Unfortunately for most people, entering addiction recovery is not as simple as just not using. Taking the first steps to quit may be straightforward but maintaining that commitment is incredibly challenging without the right treatment and tools. Relapse prevention treatment is useful for people who have found quitting on their own to be difficult.Melemis S. M. (2015). Relapse Prevention and the Five Rules of Recovery. The Yale journal of biology and medicine, 88(3), 325–332. You can benefit from relapse prevention most when you seek support to establish a life where not using is easier than using.
Relapse prevention revolves around four primary pillars:
- The first is that we must recognize relapse as a gradual process with three stages.
- Second, it is important to acknowledge that recovery is a process of personal growth that comes with a variety of risks and milestones.
- Third, relapse prevention requires you to develop healthy coping skills using two main tools: cognitive therapy and mind-body relaxation.
- The fourth pillar maintains that there are five basic rules that can be followed to help develop focus and prevent relapse.
The Stages of Relapse
Before diving into the five rules of recovery, it is important to first understand and be able to recognize the stages of relapse. Relapse occurs in three gradual and distinct stages: emotional, mental, and physical. If you have been dependent on drugs or alcohol for some time, you may find it difficult to feel “normal”’ without these substances.NIDA. (2018, July 2). Media Guide. Retrieved from https://archives.drugabuse.gov/publications/media-guide on 2022, March 4 The desire to return to what feels “normal” is what can lead to relapse. Knowing the signs and stages of relapse can help prevent it from happening.
In this first stage of relapse, individuals may not be actively thinking about using, but their behaviors are setting them up for relapse. The overall theme in the emotional relapse stage is diminished self-care, which can manifest in many ways:
- Bottling emotions
- Isolating from others
- Poor sleeping habits
- Poor eating habits
- Not going to meetings
In early recovery, occasional thoughts about using are normal. Mental relapse consists of more persistent and frequent thoughts about returning to using. At this point in relapse, individuals are at odds with themselves—part of them wants to use, and part of them wants to stay clean. As mental relapse progresses, you may have more difficulty resisting the urge to use.
Signs of mental relapse may include:
- Experiencing cravings for drugs or alcohol
- Nostalgic or glamorized feelings about past experiences with alcohol and drug use
- Looking for opportunities to relapse
- Planning a relapse
Lastly, physical relapse occurs when a person starts using again. Many researchers approach this stage in an even more detailed manner, as relapse is a process rather than a single event. They use one of three terms to define physical relapse. The initial instance of returning to using is defined as a “lapse,” which can escalate and return to the level that is similar to before the person tried to quit—an official “relapse.” A “prolapse” occurs if the person can abstain again after the initial lapse and continue in the direction of recovery.
Cognitive Therapy and Relapse Prevention
Relapse prevention is a cognitive-behavioral approach designed to help you anticipate and cope with setbacks during the recovery process. Cognitive therapy is one of the main techniques used to help develop healthy coping skills and change negative thinking. The two basic goals of relapse prevention are to minimize the impact high-risk situations have and to help you set up a lifestyle that is not conducive to using.
For example, in a relapse prevention program, you will learn a variety of ways to change your thinking and set up a lifestyle to make recovery easier. Fear is a common negative way of thinking that can lead to relapse if not addressed. You will learn how to deal with feelings of fear and realize that recovery is not based on willpower. You will also learn how to redefine fun by addressing the misconceptions that your using days were “fun” and sobriety is “boring.”Menon, J., & Kandasamy, A. (2018). Relapse prevention. Indian journal of psychiatry, 60(Suppl 4), S473–S478. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_36_18
Finally, relapse prevention programs will help you work on beginning to learn from setbacks and discovering how to be comfortable with being uncomfortable. Setbacks are a normal part of any major progress in life, recovery included. In the wrong mindset, setbacks can be viewed as failures and contribute to a cycle of negative thinking. Instead, it’s important to learn to challenge your thinking about setbacks and start to view them as learning moments. You must learn to address, rather than avoid, negative or uncomfortable feelings.
