How can you prevent relapse?
By Dr. Henry Steinberger, Licensed Psychologist
Relapse prevention is essential in recovery from chemical and behavioral addictions. Why? Because addiction has been found to reoccur more often when steps are not taken to cope with the cravings, urges, peer pressures, situational cues, bodily discomforts, neurobiological changes, and other factors which pave the way for slips and relapses.
Therefore, we regard relapse as a “normal” (though distinctly undesirable) possibility on the road to recovery. When you choose to view a relapse as a mistake, grist for the mill, a learning opportunity and a discrete single event rather than viewing it as a total failure and as evidence predictive of failures, then your chances for success increase greatly.
“The person who really thinks, learns quite as much from his failures as from his successes.” – John Dewey
Here, we outline the most effective strategies for preventing relapse into drug, alcohol or behavioral addictions. Please feel free to leave your questions or comments about relapse or creating your own relapse prevention plan template at the end. We endeavor to respond to all legitimate concerns with a personal and prompt response.
Top 10 relapse prevention strategies
1. Learn to willingly accept your mind – The first step to preventing relapse is to understand and accept your mind. The presence of whatever your mind produces such as thoughts, beliefs, images, memories, feelings, or sensations is temporary. Even if you don’t like them, if you understand that the ideas your mind creates will change, you do not need to act on what your mind is thinking. This goes for urges and cravings. Note how they simply come and go. They may seem like a problem, but avoiding them through addictive behavior appears as the real problem in the long run. Consider learning and practicing “Mindfulness” to increase your ability to “sit with” or “ride out” urges without acting on them.
2. Get psychological and medical help when needed – When needed, seek and get psychological and medical help for psychiatric illnesses and to learn better ways of coping with life events. Treatment options for addiction are not limited to psychotherapy or support groups. Consider using medications like Disulfiram (Antabuse®), Naltrexone (ReVia®), Acamprosate (Campral®), etc., as a sign of positive action and never as a mark of failure or inadequacy. Take your medications as prescribed.
3. Stimulus control – Begin to understand and practice stimulus control. Change the “activating events,” cues or “triggers” which can be changed. Accept those which can’t be changed. They can cue you, but they don’t rule you.
4. PIG Awareness – Live with awareness of the PIG (Problem of Immediate Gratification). Learn about the PIG concept and of natural penalties for slips, lapses and relapses. Carry, review and update a Cost-Benefit Analysis or list of reasons for sticking to your change plan.
5. AID’s Awareness – Beware of Apparently Irrelevant Decisions (AID’s) that lead to high risk situations and using. Recovery requires living with greater awareness or mindfulness.
6. Beware of the “Abstinence Violation Effect” (the use of a small slip as an excuse for a major relapse). Carry your how-to-cope reminder instructions. Remember: “One ‘swallow’ does not make a summer, nor a relapse.”
7. Find valued directions for your life – Develop a balanced life with healthy indulgences and activities that can substitute for unhealthy and undesirable addictive behaviors is a good start. But in the long run we each need to decide what is really important to be doing and commit ourselves to acting on those values, taking us in our own valued life directions.
8. Take better care of yourself – TLC stands for Therapeutic Lifestyle Change. Staying clean from drugs and alcohol or abstaining from unwanted behaviors is part of living a balanced life. Ample evidence exists that you can improve your mental health through exercise, better diet and nutrition (including Omega-3 found in fish oils), getting out in nature, developing and maintaining good human relationships, engaging in recreation and vital absorbing activities, relaxation, meditation, and altruistic involvements like volunteering service in one’s community.
9. Learn and apply the SMART Recovery® Four Point Program™ and Recovery Tools – Read, study, learn and apply what you learn. If you don’t help yourself, who is going to help you? Self-help requires determination and work on your part. That’s why it’s called self-help.
10. Reward yourself – Be sure to celebrate successes and reward yourself for successful abstinence, compliance with treatment and follow up.
Reference sources: The ideas summarized as: Willing Acceptance and Mindfulness, mentioned in item 1, and finding valued life directions, mentioned in item 7, can be found in the self-help literature of Acceptance & Commitment Therapy (ACT). You can learn more with a web search. The PIG and Abstinence Violation Effect were suggested and researched by the late Alan Marlatt. The extensive research supporting Therapeutic Lifestyle Change, mentioned in item 8, is summarized in an article by Roger Walsh (“Lifestyle and Mental Health” in American Psychologist, Oct. 2011). The “Cycles of Change Model”, mentioned in item 11, was adapted from Changing for Good a book by Prochaska, Norcross and DiClemente. The rest is drawn from The SMART Recovery Handbook (Henry Steinberger, editor, 2004) and the SMART Recovery website where more information on Relapse Prevention can be found.
Dr. Steinberger, licensed psychologist since 1987, Fellow of the Albert Ellis Institute for Rational Emotive Behavior Therapy since 1991, holds the Certificate of Proficiency in the Treatment of Alcohol and Other Psychoactive Substance Use Disorders from the College of Professional Psychology of the APA, and uses Acceptance & Commitment Therapy in his private practice, Advanced Psychotherapy & Recovery Options.