Relapse Prevention: Key Strategies for Sustaining Long-Term Recovery

Introduction

In behavioral health, relapse refers to the deterioration of a condition after temporary improvement. For instance, going back to substance abuse after rehabilitation. Therefore, all behavioral health treatments are developed in a manner so as to prevent relapse. 

At the NuView Treatment Center, we take relapse prevention very seriously. Our specialized behavioral health and rehabilitation services are crafted to prevent relapse, and we provide aftercare and ongoing support to our clients for the same purpose.

What is Relapse Prevention?

In behavioral health, relapse is often used in the context of substance use disorders (SUDs). Recovering from SUDs is not easy, as it requires overcoming cravings, withdrawal symptoms, and resisting the urge to use in general. Therefore, relapse is a very strong possibility.

Relapse prevention is when the therapist and the client work together to identify the triggers that can lead to substance use. These are basically physical, psychological, and social conditions that might lead to cravings and ultimately to substance use again. Once these triggers are identified, therapists seek to identify the factors that lead to these conditions. For instance, peer group is a very important factor in substance use, so this is a social condition that can lead to relapse.

A relapse prevention plan is then created to deal with the triggers and factors that can affect these triggers, and it basically involves the following strategies:

• Raising awareness regarding the triggers and the negative consequences of substance use in response to these triggers.

• Equipping clients with coping skills for specific and likely high-risk conditions for relapse, and these coping skills can be related to thinking, emotional, and behavioral patterns.

• Urge surfing, which refers to avoiding acting on undesirable behavior, and assertiveness training to clearly and confidently say no to any kind of substance offered are very important parts of relapse prevention.

• Cognitive restructuring techniques, wherein positive frames of mind regarding substance use are challenged and reshaped into more healthy thinking patterns.

• Boosting the client’s self-esteem and self-confidence in overcoming SUDs and in leading sober lives.

• Preparing for any emergencies, especially when it comes to maintaining abstinence.

Relapse prevention plans work best when they are personalized to fit the unique needs and circumstances of every client. People’s triggers and lifestyle factors that can give rise to these triggers vary from one person to another, therefore, all of these things must be kept in mind while developing a relapse prevention plan.

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The Stages of Relapse

There are three stages of relapse, and these can also serve as crucial warning signs of a relapse.

1. Emotional Relapse –

During this stage, a person is not actively thinking about substance use. However, their emotional and behavioral patterns might lead them to it. For instance, anxiety, anger, forgoing eating or sleeping, and isolation are certain signs of an emotional relapse. Identifying these signs in oneself or a loved one becomes vital in preventing relapse.

2. Mental Relapse –

At this stage, a person is of two minds – they want to use and at the same time they do not want to use. Positive memories about substance use can become more dominant than bad ones. This is when the person can begin to bargain and consider getting hold of the substance again.

3. Physical Relapse –

This is the stage when the person actively begins to use again, and when steps are not taken to prevent relapse during the emotional and mental stages, a physical relapse becomes very likely. In fact, at this point, it might just take one momentary lapse of judgment to reach out for the substance and start using it again.

Common Relapse Triggers

Relapse triggers can be physical, psychological, or social. They are very dangerous, as they can make a person start using again. Being aware of the most common relapse triggers is a good way to avoid and effectively cope with them.

Some common relapse triggers are:

• Withdrawal symptoms

• Any item that can remind a person of their past substance use, perhaps leftover supplies or materials

• Places that remind a person of their past substance use

• Peers who use and enable substance use

• Stress

• Lack of self-care

• Negative relationships

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Building an Effective Relapse Prevention Plan

To create an effective relapse prevention plan, the therapist and client must work collaboratively. It needs to be personalized, specific, and detailed to work. Some common steps to building an effective relapse plan are as follows:

Previous History of Substance Use –

This involves looking into 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 –

The therapist and client must brainstorm all the triggers that can lead to substance use. From withdrawal symptoms to peers who can enable substance use, all are possible triggers. Creating a list and educating the client about the same is a crucial step in building an effective relapse prevention plan.

Managing Cravings –

Cravings can be just as detrimental to recovery as triggers. Understanding and managing cravings can also go a long way in preventing relapse. Urge surfing, a way to stop acting on cravings, and strong social support can be a factor in managing cravings. For instance, whenever a person begins to crave a substance after recovery, they can reach out to their loved ones to rely on them for encouragement, motivation, and even distraction.

