and love can cause all sorts of highs and lows that can trigger someone. This is especially true of the lows that come from fighting or breaking up.
- Leading an isolated existence without contact from friends or family can cause someone to overthink things or just become generally depressed, which is never a good thing for someone with addiction issues.
- Being overconfident in your ability to abstain from using or thinking that you have it beat is a surefire way to relapse again. Acting as if nothing bad can happen blinds you to the dangers from all the triggers listed here, which leaves you open and vulnerable. It is important to remember that having an addiction is nothing to be ashamed of and nothing to pretend doesn’t exist.
The Stages of Relapse
There is a misconception that a relapse is an event when, in reality, it is a process. Before a person picks up a substance and begins to use again a whole process has taken place leading them to that point. This process is cumulative and can begin weeks or even months before the actual use occurs. This is why one of the main goals of treatment and relapse prevention is to recognize these warning signs in their initial stages and deal with them at their easiest. Recognizing triggering events such as those listed above is one great way to prevent a relapse. Another way is to recognize the stages of relapse listed below so that you are prepared to deal with them.
Emotional relapse is the first stage and occurs long before a person even thinks about using. They are still cognizant of their last relapse and want to avoid future use, but their emotional and behavioral states are setting them up to do just that. Denial is a big part of this stage and takes shape in many forms including isolating, bottling up emotions, not going to meetings, not sharing if they do attend meetings, focusing on other’s problems rather than their own and poor eating or sleeping habits. The underlying theme here is the denial of the person’s addiction and the need to stay vigilant during recovery.
The two important areas to address during this stage are denial and self-care. With the former, there is a mindset developing that the person is immune to or in control of their addiction. This sets up a false sense of security that will leave them open to triggers and eventual use. The latter can be problematic because neglecting oneself whether physically or emotionally will also leave them vulnerable to triggers.
Mental relapse is the next stage; at this point, a person is involved in an internal struggle between using and abstinence. As they progress through this stage, the desire to escape starts to overpower the will to abstain. Some important indicators of mental relapse include cravings for drugs or alcohol, fixating on people, places and things from when they used, minimizing or glamorizing past use, lying, bargaining, thinking of ways to control their use, looking for an opportunity to use and planning a relapse.
Avoiding high-risk situations is important in helping a person step back from this stage. If they are reminiscing about an old bar they used to go to, they might try visiting it, or they might glamorize their past use and trick themselves into believing they should have never stopped in the first place. This stage can be seen as a tightrope walk where the person walking it can fall off at any moment and start using again.
The final stage is the physical relapse where the actual process of using again. Some clinicians split this stage into a “lapse” which involves one use and “relapse” which involves multiple using events. However, this can be problematic for the person lapsing by tricking them into a false sense of security that can quickly lead right back to this point or further. It is best to minimize the potential negative consequences of any use by rejoining a treatment program whether it is a 12-step program, outpatient facility or some form of individualized care.
Relapse Prevention Tips
There are certain steps you can take to help ensure that the risk of relapse is minimized throughout the recovery process. There are many people who have gone years and decades abstaining from use, so it is definitely possible. Here are some tips that can help you avoid that next pitfall down the road to recovery:
- Stay in treatment for its duration and follow the aftercare guidelines.
- Eat a healthy diet low in refined sugars and simple carbohydrates. These two substances can cause energy spikes and crashes as well as emotional swings.
- Have a regular exercise regimen.
- Try natural ways of reducing stress such as meditation and yoga.
- Join a support group or 12-step program and make connections with people in similar circumstances.
- Avoid people, places and things that are associated with drug or alcohol use.
- Surround yourself with positive family and friends who will support your decision to stay clean.
- Pick up a hobby or creative endeavor to give yourself a positive output for your energy.
With this knowledge and these tips in hand, you can prepare yourself to deal with whatever curveballs life may throw at you in a positive way while maintaining your sobriety.