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Relapse Prevention: Strategies, Skills, & Planning

Addiction is a chronic, relapsing disease. This means that relapse is often a part of the recovery process for many people, just as it is with other chronic, relapsing diseases.1 Relapse can occur many times, especially if people do not follow their medical and aftercare plans. However, there are things you can do to take control and potentially avoid relapse.1

If you or someone you care about is struggling, you can benefit from learning more about how to not relapse, ways to prevent relapse, and relapse prevention strategies that may help you remain sober.


Understanding Relapse

According to the National Institute on Drug Abuse (NIDA), relapse occurs when a person returns to substance use after an attempt to stop.1 Some researchers define a lapse as the initial resumption of substance use, while relapse is the ongoing substance use that occurs after a lapse.2,3 Researchers view relapse as a gradual process that begins with certain warning signs that can occur weeks or months before the actual lapse takes place; it usually occurs in a series of stages.2,4

Like other chronic diseases such as diabetes or asthma, relapse is part of recovery. In fact, the NIDA explains that relapse rates for addiction range between 40–60%, compared with 50–70% for both hypertension and asthma.1 Studies have indicated that around 50% of people relapse within the first 12 weeks of leaving detox.2 Research also shows that around 60% of people who receive substance abuse treatment eventually enter sustained recovery, but many of these people first undergo a cycle of multiple relapses and return to treatment in the process.2

Relapse is different for everyone; it can take place immediately or even after a person has been in recovery for many years.2 A relapse can happen once and be over, occur a few times, or could result in a return to a full-blown addiction.4 Relapse prevention strategies may help you reduce the risk of relapse.


Why Relapse Occurs

The relapse prevention model of Marlatt and Gordon suggests that relapse can be influenced by many factors. This can include factors like being in high-risk situations or having poor coping skills, or a life imbalance between perceived external demands (things you feel you have to do) and internally fulfilling activities (things you like to do).5

Brain changes also play a role in relapse. Addiction results in persistent brain changes that reduce a person’s ability to control their substance use, and these changes do not go away overnight.6 Treating chronic diseases like addiction means working on deeply rooted behaviors that can be influenced by these changes for long after a person has been sober.1,6

There are different causes of relapse, but there is not typically just one reason it occurs; it usually involves an event and a combination of factors that can compound over time.2

Everyone’s experience with recovery and relapse is unique, but some causes of relapse might include poor self-care, not going to self-help meetings, feeling embarrassed about having cravings, frustration with having to work on recovery after a period of abstinence, feeling like you should be able to control your behavior, and feelings of personal failure after a lapse.4,5

Relapse triggers are internal or external cues associated with previous substance use that can instigate strong cravings to resume substance use; exposure to triggers is a risk factor for relapse.2 Relapse triggers can be unique to your situation as well as universal, meaning factors that might trigger anyone in recovery.2 Some common triggers include:4-6

  • Stress and tension.
  • Negative thinking.
  • Interpersonal conflict.
  • Being around substance-related stimuli (such as pipes or bongs).
  • Being around places where you used substances.
  • Associating with people who use drugs or alcohol.

9 Ways to Avoid Relapse

Abstinence is just the beginning of the process, as recovery is a life-long journey that takes work and dedication. As discussed previously, the early stages of recovery can present a high risk of relapse.2 Although relapse can occur, you may be able to avoid it by following relapse prevention strategies and tips.

1. Avoid Triggers

As mentioned above, common triggers can involve people, places, or things that are often associated with previous substance use.6 Triggers can cause cravings that can lead to relapse if not properly managed.2

Trying to avoid triggers is important because they can change the way you respond to stimuli, which, in turn, can result in cravings that can be difficult to withstand.2,6 It’s important to be aware of both universal and personal triggers so that you can take action to avoid the trigger or remove yourself from the situation, if possible.

For example, a universal trigger might be going to a bar with friends who drink alcohol; avoiding this trigger might involve finding a new group of friends who do not use substances. A personal trigger is unique to you—an example might be coming home from work to an empty house; avoiding this trigger might mean attending a self-help meeting after work or spending time on activities you enjoy.2

2. Make Time for Your Mental Health

Poor mental health and substance use are often closely related. Untreated mental illness can be a potential internal risk factor for relapse.2 Having a mental illness, like depression or bipolar disorder, and addiction at the same time is known as a co-occurring disorder, which has been found to increase a person’s risk of relapse.7

Caring for your mental health may help you avoid relapse. Emotional distress is a relapse risk factor; similarly, mental illness can impact substance use.2 It’s important to address any untreated mental illness and to make sure that you receive co-occurring disorder treatment to optimize your chances of recovery success.2

3. Manage Stress

Stress is a potential risk factor for both substance use and relapse. People may turn to substances as a way of coping with stress, and unaddressed stress can be a trigger for relapse.2 One study indicates that people who are under stress often glamorize their previous substance use and start to feel that recovery is hard but drugs or alcohol are fun.4

People also mistakenly expect that alcohol or drugs will help them feel better, which may work in the short term but only causes distress and harm in the long run.5

Of course, some level of stress is unavoidable, but you may be able to manage that stress in positive or healthier ways that don’t involve substances, such as exercising, meditating, journaling, or reaching out to supportive friends or family.

