Relapse Prevention

What Is Recovery?

When someone has a problem with alcohol or another drug, they may decide to make changes to their behaviors, beliefs, relationships, habits, and thought patterns in order to address the problem. Often, this includes abstinence from using the substance and/or a decision to become sober (abstaining from all alcohol and drug use). When a person has committed to and begun to make these changes, they can be said to be "in recovery" from their problem. According to the Substance Abuse and Mental Health Administration (SAMHSA), “Recovery from alcohol and drug problems is a process of change through which an individual achieves abstinence and improved health, wellness, and quality of life.” While there may be other definitions of recovery, this is a commonly used one.

Addiction, Dependence, and Relapse

People can become dependent on and/or addicted to a substance: Dependence means psychologically needing a substance to feel OK or function and/or using a substance despite consequences; addiction means physically needing the substance, demonstrated by higher tolerance and withdrawal symptoms if the person stops using the substance. Many factors contribute to dependence and addiction, including genetic susceptibility, personal and family history, current environment (e.g., how available are substances? how tempting is it it use them? are many of the person's peers using?), and patterns of use (i.e., increasing quantities and frequency of substance use increases the risk of addiction and dependence).

When a person becomes addicted to a substance, their brain undergoes changes in how it functions. The first year of sobriety is known as "early recovery," and over this period, the person's brain function gradually returns to more "normal" functioning that would be seen in people who are not addicted to a substance. However, recovery of normal brain function can take a long time. Thus, early recovery can be challenging, and relapses are often experienced. A relapse is a return to a problem behavior. A person may also experience a "lapse," which can be seen as a shorter-term and/or less serious form of relapse. For example, an alcoholic who has one beer at a party but then goes back to sobriety has had a lapse, but if that person had the beer at the party and then went on a 3-day bender, that would be considered a relapse. Lapses don't always lead to relapses. Sometimes, lapses are helpful in making a person more aware of their triggers and ways they need to work on being prepared to handle them. Other times, lapses can fool a person into thinking they can use the substance again and that "things will be different this time," when often, this will lead back to problematic use.

Relapse Triggers

When a situation, relationship, thought, feeling, or sensation causes a person in recovery to want to resume the problematic behavior (or actually causes a lapse or relapse), this is called a trigger. Each person is different in what may trigger them; however, being around others who use is one of the most common triggers for relapse. Other common triggers are being in situations associated with use, boredom, loneliness, and other difficult emotions (e.g., sadness after a breakup, guilt after hurting someone's feelings). General stress, lack of sleep, poor diet, and physical illness can also be triggers, making it important for people in recovery to find ways to relax, cope, and take care of themselves.

Sometimes, “apparently irrelevant decisions” can contribute to lapses and relapses if the person is not working to recognize their triggers and try to avoid or prepare for them. For example, a drug addict in recovery who could choose to have her paychecks given to her or sent directly to her bank account decides to directly receive her check and then cash it rather than deposit the money in the bank. She could choose to have coffee at a diner near where her old dealer hangs out or at a cafe where she is unlikely to see her dealer, then decides to visit the diner. These two decisions have increased her danger of relapse, because she is more likely to run into her dealer and has a lot of cash on her, which would make it easy to buy drugs.

Preventing Relapses

There are several important components to learning to prevent lapses and relapses:

  1. Get to know yourself and your triggers. Pay attention to situations, people, thoughts, feelings, and sensations that make you feel like using and reflect on how they impact you. It helps to practice being mindful and self-aware (i.e., allowing yourself to acknowledge and experience your thoughts and feelings rather than denying or avoiding them).
  2. Be honest with yourself about high-risk situations: Going to a party where everyone will be drinking heavily or attending a concert where your friends will be high may be too triggering for you, especially in early recovery.
  3. Having people in your life who don't use (or at least will support you in your recovery by avoiding or minimizing their use around you and not encouraging or pressuring you to use) is important. Being around others who use is one of the most common triggers for relapse.
  4. Rely on trusted people in your life: They may recognize potential triggers when you can't. They can also provide support, encouragement, or distraction when you need it.
  5. Having activities to do that you enjoy and that don't involve substance use is an important part of recovery and of having a fulfilling life.
  6. Recognize that urges to use come in waves: They often last a short time (e.g., 15 to 30 minutes), then subside or weaken, so finding a way to cope, distract yourself, or get support during the peak of the wave is important. Remind yourself that the urge will not continue to remain as strong, and you can get past it.
  7. Make a specific plan that helps you avoid triggers when possible and cope with them when it's not possible to avoid them. Just assuming you can deal with situations as they come can make it much harder to avoid relapse.
    1. When a trigger can be avoided, think ahead to exactly how you can do this.
    2. When you don't need to avoid a trigger (or when it's not possible to avoid it), think about ways to minimize its impact on you and/or cope with its impact.
    3. Try to come up with several specific ways you can deal with a trigger. Use a "coping card" to write down coping tools and sources of support.

When Relapses Happen

Recovery is often challenging, and relapse is common, but many people successfully resume recovery after a relapse. A lapse or relapse does not have to derail your efforts to recover. It's important to work on changing all-or-nothing thinking: Some people have a lapse then feel like they have "failed" or "ruined" their recovery so they "might as well" engage in a full-blown relapse. A small lapse does not have to lead to a bigger relapse, and a relapse does not have to mean an end to your recovery. You can get back on track and resume your recovery plan.

When a lapse or relapse happens, ask for help and support as soon as possible. If you have a sponsor, call them! Use your coping tools and step up your self-care. Keep a positive outlook: You can recover.