A relapse prevention program helps identify your personal relapse triggers. A trigger can be anything that activates a craving or a using thought. Triggers are sometimes referred to as urges or cues. Urges can be common in early recovery so do not regard them as a sign of failure. Instead they will help you to understand you triggers. You win every time you defeat an urge to use. Urges get stronger every time you give in and feed them. Remember, if you don’t feed the monster it gets weaker!
Psychologists prefer the word cues, originating from research in which a reward or punishment is paired together with something else i.e. the cue together with food. For example; dogs will associate the sound of a bell with food over time and will begin to salivate as soon as the bell rings. This is known as classical conditioning (based on the research by Ivan Pavlov known as the phenomenon of Pavlov’s dog or Pavlovian Response) and forms part of relapse prevention work.
Your biological body clock is a trigger to undertake any routine behaviour. All living creatures have an internal timing system that tells us what we should be doing at any given time to satisfy our needs. So whether it’s a lunch time drink, evening joint, bedtime pill, weekend cocaine, daily or sometimes hourly fix, you are programmed to expect it.
A pattern of relapse and remission is very common for those suffering with long-term addictions. However, it’s worth thinking about exactly what impact this has on your life and how it can be avoided. Remission can be followed by a likelihood of relapse so preventive interventions may stop future use. Post treatment relapse rates are very high so dedication and hard work is necessary.
Dual Recovery refers to those with Dual diagnosis so dual relapse prevention planning is necessary. Issues like a flare up of the psychiatric illness and symptoms such as obsessive behaviour or hallucinations are obvious triggers. Non-compliance with psychiatric medications can lead to self-medicating using alcohol, prescription and illicit drugs and not engaging in a support network or program often results in feeling overwhelmed and confused.
Relationships deserve a special mention as they are common relapse triggers and this is partly why it’s recommended not to pursue new romantic relationships in early recovery. Romantic and unhealthy sexual and non-sexual relationships can be a source of both euphoric and painful feelings, so to keep emotional stress at a manageable level they are best avoided if possible. However, forming healthy intimate relationships is very much a part of recovery and these can be with other recovering individuals, sponsor, therapist, family members, spouse, partner and children.
Environmental Triggers are People, Places or Things that have somehow become associated with your using. Also known as external or sensory triggers that can combine with internal triggers such as emotions and thoughts, some of which are listed below;
- People: Friends, family members, co-workers
- Places: Bars, neighbourhoods, holidays
- Things: Cash, paraphernalia
- Events: Wedding, funeral, birthdays, weather
- Emotional: Anger, depression, anxiety, euphoria
- Sensory: Smell, sight, sound, taste
Euphoric recall or using memories that selectively filter out the negative consequences of your using are potentially very dangerous. Refusing to engage in conversations that glorify past using experiences, however tempting and exciting, is the wisest strategy. Music can be a powerful trigger possibly causing euphoria, using memories, depressed mood, anxiety or alternatively a positive connection.
When you first return home some urges are too strong to ignore. When this happens it can be useful to sit with your urge until it passes. In time everything passes. This technique is called urge surfing.
Think of urges like ocean waves: Small at first, then they grow in size and finally break up and disappear. Imagine yourself as a surfer riding the wave, gliding above rather than getting caught up in the chaos below. Staying calm and in control of your behaviour and actions helps more than fighting and getting stressed. That’s why meditation and relaxation techniques are so effective in these situations.
What is a Craving?
A craving is a mental and physical desire to use: You know you’re experiencing a craving when you start to feel anticipation and it can be overwhelming. The compulsion to act on the craving despite previous unwanted consequences is what makes addiction so powerful and relapse so common.
Failure to accept having the disease of addiction/alcoholism is another common reason people pick up drugs or drink again.
We say relapse is a process not an event, but cravings are not something that you can always predict or guard against. You may not know when they are going to happen. You can get a craving whilst watching TV or while you are trying to work or go to sleep. All you know is that your body is telling you how much better you’d feel if only you took a drink, smoked a joint or took that drug.
Relapse prevention is all about learning what your triggers are and how to cope with cravings. You will create a personal recovery plan and attend groups that educate you on the best way manage this.
PAWS – Post acute withdrawal symptoms continue long after the physical detoxification process is over. The cessation of some medications can have lingering side effects. In general it is the symptoms of the disease of addiction that persist long after an addict gets clean and sober. A long term recovery plan, working a programme and the rewards of a healthy life help combat nagging symptoms like depression, boredom and toxic feelings.
Relapse triggers to look out for;
Automatic-pilot: unconscious using behaviour or compulsive urges, such as going to the dealer or ordering a drink without thinking.
Distress: Feeling emotionally overwhelmed or disappointed with yourself, others and life.
Impatience: Things are not happening fast enough for you or others are not doing what you want them to do. Also trying to catch up on lost time and opportunities due to addiction.
Intolerance: Getting angry and not promptly defusing your unhelpful negative thinking.
Frustration: Because things may not be going your way in your time you give up.
Anxiety & Depression: Overwhelming and unaccountable despair, low self-esteem and self doubt may occur.
Self-Pity: Feeling like a victim and refusing to acknowledge that you have choices and are responsible for your own life.
Exhaustion: Allowing yourself to become overly tired and stressed out. Not following through on self-care behaviours. HALT stands for Hungry, Angry, Lonely, Tired.