Preventative Tools –

Preventative tools like an aftercare plan, ongoing support after rehabilitation, online therapy, exercising, self-care, and others are all preventative tools that need to be incorporated into an effective relapse prevention plan.

Lifestyle Changes –

Life after rehabilitation can never be the same as it used to be before. There need to be lifestyle changes that need to be incorporated. These lifestyle factors are important to managing triggers and cravings as well.

Informal Peer Groups –

Informal peer groups like Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) play a crucial role during recovery. They provide a space for people to share their experiences, find support, and take ownership of their recovery.

Relapse Prevention Techniques

There are many relapse prevention models that provide relapse prevention techniques. Few of the most followed ones are as follows:

Marlatt’s Model – The oldest and among the widely followed models. It says that the absence of healthy coping mechanisms is what leads to relapse, as substance use becomes the substitute coping mechanism and an unhealthy one at that. Therefore, the key to preventing relapse is healthy coping techniques.

Dynamic Model of Relapse – Given by Marlatt and Witkiewitz, 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.

This model 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:

• Awareness – Education; understanding the risk of a relapse and the negative consequences of a relapse.

• Self-knowledge – Identifying warning signs, like triggers, which might lead to relapse.

• Self-regulation – Physical, psychological, and social regulation.

• Coping skills – Healthy coping skills that are required to deal with triggers, cravings, and high-risk conditions.

• Change – Reviewing the recovery plan.

• Maintenance – A follow-up plan.

• Support – Identifying near and dear who are helpful for recovery and relying on them for motivation, encouragement, and support.

Relapse Prevention in Substance Abuse Recovery

In the context of substance abuse recovery, relapse refers to a return to substance use after rehabilitation or temporary improvement. Relapse in cases of substance abuse is really high, between 40% - 60%. Therefore, substance abuse recovery programs are designed to prevent relapse.

Some key relapse prevention strategies to be implemented during substance abuse recovery are as follows:

• Ongoing Therapy and Counseling –

  Recovery is a journey that does not stop with rehabilitation. An aftercare plan, including ongoing therapy and counseling, is important for preventing relapse. Attending all of these sessions is crucial.

• Medication Management –

  Taking prescribed medications or supplements as per the directions.

• Coping Skills –

  Healthy coping skills are required to deal with triggers and cravings. These can include releasing feelings in a non-destructive way, relaxation skills, a social support system, and even complementary therapy techniques like yoga, meditation, and so on.

• Self-Care –

  Having a self-care plan is crucial to preventing relapse. This involves eating healthy, exercising, getting a good night’s sleep, and maintaining good hygiene, among others.

• Strong Social Support System –

  Having a strong social support system, which is especially central to recovery, is important for preventing relapse. They can provide motivation and encouragement, especially in terms of keeping away from triggers, cravings, and other high-risk factors.

• Pursue Creative Interests –

  Identify a passion and pursue the same – it can be anything from drawing, painting, writing, dancing, and more.

• Join Support Groups –

  Joining groups like AA or NA follow the 12-step recovery program, as they help provide support in terms of recovery. Moreover, studies have also shown people who actively participate in these groups are less likely to relapse.

Mental Health and Relapse Prevention

In the context of mental health, relapse refers to the display of the symptoms of a mental health condition that was previously diagnosed. It might need intervention and care, but not at the same level as before. However, the earlier the better.

Some of the best ways to prevent relapse when it comes to mental health are similar to relapse prevention plans in substance abuse recovery:

• Following the treatment plan as directed, this involves ongoing care and medication management as prescribed.

• Identify triggers that can lead to relapse and deal with them by using healthy coping skills. Avoiding triggers can also be useful in preventing relapse.

• Having a strong social support system, like near and dear ones one can rely on, or joining support groups can help make connections with people going through similar things in life, finding support, and taking ownership of recovery.

• Finding creative outlets, no matter how simple, can help keep the mind engaged and healthy.

• Knowing when to seek professional help is also an important step in relapse prevention. Reaching out to the therapist as soon as any warning signs of relapse are noticed can help with early intervention strategies.