Relapse Prevention

The term relapse refers to an instance in which someone who was previously free of substance abuse returns to using their preferred substance (whether drugs or alcohol).

According to the National Institute on Drug Abuse (NIDA), 40-60% of those overcoming substance abuse addiction suffer a relapse at some point during the recovery process. It's important to understand that suffering a relapse does not mean that all hope is lost, nor that the person will continue to suffer from drug addiction or alcohol addiction their whole life.

Drug Relapse Prevention

What happens during a relapse?

A mild relapse could be a single instance of using again (after going to a drug and alcohol rehab center and getting sober). Hopefully, the person has new options that they didn't have before getting substance abuse treatment: They could contact a safe person in their support network in that moment and talk to them instead of continuing to use the substance. They could call someone in their 12-step group. They could talk to their therapist or counselor about the trigger that led to the relapse (which is often an emotional reason, such as feeling low after a breakup, or feeling like a failure for some reason). Some addiction counselors say a single slip-up is not the same as a full relapse, but everyone agrees that it's critical that it's dealt with before it devolves into full-blown relapse.

When someone has fully relapsed, it means they've gone back to the same kind of substance abuse (drug or alcohol addiction) they were suffering from before going to rehab and/or getting treatment. The same issues they had before rehabilitation resurface. Sometimes, their connection to their support system is strained or even broken, depending on the circumstances (such as boundaries established by loved ones, and how many times the person has previously suffered a relapse).

What can someone do to prevent relapse?

First of all, if you are someone overcoming substance abuse, you should feel proud of yourself for getting help in the first place. In 2013 alone, it's estimated that just over 20 million people who needed treatment for drug or alcohol addiction didn't receive it. It is a courageous act to admit there's something wrong, and get the proper treatment to correct it.

It's also practically inevitable that those who've undergone substance abuse treatment (especially in a drug or alcohol rehab center) will face temptations once they're out. Sometimes this comes in the form of being around others who are still using drugs or alcohol, or simply from facing life's challenges and experiencing the same feelings that prompted substance abuse in the first place (i.e. overwhelm, anxiety, or sadness).

After rehabilitation for drug or alcohol addiction, it's essential for recovering addicts to make sure they're ready to reenter the "real world". For some, this means getting extended care. In fact, NIDA suggests that the most effective substance abuse treatment lasts longer than 3 months.

Extended care could mean extending one's stay in an inpatient drug and alcohol rehab facility; starting (or continuing with) an outpatient drug or alcohol rehab program; living in a sober living home (such as a halfway house); regularly attending 12-step meetings; and/or having regular appointments with a therapist you trust. In all cases, it means learning to establish, maintain, and make regular use of a healthy and sustainable support system.

One of the best ways to prevent relapse is to monitor your own stress level. Stress is a major trigger for drug and alcohol addiction, and there are times you may need more frequent visits to counselors and/or mentors or sponsors. If there's something stressful going on at school or at home, be proactive about reaching out to others. This is a healthy choice, and part of what helps you maintain your sobriety.

You're not alone, and you don't have to deal with stress or addiction recovery on your own.

What are some steps someone can take if they are thinking about relapsing?

For most, relapse isn't just about the event (using again) - it's about what leads up to it. In other words, relapse actually begins weeks or sometimes months before the actual drug or alcohol use. Some rehab experts even argue that "relapse" actually covers three separate phases: emotional relapse, mental relapse, and physical relapse.

During emotional relapse, you're not thinking about actually drinking or doing drugs again. Instead, you're simply experiencing uncomfortable emotions that have triggered substance abuse in the past (fear, anxiety, defensiveness, anger, moodiness, loneliness). You're also usually isolating and not asking for help.

The best way to combat relapse at this stage is to take good care of yourself. Reach out for help. Make sure you get sleep. Eat good foods. Go somewhere that you know relaxes and recharges you, like the beach or a park. Engaging in self-care at this point is an extremely effective way of stopping the cycle.

Mental relapse is the next phase, and it usually involves an inner battle. One part of you wants to use your preferred substance, the other wants to protect your sobriety and honor everything you learned in rehab. Signals of this phase include glamorizing your past life of substance abuse, reminiscing about people or places associated with it, fantasizing about drinking or doing drugs, and lying.