Conflict: Arguing over small and insignificant points, indicating a need to always be right.
Expectation: Too much from others and self, “I’ve changed, why hasn’t everyone else changed too?”
Co-dependency and Boundaries: Being enabled by loved ones or others expectations becoming an overwhelming pressure.
Loneliness and feeling isolated, social anxiety around others becoming unmanageable.
Discipline: Letting go of recovery rituals: keeping daily inventory, repeating positive affirmations, going to 12-Step meetings, therapy, meditation and prayer. These are important structures for a new life in recovery.
Boredom: Waiting for things to change, not stimulated, unsatisfied and feeling unmotivated and lazy.
Complacency: Not working your program with the commitment that you started with. Having a little fear can be a good thing as it creates necessity for action.
Dishonesty: Denial begins with a pattern of small unnecessary lies to self and others.
Old behaviour: Self-will, not taking advice, anger, going to bars etc.
Medications: Your doctor may participate by prescribing mood-altering medications and you could convince yourself that this time will be different.
Not had enough: Negative self talk such as “just one more” and reward-seeking or relief-seeking behaviour.
Comparing my addiction to others and coming out better “I could use a lot more” or worse “what’s the point? I’ve already lost everything”.
Defusing Triggers and urges;
- Identify and recognize your individual triggers
- Talk about them – call someone – go to a meeting
- Create a visual image of an on/off switch that you can flick when triggered
- A rubber band around the wrist – snap when triggered
- Healthy alternatives – dried fruit & nuts and soft drinks
- Displacement activities – go somewhere and do something different
- Delaying tactics – cravings and urges always pass – buy yourself some time
- Affirmations – employ positive affirmations about recovery
Myths about relapse;
Relapse is unpredictable: No, numerous warning signs always precede the actual using itself.
Relapse is unavoidable: No, relapse is a process that can be identified, you can avoid relapse by increasing awareness.
Relapse is an indication of poor motivation: No, highly motivated people relapse too. It may just mean that there is something wrong with an individual’s recovery program.
Relapse erases positive changes have been made in recovery up to that point: A relapse is a temporary setback that can provide a person with valuable information regarding what caused the relapse. It is likely to highlight what he or she may need to focus on to prevent it from happening again.
Relapse is a sign of treatment failure: No, relapse indicates that a person’s recovery plan is incomplete and needs adjustment.
Relapse occurs only when people return to their drug of choice: Due to the nature of addictive disease, any use of mood-altering chemicals is a relapse.
Relapse is an instantaneous event: Relapse is a process not an event.
Abstinence guarantees successful recovery: Abstinence and lifestyle change is the first step necessary to maintain recovery. If abstinence is all that is attained, dry drunk syndrome or PAWS is very likely to take hold.
The individual who continues to relapse simply has not hit bottom yet: Persons who continually relapse are already in a great deal of pain. In fact, part of the reason they continue to relapse is because of the tremendous pain they are experiencing. What they need is a relapse prevention plan that adequately addresses their needs in recovery.
An example of a very brief Relapse Prevention action plan:
Your journey home
- Inform airline not to serve drinks
- Stay away from “wet places” in the airport
- Have a good book to read – something light-hearted or recovery text
- Phone numbers of recovering people to ring and text when possible
- Short-term goals
NA & AA meetings home group
- Meditation practise to stay calm
- Stay in contact with Hope Rehab
- Reading daily
- Physical exercise
- Practise affirmations and visions
- Permanent sponsor & Complete 12 steps
- Healthy social life
- Healthy work life
- Work leisure balance
- Practice healthy boundaries
- Healthy relationships
- Have a contingency plan in place
- Be aware of triggers
- Attend 90 meetings in 90 days
- Call sponsor/counsellor for support
- Take time out when stressed to process events
Most recovering people learn that in order for their recovery to continue, they must constantly assess themselves. Part of this process includes making changes to their attitude.
Those that have relapsed, almost without exception, indicate that failure to attend support group meetings preceded their using.
Change is very much a part of living. It’s been said that the only unchanging thing in life is change. In general, addicted people tend to find it unusually difficult to accept an unpleasant reality. Perhaps that’s why they often look for “an easier, softer way” and thus gravitate towards addictive substances and processes.
One of the unpleasant truths involved in relapse prevention is that you need to feel the pain that your illness has caused you although it is uncomfortable. Why must one keep looking at the pain?
Once forgotten it becomes easy to regard that the past addiction wasn’t that bad or one drink can’t hurt me that much. Remembering the pain is one of the best forms of relapse prevention that is available. However, dwelling on painful past events can paralyse the recovering individual to a point of inaction and relapse. A balanced view of the past, present and future can stave off despair.
Recovering people are often affected by low self-esteem. While changing this can be a lifelong task, positive self affirmations can be helpful in changing bad feelings about ourselves. People practice affirming themselves in various ways as a means of improving mental and emotional health. A simple solution to raise self esteem is to take part in esteemable activities. Recovery is about action. It is also about love, joy, peace and contentment.
A useful relapse prevention reminder is the acronym D.E.A.D.S
- Delay – Everything passes, even strong cravings
- Escape – Leave a place if you are feeling triggered or threatened
- Avoid – Stay away from very high stress situations and people
- Distract – Talk to someone or have a soft drink
- Substitute – Do something healthy and fun instead of using
Relapse Prevention by Simon