Saturday December 10th 2016

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How do you prevent relapse?

Can you prevent a relapse to drug or alcohol use? Absolutely.

In addition to learning to cope with cravings, one important way to prevent relapse is to resolve feelings of guilt in addiction recovery. Additionally, you’ll need to learn to deal with setbacks as they occur. What is a setback and how is it important to a program of addiction recovery?  We explore more here and invite your questions about these tools for addiction recovery, as well as your comments, at the end.

Relapse vs setbacks

Relapse is often seen as the antithesis of recovery. However, there are often more subtle mistakes, slip-ups, obstacles and problems that can come up along the way in recovery, particularly early on in the change process. Therefore, it can be helpful to consider a simplified, more inclusive term in addition to just relapse. That term is setback. People regress toward negative behaviors for a variety of reasons, many of which cannot easily be considered relapse.

Setback: An unfortunate happening that hinders or impedes; something that is thwarting or frustrating.

Managing setbacks

Referring to these periods of digression as setbacks takes into account the complex array of daily ups and downs most people experience when struggling to overcome a substance abuse issue. A situation that can be explained as a setback can include many types of situations. To understand this better, consider a few examples of setbacks in the change process:

  • Tim is addicted to IV heroin shooting 20 bags per day but goes to detox and then stays drug free for 60 days. Tim’s old college buddy visits from out of town and Tim spends the weekend smoking marijuana with him but it does not go any further than that. Tim realizes afterward that this may have not been a good idea and he is willing to discuss it with his counselor further.
  • Linda suffers from depression and alcohol abuse. She is 6 months sober and doing great as she has not had a depressive episode in months. Suddenly, Linda’s boyfriend leaves her and she experiences a return of depression. As her counselor, Linda tells you she is frequently thinking about drinking out of frustration but she has not done so yet.
  • Jacob hasn’t used cocaine in 3 weeks and he came to you for counseling because he used to smoke crack several times per week. Tim tells you missed the train and got stuck in a bad neighborhood over the weekend and he smoked $10 worth of crack but immediately felt guilty and called his sister to come pick him up. Tim confesses that he probably would have used more but he only had $10. Now he is back on track as he has been clean and back in his sober routine for the past 5 days.

These are just a few examples to put the concept in perspective. Not every situation where there is a “lapse backward” ends up going back to square one, so to speak, especially if the person involved is willing to discuss their issues and get back on track.

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Understanding and coping with setbacks: The Key Principles

1. Get honest.

A really important factor that needs to be considered honestly and insightfully is to determine whether or not the setback was a mistake or is there really is just a lack of readiness to change. Quite often the real reason people go backward after a period of progress, especially early in the recovery process is not because of a relapse, but rather the person simply lost motivation. This can be difficult to determine but it is worth discussing and looking at with an open mind. If the issue is that someone simply is not ready to change then the focus of intervention needs to be more on further motivation building as opposed to relapse or setback prevention planning.

2. Do not give up.

This is the single most important principle for eventual success for both the counselor and the substance user. If you find yourself going backwards that does not mean you are not succeeding overall. The change process involves learning from mistakes. Therefore using setbacks as a learning tool can be a critical part of that process.

3. There is no room for discouragement

Discouragement saps you of your power and strength so if you or those that you are working with are experiencing discouragement it is important to crush that discouragement like a bug. Hope and courage must triumph over discouragement wherever possible in the change process.

4. Setbacks happen.

Accepting the fact that more often than not, there may be steps backward within the greater goal of moving forward is critical to process of positive change as a whole. It is important not to use this as an excuse for allowing setbacks, relapses and other temporary or extended periods of sliding backward. Still, someone who is sincere in their desire for change that makes an honest mistake can find relief in the fact that setbacks are often part of the process

Did you “give yourself permission” to have the setback? Getting honest about that searching question speaks volumes about the true nature of a setback. Simply put, sometimes after a period of progress, a person can sense a “cushion” between themselves and the consequences of their actions. For example, a person who is sober for a period may reason to himself “It’s been quite a while since I got high so my family would probably forgive me if I slipped up for a little while” Sometimes this occurs on an unconscious level but in analyzing setbacks it is important to consider this all too common situation.

5. Setbacks are not just about “people, places and things”.

It is an essential fact that when trying to avoid the return of negative behaviors, identifying relapse triggers and then coming up with steps to avoid those triggers is the at the very core of traditional relapse prevention. Triggers are most commonly viewed in terms of “people, places, and things” associated with substance use. However, it is so important to also consider these other issues which can trigger a setback:

Conditions – Mental health issues like depression or anxiety, as well as physical conditions like an injury or an illness.

Events – Anniversaries, holidays, losses such as losing a job, a relationship or loved one.

Internal Factors – Such as negative thoughts, emotional struggles, mood swings, emotional or physical pain or suffering, trauma.

Preventing relapse by dealing with setbacks

Life throws you more and more responsibility in recovery. In order to continue to abstain from drugs and/or alcohol, it is important that you address setbacks as they occur.

Do you have something to get off your chest? We invite you to share your feedback, your thoughts, or questions in the comments section below. We’ll do our best to respond to you personally and promptly.

Photo credit: Chris Dlugosz

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About Kenneth Pecoraro, LCSW, LCADC, CCS

Kenneth Pecoraro, LCSW, LCADC, CCS has worked directly providing treatment for individuals with substance use and coexisting emotional-behavioral issues for over 20 years using a motivational, skills and strengths based, individualized client-centered perspective. The techniques explained in his method, Taking the Escalator: An Alternative to the 12 Steps, help individuals who are resistant to traditional approaches gain the tools needed for learning to increase insight and motivation for positive change.

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