Substance Use Blog Series: Relapse Prevention
Today’s substance use blog post is about relapse prevention. There is no consensus for a definition of “relapse,” but it occurs after you have made a choice to limit a behaviour, in this case substance use. It involves a setback that disrupts the goals you had set previously [1].
Relapse prevention planning involves coming up with a plan for how to handle increasing urges to use, after you have reached a point of recovery that you would like to stay in.
It is important to complete one of these plans at this point and before reaching the point of relapse, because you will be more in touch with your recovery goals, from the stance of having achieved some of them already.
Stages of Relapse
Relapse happens gradually, and contrary to certain misconceptions, does not simply refer to the action of increasing substance use again or removing protective practices. It begins weeks and sometimes months before picking up a substance, and is typically described in three stages.
Emotional relapse
When entering emotional relapse, you are not actively thinking about using yet. This is the stage where your emotions and behaviours are setting you up for a relapse down the road. These can be influenced by any number or situations or life stresses. When coming up with a relapse prevention plan it is important to take note of your own unique warning signs. Some common ones include:
- Bottling up emotions
- Isolating
- Withdrawing from community
- Faltering self-care habits both emotionally and physically [2].
Mental Relapse
This stage occurs when the urge to use is more consciously present, and involves conflicting urges and impulses.
Mental relapse involves part of you wanting to use but part of you wanting to stay on the recovery path you had set out previously.
Typically, the deeper you go into mental relapse, the more your resistance diminishes and the desire to escape increases.
Common warning signs for mental relapse include:
- Craving the substance
- Thinking about people, places and things associated with your past use
- Glamorizing or minimizing consequences of past use
- Bargaining
- Looking for opportunities to use
- Directly and actively planning a relapse
When experiencing mental relapse, it is important to avoid high-risk situations. At the beginning of this post I stated how it is important to note your own warning signs and come up with a relapse prevention plan before entering these 3 stages. This is partially because while experiencing mental relapse, it is common to feel like high risk situations are less detrimental than they are, because you are not perceiving them through the same perspective as you would when in a recovery-oriented and/or unconflicted mindset [2].
Physical relapse
Physical relapse is the stage that most commonly comes up when we think of relapse. This is when an individual actively starts using again, or stops using strategies they had set out for controlled and/or safer use. This is sometimes divided into two categories. A “lapse” refers to the first incident that goes against recovery goals, and “relapse” refers to an ongoing return to uncontrolled use.
A lapse does not need to be seen as a dead end, but a fork in the road. A lapse may lead to a full-blown relapse, but it may also be corrected before reaching that point and be used as an opportunity for growth. This is called a prolapse [1]. It is also important to mention that these three stages do not inevitably lead to each other once entered. They can be reversed at any time if the warning signs are noticed, or if you catch yourself before or after a lapse. Strengthening that awareness/response is the purpose of relapse prevention planning.
Like we said at the beginning of this post, people often think relapse prevention only involves saying no just before using, but this is the final and most difficult stage to stop, and waiting to respond until this last stage is partially why we fall back into old patterns.
If someone stays in mental relapse long enough without the necessary coping skills, clinical research has shown they are more likely to return to a substance just to escape inner turmoil [2].
Coming up with your own relapse prevention plan
For the reasons we have stated, it’s important to keep an eye out for warning signs of emotional and mental relapse. Oftentimes people choose to do these plans with members of their community or with healthcare teams, but that is up to you and you know how to make the process the most personally meaningful. Before completing a plan, it is often helpful to brainstorm a few topics. Doing this may help you get into a headspace that is unique to your recovery:
Your history with the substance
- Was there a certain time when you were more prone to substance use?
- Did specific people factor into the times you used?
- What thought patterns make you most likely to use?
- If you have relapsed before, what events, thoughts and/or emotions led to it?
- Determine any signs that could lead to relapse (Recovery Village)
You can access a template for a relapse prevention plan here. If there is anything else that feels relevant to add, it is usually best to follow your intuition and include it. The more your plan is personalized to your own needs, the more likely it is to address them.
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References
[1] Hendershot, C. S., Witkiewitz, K., George, W. H., & Marlatt, G. A. (2011). Relapse prevention for addictive behaviors. Substance Abuse Treatment Prevention and Policy, 6(1). [2] Melemis, S. M. (2015). Relapse prevention and the five rules of recovery. Yale J Biol Med, 88(3), 325-332.
