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Relapse Prevention: Navigating Addiction

You may have heard of the terms lapse and relapse as they hold much weight in the realm of addiction. A lapse is a temporary return to substance use with continued focus on recovery; relapse on the other hand refers to a return to substances following a period of abstinence in which a person has full-blown regression towards active addiction.  While these terms are unavoidable in recovery and addiction, it is important to note that they do not deserve the negative connotations often associated with them. Recovery takes the form of a squiggly, non-linear line rather than a straight path, meaning that lapse and relapse are a part of the journey rather than a dead end. Rather than looking at relapse as an event, look at it as a process; the focus is progress, not perfection. With that being said, the purpose of this blog post is to offer a practical, foundational understanding of relapse prevention.

Relapse occurs over a period, meaning that the relapse process begins prior to picking up a substance again. Recognizing the stages of relapse can help an individual engage in early prevention for a much greater chance of success. In the Yale Journal of Biology and Medicine, author Melemis outlines three stages of relapse: emotional, mental, and physical (1). Here are characteristics of each and what you can do to engage in relapse prevention during each stage.

Emotional Relapse

  • The substance might not be on the mind, not wanting to repeat the last relapse
  • Emotional warning signs: anxiety, denial, restlessness, anger, defensiveness
  • Behavioral warning signs: decline in self-care such as sleeping and eating habits, isolation, removing self from recovery environment by not attending meetings or not reaching out to support system, and bottling up emotions

Recognize that you are in the emotional relapse stage and begin making small changes to behavior.

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Prioritize self-care

Implement an exercise routine and stick to a more balanced diet. Identify and follow a structured sleep schedule. Re-define fun, specifically what it looks like to engage in sober fun.

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Utilize the HALT method

HALT stands for Hungry, Anger, Lonely, and Tired. This can help you check in with yourself to identify if any of these categories needs attention. Feeling these stressors might make you more vulnerable to make poor, emotional-based decisions.

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Reaching out for help

Do not bottle up your emotions and do try to reconnect with those you might have fallen out of touch with. Despite motivation to do so, attend meetings, stay consistent in treatment, and reach out to your support system.

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Create a new lifestyle.

Engage in a new, healthy routine that reinforces sober behaviors and ways of thinking. Identify triggers, people, places, and things, in your previous lifestyle that no longer serve you. Replace these with healthy, positive connections.

Mental Relapse

  • Internal conflict, where you might be on the fence, one foot in recovery and one foot in addiction.
  • Thoughts of using are increasing in frequency and intensity. 
  • Warning signs: cravings, planning relapse, glamorizing use, glorification of past use and experiences while using, lying and bargaining, seeking out opportunities to support a relapse, and fantasizing about use.

In this stage, it is increasingly important to utilize techniques as the need for substances escalates; it will only get more difficult to derail using thoughts as cognitive resistance fades.

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Practice mindfulness and meditation techniques

This will help reduce the emotional reactions involved, including stress and frustration. It can help mitigate negative thinking, anxiety, and tension. It focuses on self-compassion and self-care, being able to learn to relax and rest in life.

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Identify and reframe negative thinking

Identify cognitive distortions and ‘hot thoughts’ such as all or nothing thinking and catastrophizing. Be honest about your thoughts on recovery, even if it means being vulnerable about your progress or negative behaviors such as lying and hiding things. Learn to break away from the cycle of thinking that feeds addiction thinking and self-destructive patterns.

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Play the tape forward

Think about the consequences of use. Remind yourself of what happened in previous relapses and how you have wanted to avoid feeling that way again. Identify both long term and short term outcomes. Ignore deceiving thoughts that say you can control it this time or it will not escalate.

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Wait out the urge

Cravings and urges diminish or go away within an hour. While waiting it out, distract yourself, use your coping skills, and get help from your support system. Do not let your mind entertain these thoughts and let them grow.

Physical Relapse

  • This entails the act of using substances again, whether it be a lapse or relapse, or at the very least heading to your relapse opportunity. 
  • You might see an opportunity, one in which you feel you will not get caught for.

In this final stage, relapse is almost unavoidable if not already in play. Prevention comes before this stage with rehearsing situations like this out and identifying how to exit effectively and adaptively. If you find yourself in this stage, it is likely that the mental relapse stage went on too long to the point where escapism through substances felt like the only answer to how you were feeling. We go back to what we are familiar with and by the time we are faced with a decision to say no, it is simply not that easy anymore.

Relapse prevention is a process, not just a plan. If you or a loved one need support in navigating addiction and engaging in successful, long term relapse prevention, seek out professional support, whether it is attending substance use meetings (AA, NA, AlANON), counseling, and/or intensive outpatient groups. 

Reference: 

Melemis S. M. (2015). Relapse Prevention and the Five Rules of Recovery. The Yale journal of biology and medicine88(3), 325–332.

Meet The Author

Michaela Quinley, Clinical Therapist at Sea Glass Mental Health

MICHAELA QUINLEY

MC, LAC

Meet The Author

Michaela is a Clinical Counselor at Sea Glass Mental Health. She works with teen, couples, and adult populations. Michaela specializes in treating  anxiety, depression, and substance abuse. 

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