A person working to end their addiction to drugs or alcohol needs help from doctors, therapists, and loved ones to safely detox, relearn behaviors that changed because of compulsive substance abuse, and stay sober after they leave a rehabilitation program. To sustain recovery, there are several relapse prevention techniques that can help to reduce the risk and severity of a relapse.
What Is a Relapse, and How Can It Be Prevented?
It is important to understand that people who struggle with addiction have a chronic disease of the brain. Like asthma, diabetes, and even schizophrenia, addiction is a disease that can relapse, meaning that there is no cure, but it can be managed. For people with diabetes, for example, relapse rates are about 40 percent, so around half of people with this disease will experience their symptoms getting worse, which means they must return to the doctor to re-establish a care plan. For people with an addiction, symptoms of the disease involve compulsively abusing intoxicating substances to stimulate neurotransmitter release in the brain.
There are two forms of recurrence with addiction: relapse and the less intense lapse.
- A lapse may be the first time a person consumes alcohol or drugs after leaving rehabilitation, especially in small amounts, or lapses can be short episodes involving a small amount of an intoxicating substance later. Lapses could last a few hours or a day.
- A relapse involves an inability to stay sober over a period of time after leaving rehabilitation. This involves either a series of lapses occurring close together, making up a longer span of substance abuse, or a similar substance becomes the target of abuse, like a person overcoming an alcohol use disorder beginning to drink mouthwash.
Instead of treating a relapse as a failure of willpower, it is important to treat addiction as a chronic disease among other chronic diseases and return to a doctor and therapist for help addressing the new symptoms. People who struggle with addiction are likely to lapse or relapse at least once within the first year after their recovery; between 40 percent and 60 percent of people who go through substance abuse treatment relapse back into patterns of addiction and drug abuse, and 70-90 percent will experience a lapse. It is important to remember a lapse or relapse does not mean that treatment has failed, only that it is time to get help again and stay focused on sobriety.
Understanding what may trigger a relapse, deciding to avoid relapse, and creating a plan to manage a relapse when it does occur are the best steps to reducing the risk of this condition. Without understanding, recognition, and preparation, a person who relapses back into substance abuse is at greater risk of overdosing and dying because they did not get the help they needed.
What Increases the Risk of Relapse?
When a person completes their rehabilitation program, they may feel happy and successful for several days or weeks, and they should because they have worked hard and focused on becoming healthy. However, the period immediately after leaving rehabilitation is also a vulnerable time, as the individual re-enters a world that could trigger a relapse. Some experiences that can trigger a relapse include:
- Visual reminders of drugs, including sign posts, street names, or specific items associated with drug abuse or the environment in which drugs were abused
- Other sensory reminders, like smells, sounds, or tactile sensations
- Negative or low moods
- Stress or anxiety
- Positive moods around celebrations or socializing, which previously may have involved abusing drugs or alcohol
- Sampling the drug itself, accidentally or on purpose, even in small amounts
Generally, around half of those in recovery will relapse, although the specific percentages vary based on which drug was abused. For example, among those recovering from opioid addiction, 85 percent will relapse within one year after treatment; alcohol use disorder relapse rates range from 30 percent to 70 percent, depending on individual factors, like mental health.
The amount of time a person has been sober can also influence whether or not they will relapse, although the reality feels counterintuitive. A person is most likely to relapse within the first 90 days of their recovery, which is why it is important to stay involved in a rehabilitation program for this long. However, the longer a person has remained abstinent from drugs and alcohol, the more likely they are to relapse; a person is at a greater risk for relapse two or three months into sobriety than within the first week. This has to do with the way the structure of the brain’s reward system is changed by intoxicating substances and the disease of addiction.
Fortunately, studies have shown that being in a rehabilitation program for 90 days, as recommended by the National Institute on Drug Abuse (NIDA), can create “treatment relapse” habits the same way that drugs and alcohol can create cravings and mental changes that lead to relapse. If a person continues to work in individual and group therapy to change their behaviors for an appropriate amount of time, getting help becomes a habit; people who spend three months working with counselors and doctors to change their behaviors around substances are more likely to return to this form of help when they relapse. Part of a rehabilitation program should involve how to understand relapse, the risks around it, and the development of a plan to treat relapse when it happens.
How to Develop a Relapse Prevention Plan
A person working to overcome addiction should work with their therapist to understand relapse and develop a plan to manage it once it occurs. Some basic steps that should be taken by the therapist and client are outlined below.
- The individual and therapist should work together to understand the individual’s potential relapse triggers, so these can be avoided.
- Triggers like stress from family or employment will need specific techniques to be managed (e.g., learning mindfulness techniques to relax).
- Be honest about high-risk situations, like parties, and ask for emotional support if necessary.
- Make friends and attend support groups to be around people who also do not use drugs or alcohol.
- Find activities and hobbies that can minimize stress and improve mood.
- Understand that cravings or urges may come in waves, peaking around 30 minutes, and then subside. Find ways to manage these experiences until they go away to avoid substance abuse.
- Make a list of people who can be relied on for support during stressful situations or in the event of relapse.
If relapse does occur, it is important to manage the symptoms right away to return to healthy habits. This plan should include:
- Get rid of drugs or alcohol in the house or immediate vicinity.
- Take deep breaths and remain calm.
- Call friends and family who have offered emotional support for help.
- Understand how the relapse occurred, and consider documenting the experience with journaling or another method.
- Work with a therapist and/or support group to find ways to prevent similar relapses in the future.
There are sample written relapse prevention plans available online; these are a good start to understanding how relapse prevention plans are structured and what information should be included. However, as needed, these can be expanded with a therapist as a guide. One’s treatment plan, which includes the relapse prevention plan, should be evaluated after a year and as frequently as the therapist and client feel is necessary for the next five years. After that time, the risk of relapse drops greatly, although it does not go away.
A relapse prevention plan should be revisited to address any new circumstances that have developed in an individual’s life. The plan should continue to focus on sobriety, managing stress, and maintaining mental health.
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