Ways to combat relapse at this stage are:

  • Play the situation out in your mind. A common fantasy is that this time, you'll be able to control yourself. You'll just have a little bit. It won't get out of hand. But one one drink or hit almost always leads to more, and you aren't likely to stop. See this happening, and see yourself waking up the next day, discouraged. You've lost your sobriety and let people down - first and foremost, yourself. It gets a lot less tempting to think about using again when you truly consider the aftermath.
  • Talk to someone. Tell someone what's happening - that you're feeling tempted to use again. Ideally, tell someone who is also in recovery (such as someone in a 12-step program), since they've been there. They'll "get it", and there's something profound about sharing your thoughts and feelings about urges. Many recovering alcohol and drug addicts report that for some reason, sharing cravings has them go away.
  • Wait 30 minutes. Research suggests that urges generally last 15-30 minutes. So distract yourself - go for a walk, read a book, go to a meeting, cook something, walk a dog - do anything to get your mind off it. Don't just sit there with the urge and do nothing; this is when thoughts fester.
  • Take it one day at a time. Don't think about whether you'll be able to stay sober for the rest of your life; stay focused on the present moment. The thought of having to make it "forever" can be overwhelming even for those who've been in recovery for a long time. Just tell yourself you won't use for today, or for the next 30 minutes. One step at a time.

Physical relapse is the last phase, and involves actually engaging in substance abuse again.

What happens if you do relapse?

The fact is, like all normal human beings, recovering addicts do make mistakes. If you suffer a relapse, it doesn't mean you're never going to be fully free of substance abuse. It also doesn't mean there's something wrong with you. You're not the only one who has hit rocky patches on the road to full recovery, and you shouldn't feel ashamed.

The most important thing to do if you relapse is to seek help immediately. Sometimes this involves going back to a drug and alcohol rehab center. Re-starting the substance abuse treatment process is important, since it reinforces what you already know about sobriety (and can help you detox safely if your relapse has gotten to that point).

If you've already been through the drug and alcohol rehab process, it's good to keep in mind that you if did it once, you can do it again. Again, suffering a relapse doesn't mean you're a bad person or that there's something wrong with you. It's just another part of the journey. It's not about how many times you fall; it's about getting up.

What else is involved in relapse prevention?

In some cases, those recovering from drug or alcohol addiction may require medication to remain sober. Especially for those who engaged in very heavy drug or alcohol use, certain medications can help to correct imbalances in the brain, and can be used to subdue cravings an addict may experience. For example, those who were addicted to opiates or opioids (heroin, OxyContin, Vicodin) may be served by getting methadone, a synthetic narcotic that has proved useful in tempering cravings. A qualified psychiatrist can help make the determination as to whether you or your loved ones should use one to aid in drug or alcohol rehabilitation.

Addiction therapy is another important element. Mental health professionals like drug addiction counselors are experienced in helping people get and stay sober. They teach tools like cognitive behavioral therapy (CBT), which is a therapy that helps you become aware of and regulate your own thoughts and emotions. This can give you more control over your experience of life and raise your self-esteem because you can see progress in how you react to things.

It's also vital to have a strong support system. This means having access to the right kind of support, when you need it. For example, at 11pm on a Saturday night, your therapist may not be available, but your sponsor from your 12-step program may be. Similarly, your friends and mentors from a 12-step group will be able to help you with different things than your family members will, but family and friends can often offer something different than a therapist (such as a hug when you need it). It's equally important that you have sources of joy and excitement in your life, like learning a new activity, or joining a sports team.

Finally, it's important to recognize and honor your own personal goals. Do you want to go back to school (or go to school for the first time)? What kind of career would you like to have? Where do you want to contribute? Actively pursuing your dreams focuses your mind on something healthy, concrete, and uplifting, which leaves it less available to think about addiction.

The ultimate goal of getting sober isn't just to not engage in substance abuse, but to feel and be truly healthy. In other words, the best substance abuse treatment is living a vibrant and uplifting life.

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