Relapse Prevention at Hope Rehab

Recovery Tool Kit, Hope Rehab Thailand

What is relapse prevention? After making changes to your life, it is important to consider how to maintain these changes so they are sustainable throughout everyday life. Relapse prevention will equip you with the tools you need to ensure that you do not fall back into old habits.

Relapse Triggers

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.

The body itself has been conditioned to respond to routine behaviour. Most living creatures have an internal timing system that makes them automatically respond to the course of the day to meet their needs. For example, people feel the urge to drink after work, have an evening joint, bedtime pill, weekend of meth, a binge, daily fix or even hourly fix. We’ve become programed to expect something.

Unfortunately, without setting yourself clear goals and using tools to cope, it is very common for most people with addiction issues to experience relapse and remission.

In the 1800’s Ivan Pavlov conducted experiments on how cues around dogs would stimulate them to respond to eating. For example: whenever a bell was rung the dogs would receive food. Eventually, the dogs would salivate as soon as the bell was rung.  This is known as classical conditioning , it now forms part of the basis of the relapse prevention work we cover at Hope Rehab. For more in-depth information please visit our “Relapse Triggers & Radar” page.

Addiction is a complex illness characterised by intense and, at times, uncontrollable drug craving, along with compulsive drug seeking and use that persist even in the face of devastating consequences. While the path to drug addiction begins with the voluntary act of taking drugs, over time a person’s ability to choose not to do so becomes compromised, and seeking and consuming the drug becomes compulsive. This behavior results largely from the effects of prolonged drug exposure on brain functioning.

– National Institute on Drug Abuse (NIDA)

Common problems

Although common, the harm and impact this has on your life should not be minimised. Instead, one should consolidate the reasons behind this and work to avoid those triggers in future. Remission is the beginning of a relapse. Slipping back into old ways of behaving can often be on the cusp of relapse back into drink or drug use. You have to be honest with yourself, where have you gone wrong before?

Not all relapse triggers are external cues –  some come as stress builds up from pre-existing conditions such as depression, psychosis, obsessive behavior, bi-polar and other psychiatric illnesses. Non-compliance with medical treatment and medicines can lead to self-medicating with more mind-altering substances such as alcohol and other drugs.

Dual-DiagnosisThose with dual-diagnosis (the co-existence of substance-use and psychiatric issues) need to factor in special consideration for this and often draw support from planning with Hope and addiction groups like Dual Recovery.

Relationships – supportive relationships can often be difficult and can unfortunately lead to stressful factors and even present direct triggers to use. It is not recommended that in early recovery you pursue new romantic relationships. Sexual relations and non-sexual relations can be both a source of pain and pleasure, in other terms –emotional stress.


The Environment around us forms one of our largest triggers. It comes in the shape of People, Places and Things, some of which will have strong associations with your using.  These are known as the external or sensory triggers. When combined with internal triggers such as emotions and thoughts, they can impact us greatly.  Below are some of the external triggers that can influence your decision-making:

External Triggers

  • People: Parents, friends, family members, co-workers

  • Places: Bars, neighbourhoods, home, holidays

  • Things: Cash, paraphernalia, bottles

  • Events:  Weddings, funerals, BBQ’s, birthdays, weather

  • Sensory:  Smells, sight, sound, taste

Internal Triggers

  • Emotional: Anger, depression, anxiety, euphoria, memories

  • Mental: Insane and distorted thinking patterns

Euphoric Recall

A common trait for many people recovering from drug and alcohol usage is to only recall the positives from their usage. This is called euphoric recall. Often, people remember the times where they partied on drink and drugs and forget all about the agony.

By unconscious desires to use alcohol or drugs, the mind filters out the negativity and potentially glorifies past experiences. Even music can be a powerful trigger, recalling moments of euphoria, memories of using, positive connections or alternatively negative feelings of depression and anxiety.

Sometimes when people leave treatment they are suddenly faced with an urge to use drink or drugs again. It is important to recognise that cravings are an understandable part of the process and they come and go in waves.  The first wave is characterized by intense feeling or desire to use. Eventually, over the span of a few minutes or more, the wave begins to diminish. However, it can return at similar levels.

Relapse is a process not an event, its best avoided – Sadly I have known too many addicts relapse and die. I don’t want to relapse again. The only thing I had to change in recovery was EVERYTHING. But attitude is a little thing that makes a big difference in recovery. Be prepared the change somethings you don’t want to, that’s what will make the most difference.

The Recovery Map

The recovery map is the last exercise of the client’s treatment. It helps the client to get a clear view of their new recovery life, what they are going to do, plans and commitments etc., as well as of their personal triggers and slippery behavior, which would lead the client back to the addiction.

Clients fill in their bottom lines in the center of the recovery map. Bottom lines are the things they cannot go back to, i.e. alcohol, medication, heroin and/or cocaine. They also write down their clean date at the bottom of the bottom lines.

After the bottom lines, the focus is on the outer part of the recovery map, the four corners about health and lifestyle, work and education, relationships and their recovery. It is important that clients honestly describe what they are going to do after treatment, and not make a ‘wish list’.

A few examples:

Health / Lifestyle

  • Yoga 3 times per week

  • Biking to work at least twice a week

  • Biking to work at least twice a week

Work / Education

  • Back to the old job

  • Start a study

  • Applying for a new job

  • Enroll in a course


  • New friends from meetings

  • Taking your spouse to the zoo

  • Contacting ‘good’ old friends

After the center and the outside of the recovery map, it is time to write down the triggers and slippery behaviour.

What leads the client from their new recovery life back to their addiction/bottom lines?

A few examples:

Health / Lifestyle

  • Laziness

  • Boredom

  • Not sticking to the goals

  • Not exercising

Work / Education

  • Stress

  • Not finding a job

  • Not doing homework

  • Coming late


  • Anger

  • Visiting old using friends

  • Mother in law

  • Lack of assertiveness


  • Complacency

  • Excuses

  • Not going to meeting

  • Lack of routine

  • Going to a bar

When finished, the recovery map helps the client back in their home situation evaluate where they are in their recovery. Do I write down my gratitude list? Have I done my exercise this week or did I lay lazy on the couch? Did I go to the meetings or did I make excuses? Am I seeing my old using friends again while I know that is a trigger?

Scientific research by NIDA over the last 50 years shows that treatment can help patients addicted to drugs stop using, avoid relapse, and successfully recover their lives. These criteria are important:

  • Availability

  • Address underlying issues

  • Long enough period of time is critical

  • Individual counselling

  • Group work

  • Diagnose mental disorders

  • Medically assisted detoxification

  • Treatment voluntary or coerced

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