A Plan For Relapse Prevention

The Stages of Relapse replase-prevention

Relapse is a process, it’s not an event. In order to understand prevention you have to understand the stages of relapse. Relapse starts weeks or even months before the event of physical relapse. In this page you will learn how to use specific relapse prevention techniques for each stage of relapse. There are three stages of relapse

Emotional relapse
Mental relapse
Physical relapse

Emotional Relapse

In emotional relapse, you’re not thinking about using. But your emotions and behaviors are setting you up for a possible relapse in the future.

The signs of emotional relapse are:

Anxiety
Intolerance
Anger
Defensiveness
Mood swings
Isolation
Not asking for help
Not going to meetings
Poor eating habits
Poor sleep habits

The signs of emotional relapse are also the symptoms of post-acute withdrawal. If you understand post-acute withdrawal it’s easier to avoid relapse, because the early stage of relapse is easiest to pull back from. In the later stages the pull of relapse gets stronger and the sequence of events moves faster.
Early Relapse Prevention

Relapse prevention at this stage means recognizing that you’re in emotional relapse and changing your behavior. Recognize that you’re isolating and remind yourself to ask for help. Recognize that you’re anxious and practice relaxation techniques. Recognize that your sleep and eating habits are slipping and practice self-care.

If you don’t change your behavior at this stage and you live too long in the stage of emotional relapse you’ll become exhausted, and when you’re exhausted you will want to escape, which will move you into mental relapse.

Practice self-care. The most important thing you can do to prevent relapse at this stage is take better care of yourself. Think about why you use. You use drugs or alcohol to escape, relax, or reward yourself. Therefore you relapse when you don’t take care of yourself and create situations that are mentally and emotionally draining that make you want to escape.

For example, if you don’t take care of yourself and eat poorly or have poor sleep habits, you’ll feel exhausted and want to escape. If you don’t let go of your resentments and fears through some form of relaxation, they will build to the point where you’ll feel uncomfortable in your own skin. If you don’t ask for help, you’ll feel isolated. If any of those situations continues for too long, you will begin to think about using. But if you practice self-care, you can avoid those feelings from growing and avoid relapse.

Mental Relapse

In mental relapse there’s a war going on in your mind. Part of you wants to use, but part of you doesn’t. In the early phase of mental relapse you’re just idly thinking about using. But in the later phase you’re definitely thinking about using.

The signs of mental relapse are:

Thinking about people, places, and things you used with
Glamorizing your past use
Lying
Hanging out with old using friends
Fantasizing about using
Thinking about relapsing
Planning your relapse around other people’s schedules

It gets harder to make the right choices as the pull of addiction gets stronger.

Techniques for Dealing with Mental Urges

Play the tape through. When you think about using, the fantasy is that you’ll be able to control your use this time. You’ll just have one drink. But play the tape through. One drink usually leads to more drinks. You’ll wake up the next day feeling disappointed in yourself. You may not be able to stop the next day, and you’ll get caught in the same vicious cycle. When you play that tape through to its logical conclusion, using doesn’t seem so appealing.

A common mental urge is that you can get away with using, because no one will know if you relapse. Perhaps your spouse is away for the weekend, or you’re away on a trip. That’s when your addiction will try to convince you that you don’t have a big problem, and that you’re really doing your recovery to please your spouse or your work. Play the tape through. Remind yourself of the negative consequences you’ve already suffered, and the potential consequences that lie around the corner if you relapse again. If you could control your use, you would have done it by now.

Tell someone that you’re having urges to use. Call a friend, a support, or someone in recovery. Share with them what you’re going through. The magic of sharing is that the minute you start to talk about what you’re thinking and feeling, your urges begin to disappear. They don’t seem quite as big and you don’t feel as alone.

Distract yourself. When you think about using, do something to occupy yourself. Call a friend. Go to a meeting. Get up and go for a walk. If you just sit there with your urge and don’t do anything, you’re giving your mental relapse room to grow.

Wait for 30 minutes. Most urges usually last for less than 15 to 30 minutes. When you’re in an urge, it feels like an eternity. But if you can keep yourself busy and do the things you’re supposed to do, it’ll quickly be gone.

