Relapse Prevention: Key Strategies for Sustaining Long-Term Recovery

Once you embark on the journey of recovery, you need to make recovery your priority every day of your life. However, recovery comes with its challenges. One significant challenge is relapse. Relapse happens when one goes back to using alcohol or drugs after a period of sobriety. It is a huge risk with substance use disorders (SUDs) and can run up to 60%. So, the key is not to consider relapse as a failure but as a challenge to a sober life.

Relapse prevention is a personalized approach provided to those recovering from Substance Use Disorders to identify and prevent any events or circumstances that can lead to relapse.

In the context of substance use disorders (SUDs), relapse is when a person goes back to using alcohol or drugs after a period of abstinence. As the risk of relapse is really high with SUDs, you are provided with personalized relapse prevention plans to identify and prevent the different elements that can lead to relapse.

In relapse prevention, you collaborate with a therapist to identify your unique triggers that can result in relapse. These can be physical, psychological, or social conditions that induce cravings, which can lead you toward the path of substance use again.

Once you identify the triggers, your therapist will seek to equip you with relapse prevention techniques and strategies, which look something like this:

• Psychoeducational sessions regarding triggers and the negative consequences of substance use.
• Healthy coping skills for specific, high-risk conditions for relapse. These coping skills seek to target your thinking, emotional, and behavioral patterns.
• Cognitive restructuring techniques are used to restructure negative thinking patterns related to substance use into productive ones that focus on recovery and sobriety.
• Urge surfing is commonly used in relapse prevention therapy. It focuses on avoiding undesirable behaviors and assertiveness training to clearly and confidently say no to any substance offered during and after recovery.
• Preparing for any emergencies, especially when it comes to maintaining recovery.
• Boosting your self-esteem and self-confidence in leading a sober life.
• Identifying your near and dear ones who can enable your recovery so that you can rely on them whenever you feel that things are getting overwhelming for you.

Relapse prevention is integral to substance use treatment. It leads to the best outcomes when it is personalized to fit your unique needs, challenges, circumstances, strengths, and goals.

Relapse happens in three stages. Understanding these stages is crucial to designing relapse prevention in therapy as well as your own awareness.

Emotional Relapse:

During this stage, you might not be actively thinking about using substances, yet there are some emotional and behavioral signs that can lead to it. For instance, anxiety, anger, forgoing eating or sleeping, and social withdrawal.

Mental Relapse:

You are of two minds, you want to use substances and want to abstain from them at the same time. You will find that the positive or pleasant memories related to substance use dominate the negative or unpleasant ones. Therefore, you might consider striking a bargain and getting hold of substances again.

Physical Relapse:

This is when you actively use substances again. When you do not take actionable steps to prevent relapse at emotional and mental relapse stages, physical relapse becomes very likely.

The triggers of relapse can be physical, psychological, and social. Triggers can be detrimental to your sustained recovery, so you need to be aware of the common relapse triggers as your relapse prevention plan is built around them.

Some common relapse triggers are:

• Withdrawal symptoms
• Any item that reminds you of your past substance use, like leftover supplies or materials.
• Places that remind you of your past substance use.
• Peers who use and enable substance use.
• Stress.
• Turbulent interpersonal relationships.
• Lack of self-care.

To create an effective relapse prevention plan, you must collaborate with your therapist for it to be personalized, specific, and comprehensive. You are an active participant in your recovery, and the same goes for relapse prevention in therapy.

Some of the common steps to building an effective relapse prevention plan are as follows:

Previous History of Substance Use:

This aspect of your relapse prevention plan includes certain things like the length of substance use, specific times and state of mind when there was increased substance use, and, in case of a prior relapse, the conditions that led to the relapse.

Identifying Triggers:

You and your therapist brainstorm all the triggers that can lead to substance use. From withdrawal symptoms to near and dear ones who enable substance use, all are the possible triggers you will have to consider.

Then, your therapist will create a list and educate you regarding these triggers and their negative consequences.

Managing Cravings:

Triggers lead to cravings, which can undo your recovery. Therefore, effective relapse prevention will involve effectively managing cravings by using coping mechanisms, cognitive restructuring, urge surfing, and other techniques.

Preventative Tools:

Preventative tools like an aftercare plan, ongoing support after rehabilitation, telehealth sessions, regular exercise, and self-care are the preventative tools integrated into your daily routine to prevent relapse.

Lifestyle Changes:

Once you embark on recovery, your life can never be the same as it was before. Therefore, you need to make lifestyle modifications, which will basically focus on managing triggers and cravings.

Personalized Aftercare:

Your recovery is a journey that does not end with rehab. An aftercare plan, including ongoing therapy, counseling, and medication management, is crucial in preventing relapse.

Informal Peer Groups:

Informal peer groups like Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) play a crucial role during your recovery. They provide a safe environment where you can share your experiences, find encouragement, and take ownership of your recovery. They are integral to your aftercare and relapse prevention plans.

During relapse prevention in therapy, you will learn robust relapse prevention techniques that are key to lasting recovery and a sober life ahead. These relapse prevention techniques are based on relapse prevention models, which your therapist will use to inform your relapse prevention plan. Some of the well-known ones are as follows:

Marlatt’s Model:

The oldest and among the widely followed models, the Marlatt's model says that it is basically a lack of healthy coping mechanisms that leads to relapse, as substance use is an unhealthy substitute for coping mechanisms. Therefore, the key is to equip you with healthy, strong coping skills that you can always rely on.

Dynamic Model of Relapse:

Marlatt and Witkiewitz gave this model of relapse prevention. It says that distal and proximal risks can contribute to relapse. Distal risks pertain to genetic predispositions, while proximal risks pertain to more immediate high-risk circumstances.

The dynamic model of relapse emphasizes strong social support and 12-step recovery programs like the ones AA and NA follow to prevent relapse.

Gorski-CENAPS Relapse Prevention Model:

This model says that relapse prevention requires the following:

• Awareness: Psychoeducation, which revolves around understanding the risks and the negative consequences of a relapse.
• Self-knowledge: You need to identify warning signs in yourself, like the triggers that can lead to a relapse.
• Self-regulation: Physical, emotional, and social regulation skills that allow you to manage your triggers and cravings.
• Coping skills: Healthy coping skills allow you to effectively deal with triggers, cravings, and high-risk conditions.
• Change: Reviewing the recovery plan.
• Maintenance: A follow-up plan.
• Social Support: Identify your loved ones who enable recovery so that you can reach out to them for motivation, encouragement, and support.

We have spoken at length about relapse prevention in the context of SUDs in this blog. Yet, we cannot overlook the risk of relapse and the importance of relapse prevention in the context of mental health either. In case of a relapse, you might need intervention and care, but not at the same level as before. Yet, earlier detection and intervention lead to the best outcomes.

Some of the best ways to prevent relapse when it comes to mental health conditions are as follows:

• Following your treatment plan as directed, which also involves ongoing care and medication management.
• Identify your triggers that can lead to relapse and effectively deal with them using the coping mechanisms you learned during therapy.
• Surround yourself with near and dear ones whom you can rely on. You can also join support groups that enable you to build connections with peers and find encouragement along the way.
• Finding creative outlets, no matter how simple, to keep your mind engaged and healthy.
• Knowing when to seek professional help is also an important step in relapse prevention. Reaching out to your therapist as soon as you notice any warning signs of relapse can help with early intervention.