The Stages of Recovery
While breaking recovery down into stages might seem to minimize the long road it truly is, recovery experts recognize three broad stages. Each stage comes with its own challenges and to-do lists to aid in successful recovery. The length of each stage can vary depending on the individual, but the stages are a useful roadmap when learning what to expect throughout the recovery process. The stages include abstinence or transition, repair or early recovery, and growth or ongoing recovery.
Abstinence or Transition Stage
The abstinence stage begins immediately after a person stops using and typically lasts for 1 to 2 years. During this time, individuals are focusing on dealing with cravings, avoiding using, and improving self-care.
Tasks of the Abstinence Stage:
- Accept that you have an addiction
- Practice honesty in life
- Understand the dangers of cross-addiction
- Develop healthy alternatives to using and coping skills for addressing cravings
- Become active in self-help groups
- Practice self-care, learn to say no
- Learn about the stages of relapse
- Cut ties with friends who are using
- Envision yourself as a non-user
- Avoid big life changes
- Deal with post-acute withdrawal
Common Risks to Recovery in the Abstinence Stage:
- Poor self-care
- Cravings to use
- Post-acute withdrawal
Post-acute withdrawal is a notable risk of the abstinence stage that begins shortly after the acute phase of withdrawal. Unfortunately, it is a common cause of relapse. It consists of mostly psychological and emotional symptoms that you might experience in the stage of emotional relapse. Symptoms to look out for include mood swings, anxiety, variable energy and concentration, and disturbed sleep. Post-acute withdrawal could last up to 2 years, with symptoms coming and going, but should improve overall over time.
A relapse prevention program will prepare you to deal with the symptoms associated with post-acute withdrawal. The challenge is to recognize your long-term progress rather than focusing on day-to-day fluctuations.
Repair or Early Recovery Stage
In the repair stage of recovery, individuals will focus on repairing the damage addiction has caused. This often leads to dealing with difficult conversations and feelings. Due to the emotions and negative feelings that could come up in this stage, it is helpful to have participated in a cognitive relapse prevention program to be better equipped to deal with these feelings.
Tasks of the Repair Stage:
- Use cognitive therapy to overcome negative thoughts
- Understand that you are not your addiction
- Repair relationships and make amends when possible
- Feel comfortable with being uncomfortable
- Make self-care a priority
- Develop a balanced and healthy lifestyle
- Continue to engage in self-help groups
- Develop more healthy alternatives to using
Common Risks to Recovery in the Repair Stage:
- Poor self-care
- Not attending rehab or group treatment
Growth or Ongoing Recovery Stage
The final stage of recovery is about moving forward for a lifetime and typically begins 3-5 years after a person has stopped using. This is the time to deal with past traumas or familial issues that may have occurred. It is important to wait until this stage to deal with these types of issues, as you have developed the coping skills to handle the feelings associated with this work by the growth stage. Addressing these issues too soon, without the proper coping skills, could lead to relapse.Laudet, A. B., Savage, R., & Mahmood, D. (2002). Pathways to long-term recovery: a preliminary investigation. Journal of psychoactive drugs, 34(3), 305–311. … Continue reading
Tasks of the Growth Stage:
- Identify and repair negative thinking and self-destructive patterns
- Understand how negative familial patterns have been passed down
- Let go of resentments
- Challenge fears with cognitive therapy and mind-body relaxation
- Set healthy boundaries
- Begin to give back and help others
- Reevaluate your lifestyle to make sure it facilitates recovery
Common Risks to Recovery in the Growth Stage:
- Overconfidence can lead to decreasing self-care or group attendance
- Attempting to forget addiction ever occurred
- Shame or embarrassment at needing to focus on the basics of recovery at times
The Five Rules of Recovery
Research has found that recovery—and most relapses—can be explained in terms of a few basic rules.Hendershot, C. S., Witkiewitz, K., George, W. H., & Marlatt, G. A. (2011). Relapse prevention for addictive behaviors. Substance abuse treatment, prevention, and policy, 6, 17. … Continue reading It is useful to understand these basic rules and start to live by them to help your chances of avoiding relapse.
Rule 1: Change Your Life
Long-term recovery is not achieved simply by making the decision to not use and sticking with it. Sticking with it requires you to change your life so that not using it becomes easier. This might involve examining current relationships, avoiding triggering locations, and learning how to change negative thought patterns. Making no changes to your lifestyle will result in being exposed to temptations and triggers that were in place during active addiction. Unfortunately, this makes recovery very difficult.