4. Think Positively

Negative emotional states and thought patterns may contribute to addiction and relapse.5 These thoughts and feelings, such as anger, anxiety, depression, frustration, and boredom, are associated with the highest rates of relapse.5,6

It’s not always easy to know how to avoid relapse, especially when you’re struggling with difficult emotions. Cognitive-behavioral therapy can be a helpful way of dealing with negative emotions and thoughts and cultivating a more positive mindset. It works by helping you learn to identify unhealthy patterns, helps you develop healthier thoughts and behaviors, and teaches you ways to avoid relapse.1

5. Find a Purpose or Passion

Drugs and alcohol can consume someone’s life when they are in active addiction, and substances might seem to be the only way to experience pleasure or relief.6 Early recovery can feel like there’s a void left behind from drugs and alcohol, but filling this void may help you prevent relapse.6 Finding something that is meaningful to you and that gives you a sense of energy and purpose can help you learn to enjoy a substance-free life.

A hobby or passion project can help by giving you a sense of purpose and meaning. Some examples could include volunteering or community service, finding a hobby you enjoy, learning a new skill, or taking an adult education class on a subject that interests you.

6. Follow a Healthy Routine

Using drugs and alcohol can damage your physical and mental health. Recovery is a time to focus on becoming healthy and healing. Taking care of your health can start with making sure to take care of the basics, such as ensuring that you get enough sleep, eating a healthy diet, and exercising regularly.2

Having a daily routine for wellness can help with preventing relapse and promoting good health, but it can also help you stay sober by staying busy.4 You could consider joining a sports team, going to a gym, taking yoga classes, consulting your doctor or a dietitian to determine your nutrition needs and build a healthy diet, and practicing good sleep hygiene, such as sticking to a regular bedtime and avoiding stressful triggers before bed.

7. Maintain/Build Healthy Relationships

A strong support system is an important part of recovery and preventing relapse. You may need to find a new social circle and build new relationships with people who do not use substances.2 Many people can be a part of your recovery support network, such as people from mutual support groups, your sponsor, close friends, family, or mentors.

In addition, family therapy can be a helpful adjunct to your relapse recovery by helping address issues and repairing the damage that may have been caused by addiction.

8. Continue Medications as Recommended

You may have been prescribed medications to help maintain recovery. This can include medications like acamprosate, naltrexone, or disulfiram for alcohol use disorders, or buprenorphine, methadone, or naltrexone for opioid use disorders.2 People often worry that using medication means substituting one substance for another, but it does not negate your sobriety—on the contrary, medication can be important for helping you stay sober.8

Stopping medication can increase the risk of relapse, so it’s important to stick to your medical plan and consult your physician if you have any concerns or questions about your medication regimen.2

9. Continue Treatment

Remember that recovery is a journey. Many people benefit from ongoing care after they’ve completed a formal period of treatment to help them stay sober and focused on recovery. This can include attending weekly sessions at an outpatient substance abuse treatment program, seeing an individual counselor, attending 12-step meetings, or a combination of different options.2

It’s important to follow the recommended aftercare plan you may have received at the end of treatment, and to seek additional help if you’re struggling with how to stop relapsing. You may need to include another or different form of aftercare or require an adjustment in your plan.2


What to Do If You Relapse

Keep in mind that relapse can happen often, and it is normal if it happens to you. It’s a normal part of recovery and it’s nothing to be ashamed of.2 If you relapse, don’t wait to get help, and tell someone you trust, such as your sponsor, as soon as possible. This can help you get back on track and prevent things from becoming worse if you wait.

If you relapse, you may benefit from re-engaging in treatment. Seeking help when you need it is not weakness, it is a sign of strength that can help you regain control of your life.

American Addiction Centers is here to help support your recovery. Please reach out if you have questions about relapse or to learn about relapse prevention and treatment options that can help you get back on track. You can call our free, confidential, 24/7 helpline to speak to an admissions navigator about your options and easily verify your insurance online.


Sources

  1. National Institute on Drug Abuse. (2020). Drugs, brains, and behavior: The science of addiction treatment and recovery.
  2. S. Department of Veterans Affairs. (2022). Whole health library: Reducing relapse risk.
  3. Guenzel, N. & McChargue, D. (2022). Addiction relapse prevention. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing.
  4. Melemis, S. M. (2015). Relapse prevention and the five rules of recovery. The Yale journal of biology and medicine, 88(3), 325–332.
  5. Larimer, M. E., Palmer, R. S., & Marlatt, G. A. (1999). Relapse prevention. An overview of Marlatt’s cognitive-behavioral model. Alcohol research & health, 23(2), 151–160.
  6. Substance Abuse and Mental Health Services Administration; Office of the Surgeon General. (2016). Facing addiction in America: The Surgeon General’s report on alcohol, drugs, and health [Internet]. Chapter 2, the neurobiology of substance use, misuse, and addiction. Washington, DC: US Department of Health and Human Services.
  7. Andersson, H. W., Wenaas, M., & Nordfjærn, T. (2019). Relapse after inpatient substance use treatment: A prospective cohort study among users of illicit substances. Addictive behaviors, 90, 222–228.
  8. Substance Abuse and Mental Health Services Administration. (2022). Medication-Assisted Treatment (MAT).

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