Do your recovery one day at a time. Don’t think about whether you can stay abstinent forever. That’s a paralyzing thought. It’s overwhelming even for people who’ve been in recovery for a long time.

One day at a time, means you should match your goals to your emotional strength. When you feel strong and you’re motivated to not use, then tell yourself that you won’t use for the next week or the next month. But when you’re struggling and having lots of urges, and those times will happen often, tell yourself that you won’t use for today or for the next 30 minutes. Do your recovery in bite-sized chunks and don’t sabotage yourself by thinking too far ahead.

Make relaxation part of your recovery. Relaxation is an important part of relapse prevention, because when you’re tense you tend to do what’s familiar and wrong, instead of what’s new and right. When you’re tense you tend to repeat the same mistakes you made before. When you’re relaxed you are more open to change.

Physical Relapse

Once you start thinking about relapse, if you don’t use some of the techniques mentioned above, it doesn’t take long to go from there to physical relapse. Driving to the liquor store. Driving to your dealer.

It’s hard to stop the process of relapse at that point. That’s not where you should focus your efforts in recovery. That’s achieving abstinence through brute force. But it is not recovery. If you recognize the early warning signs of relapse, and understand the symptoms of post-acute withdrawal, you’ll be able to catch yourself before it’s too late.

The First Rule of Recovery

You don’t recover from an addiction by stopping using. You recover by creating a new life where it is easier to not use. If you don’t create a new life, then all the factors that brought you to your addiction will eventually catch up with you again.

You don’t have to change everything in your life. But there are a few things and behaviors that have been getting you into trouble, and they will continue to get you into trouble until you let them go. The more you try to hold onto your old life in recovery, the less well you will do.

Here are the three most common things that people need to change in order to achieve recovery.

Avoid High-Risk Situations

Some common high-risk situations are described by the acronym, HALT:

Hungry
Angry
Lonely
Tired

How do you feel at the end of the day? You’re probably hungry because you haven’t eaten well. You’re probably angry because you’ve had a tough day at work or a tough commute home. You may feel lonely because you’re isolated. You don’t have to be physically alone to feel lonely. And you’re tired. That’s why your strongest cravings usually occur at the end of the day. Here’s another way of looking at high-risk situations:

People. (People who you use with or who are related to your use. People who you have conflicts with, and who make you want to use. People who you celebrate with by using. People who encourage you to use either directly or indirectly.)
Places. (Places where you use or where you get your drugs or alcohol.)
Things. (Things that remind you of your using.)

How can you avoid high-risk situations? Of course, you can’t always avoid these situations. But if you’re aware of them, they won’t catch you off guard, and you can prevent little craving from turning into major urges.

Take better care of yourself. Eat a healthier lunch so you’re not as hungry at the end of the day. Join a 12 step group so that you don’t feel isolated. Learn how to relax so that you can let go of your anger and resentments. Develop better sleep habits so that you’re less tired.

Avoid your drinking friends, your favorite bar, and having alcohol in the house. Avoid people who you used cocaine with, driving by your dealer’s neighborhood, and cocaine paraphernalia.

Recovery isn’t about one big change. It’s about lots of little changes. Avoiding those high-risk situations helps you create a new life where it’s easier to not use.

Make a list of your high-risk situations. Addiction is sneaky. Sometimes you won’t see your high-risk situations until you’re right in the middle of one. That’s why it’s important that you learn to look for them. Make a list of your high-risk situations and keep it with you. Go over the list with someone in recovery so that can spot any situations that you might have missed. Make the list and keep it with you. Some day that list may save your life.

Learn to Relax

There are only a few reasons why people use drugs and alcohol. They use to escape, relax, and reward themselves. In other words, people use drugs and alcohol to relieve tension.

The first rule of recovery is that you must change your life. What do you need to change? If you understood the previous paragraph, then you need to change the way you relieve tension. Everyone needs to escape, relax, and reward themselves. Those are essential coping skills for a happy life. But addicts don’t know how to do those things without using.

If you manage to stop using for a while, but don’t learn how to relax, your tension will build until you’ll have to relapse just to escape again. Tension and the inability to relax are the most common causes of relapse.