Rule 2: Be Completely Honest
Active addiction revolves around webs of lies used to hide, plan, and deny substance abuse. Lying is a sign of emotional relapse.Newman, C.F. (2001). Cognitive therapy of substance abuse. Guilford Press. It is important to not only learn how to be honest but also to learn when and where complete honesty is appropriate. Of course, discretion can be used when it comes to sharing your story. The circle of people you share with often starts small but grows as you become more comfortable.
Rule 3: Ask for Help
Don’t go through recovery alone. Like most challenging experiences in life, recovery is easier with supportive people around you. Self-help groups and participation in substance abuse programs, such as a cognitive relapse prevention program, contribute to recovery success.
Benefits of self-help programs include:
- Not feeling alone in guilt and shame
- Hearing others’ recovery stories
- Having a safe, non-judgmental space to accomplish the above
Rule 4: Practice Self Care
Most people use substances to escape struggles in life, relax, or reward themselves. These are all things that can be achieved in an alternative way through self-care practices. Relaxation can be found through a massage, spending time in nature, or meditation. Consider exploring alternative ways to reward yourself depending on your interests. In time, you can learn how to meet the needs that have been met by using, by accomplishing self-care practices personal to you.
Rule 5: Don’t Bend the Rules
The purpose of this rule is to remind all individuals seeking relief from addiction that there is a broad path to recovery. However, bending the rules to fit your desires during recovery is not an option. Looking for loopholes or avoiding advice are both warning signs when it comes to pursuing your recovery.Miller, W. R., & Harris, R. J. (2000). A simple scale of Gorski’s warning signs for relapse. Journal of studies on alcohol, 61(5), 759–765. https://doi.org/10.15288/jsa.2000.61.759
Treatment Programs and Preventative Care
Here at Illuminate we include relapse prevention in our recovery program. It’s an important part of recovery. But, remember, relapse happens.
With help, you can arm yourself with the knowledge and tools you need to cope with and help prevent relapse in the future.
Having been on both sides of active addition, both the person using, and the person affected by a loved one using drugs and alcohol, Lucas has been involved in recovery since 2009. He has been working in the treatment industry since 2013. Using his personal experience and wealth of knowledge learned from professional development and immersion in the recovery field, he has spoken with thousands of families and helped hundreds of people attain long-term sobriety. In 2020, the opportunity presented to join in and start Illuminate Recovery. Understanding the importance of personalized treatment plans and the complex nature between substance abuse and co-occurring disorders, has helped Illuminate Recovery build a strong curriculum and a phenomenal staff. Illuminate Recovery now has a medical doctor who is board certified in addiction medicine and a psychiatric medical doctor who works side by side with independently licensed therapists to provide compassionate and effective treatment.
|↑1||Melemis S. M. (2015). Relapse Prevention and the Five Rules of Recovery. The Yale journal of biology and medicine, 88(3), 325–332.|
|↑2||NIDA. (2018, July 2). Media Guide. Retrieved from https://archives.drugabuse.gov/publications/media-guide on 2022, March 4|
|↑3||Menon, J., & Kandasamy, A. (2018). Relapse prevention. Indian journal of psychiatry, 60(Suppl 4), S473–S478. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_36_18|
|↑4||Laudet, A. B., Savage, R., & Mahmood, D. (2002). Pathways to long-term recovery: a preliminary investigation. Journal of psychoactive drugs, 34(3), 305–311. https://doi.org/10.1080/02791072.2002.10399968|
|↑5||Hendershot, C. S., Witkiewitz, K., George, W. H., & Marlatt, G. A. (2011). Relapse prevention for addictive behaviors. Substance abuse treatment, prevention, and policy, 6, 17. https://doi.org/10.1186/1747-597X-6-17|
|↑6||Newman, C.F. (2001). Cognitive therapy of substance abuse. Guilford Press.|
|↑7||Miller, W. R., & Harris, R. J. (2000). A simple scale of Gorski’s warning signs for relapse. Journal of studies on alcohol, 61(5), 759–765. https://doi.org/10.15288/jsa.2000.61.759|