I know relaxation will help. I have treated thousands of patients. Many of them have told me that relaxation has changed their life. There is only one reason why people don’t relax – because they think they’re too busy to relax. It goes something like this, “I know it makes sense, but I’ve got so many other things I have to do.”

Ask yourself how much time you spend on your addiction. If you add up all the time it takes to get your drug, use it, deal with its consequences, and plan your next relapse, you’ll realize that relaxing for twenty to forty minutes a day is a bargain.

Relaxation is not an optional part of recovery. It’s essential to recovery. There are many ways to relax. They range from simple techniques like going for a walk, to more structured techniques like meditation. Meditation is an important part of that mix because the simple techniques don’t always work. If you’re under a lot of stress, you may need something more reliable like meditation. Use any of these techniques, or any combination. But do something everyday to relax, escape, reward yourself, and turn off the chatter in your mind.

Numerous studies have proven that relaxation reduces the use of alcohol, tobacco, and marijuana.

Be Honest

An addiction requires lying. You have to lie about getting your drug, using it, hiding its consequences, and planning your next relapse. An addiction is full of lying. By the time you’ve developed an addiction, lying comes easily to you. After a while you get so good at lying that you end up lying to yourself. That’s why addicts don’t know who they are or what they believe in.

The other problem with lying is that you can’t like yourself when you lie. You can’t look yourself in the mirror. Lying traps you in your addiction. The more you lie, the less you like yourself, which makes you want to escape, which leads to more using and more lying.

Nothing changes, if nothing changes. Ask yourself this: will more lying, more isolating, and more of the same make you feel better? The expression in AA is – nothing changes if nothing changes. If you don’t change your life, then why would this time be any different? You need to create a new life where it’s easier to not use.

Recovery requires complete honesty. You must be one-hundred percent completely honest with the people who are your supports: your family, your doctor, your therapist, the people in your 12 step group, and your sponsor. If you can’t be completely honest with them, you won’t do well in recovery.

When you’re completely honest you don’t give your addiction room to hide. When you lie you leave the door open to relapse.

One mistake people make in the early stages of recovery is they think that honesty means being honest about other people. They think they should share what’s “wrong” with other people. But recovery isn’t about fixing other people. It’s about fixing yourself. Stick with your own recovery. Focusing on what you don’t like about others is easy because it deflects attention from yourself.

Honesty won’t come naturally in the beginning. You’ve spent so much time learning how to lie that telling the truth, no matter how good it is for you, won’t feel natural. You’ll have to practice telling the truth a few hundred times before it comes a little easier. In the beginning, you’ll have to stop yourself as you’re telling a story, and say, “now that I think about it, it was more like this…”

Show common sense. Not everybody is your best friend. And not everybody will be glad to know that you have an addiction or that you’re doing something about it. There may be some people who you don’t want to tell about your recovery. But don’t be reluctant to tell the people close to you about your recovery. You should never feel ashamed that you’re doing something about your addiction. (Reference: www.AddictionsAndRecovery.org)
The Chance to Change Your Life

Your addiction has given you the opportunity to change your life. Changing your life is what makes recovery both difficult and rewarding. Recovery is difficult because you have to change your life, and all change is difficult, even good change. Recovery is rewarding because you get the chance to change your life. Most people sleepwalk through life. They don’t think about who they are or what they want to be, and then one day they wake up and wonder why they aren’t happy.

If you use this opportunity for change, you’ll look back and think of your addiction as one of the best things that ever happened to you. People in recovery often describe themselves as grateful addicts. Why would someone be grateful to have an addiction? Because their addiction helped them find an inner peace and tranquility that most people crave. Recovery can help you change your life.

After 5 years of abstinence relapse is rare. A study followed 268 Harvard University undergraduates, and 456 non-delinquent inner-city adolescents. The men were followed every two years by questionnaire, and every 5 years by physical examination. At some point during their lives, 55 (21%) of the college men and 150 (33%) of the inner-city men met the criteria for alcohol addiction.The study concluded that after 5 years of abstinence relapse is rare.

Excerpted from “I Want to Change My Life: How to Overcome Anxiety, Depression and Addiction” by Dr. Steven M. Melemis. (www.AddictionsAndRecovery.org) and https://www.addictionsandrecovery.org/relapse-prevention.htm


December 7, 2016

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