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Relapse Prevention Plan & Worksheets

 
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Relapse Prevention Information, Plan, Worksheets, & Workbook

Addictions Free Living, Click Here!

When an individual relapses, for the most part it is not a spontaneous accident, there are usually warning signs and symptom’s that may be or may not be obvious to the addict and before they realize they are heading down the path of a relapse, it is too late. As a drug addict, we are very good at talking ourselves into situations and actions that we know will be detrimental to our success but the cleverness of our disease tricks us into thinking that our thoughts and actions will benefit us rather than lead us down the same path that we have been fighting to overcome. We have added several different options for every recovering addict to consider. Each person is different so finding what works for you is vital to your recovery and continued sobriety.

THEORY & PRACTICE

Relapse Prevention- Theory & Practice  ~ Supporting Recovery from all addictions!

What is Relapse Prevention?

  • Relapse prevention shifts the focus of therapy from the process of creating change to that of maintaining treatment gains or preventing relapse.
  • Many forms of addiction or addictive behaviors are often considered to be intractable. In particular the psychological components that could be collectively called “willpower”.  Intractable: Resisting attempts to control, correct, or influence; difficult to deal with or solve; difficult to shape or manipulate.
  • Relapse prevention therapy is considered to be a critical component to maintain the long-term measurable success of treatment programs that deal with the psychological aspects of addiction.
  • Success is gauged in terms of a follow up measurement of abstinence from ongoing psychological problems such as substance abuse, gambling or sexual addictions.
  • Ideally the components of the relapse prevention module should be embedded throughout the treatment program and part of the unifying philosophy of the program. As such relapse prevention becomes a part of the continuing self-management process beyond the termination of the formal treatment program.

Looking at the Relapse Process (Marlatt, 1982, 1985)

Developed the original relapse prevention model for the treatment and management of addictive behaviors (alcoholism). His main contribution is that of the relapse process. Marlatt assumed that relapse occurred in discrete steps over time. This led to the distinction between a lapse (a single occurrence of the prohibited behavior) and a relapse (a return to an addictive pattern). The author of this article, (Pamenter, 2005) further distinguishes between the psychological components of addiction and addictive behaviors as a psychological “pull” and the physical or genetic components of addiction as a physical “push”. Typically stimulant use such as an addiction to methamphetamine’s tends to create a stronger “pull” effect, than is generally evident with depressant addictive disorders such as alcoholism. Indeed one recent research study determined that gambling addiction was stronger that alcoholism. This fits the above assumption that the psychological components of addiction are more deeply ingrained and affected by internal cognitive and affective factors than the physical components of addiction that may be influenced in part by external factors.

In Marlatt’s cognitive behavioral model a high-risk situation occurs in when a person is placed in a situation where their commitment to abstinence is threatened—essentially because of lack of effective coping skills. High-risk situations are generally considered to follow three distinct pathways:

  1. The person is in an unmanageable situation (external factors—environment).
  2. The person maintains a lifestyle imbalance and has difficulty in coping with stressors, and as a result feels overwhelmed and relies on the addictive behaviors as a coping method. The high-risk situation is considered to be an internal lack of ability to deal with a negative affective state (emotional upset & resolution process).
  3. The person makes a series of apparently irrelevant decisions, which lead to the high-risk situation occurring, and create a mental excuse for lapsing (lack of effective insight and mental safeguards).

Problem of Immediate Gratification (P.I.G.) & Abstinence Violation Effect (A.V.E.)

Once the person is in the high-risk situation then their anticipation of the pleasurable and positive effects of the addictive behavior creates a situation of cognitive dissonance with their desire to avoid the negative consequences. This is called the problem of immediate gratification (PIG), and facilitates the chances of a lapse occurring. Failure to deal adaptively with the high-risk situation leads to decreased self-efficacy, lapse, and the abstinence violation effect (AVE)—essentially a self-awareness that the person’s commitment to abstinence has been violated. Depending on how the AVE is managed a relapse may or may not occur. An issues of Attributions According to Marlatt, the AVE consists of two main components, an attribution concerning the cause of the lapse and an affective reaction to this attribution. For example if the lapse is thought to be caused by external, unstable and specific factors then the effect is likely to be minimal. (“I only smoked because I was at the bar.”) However, if the lapse is attributed to internal and unavoidable factors (“I am weak.”) then a negative emotional reaction will be felt on a deeper level and the likelihood of relapse increased. The greater the intensity of the AVE the more likely it is that an individual will relapse and return to his or her previous level of addictive behavior. Thus the function of the addictive behavior is to cope with emotional stressors, and represents a maladaptive coping strategy. 

Attribution: The ascribing of something to somebody or something, the reason for an occurrence of an event or situation. The above model places a pivotal emphasis on the individual’s commitment to abstinence, the resultant cognitive dissonance and affective reaction to the violation of this commitment. It places little emphasis on the creation of a self-management approach typified by the statement: “I could use if I want to, but choose not to.” This takes away some of the mental temptation of the addictive behavior being “forbidden fruit” and re-frames the behavior as a conscious and healthy choice. Thus individuals following a self-managed approach are less likely to be set up for failure with internally or externally imposed absolutes and ultimatums such as: “If you relapse you are kicked out of the recovery program”; and are more likely to follow a process of increasing their self-efficacy.

Cognitive Behavioral Chain (Pithers, 1990) Looked at the relapse process as a cognitive behavioral chain. The unwanted behavior is the end result of a lengthy sequence of thoughts and actions.

This behavioral chain generally consisted of four distinct stages:

  1. First there is a lifestyle, personality or situational event, which forms the background to the addictive behavior.
  2. Second, the individual becomes dysphoric (experiences negative mood states) as a result of the stressors, and consequently enters a high-risk situation.
  3. The person lapses by thinking or fantasizing about the behavior.
  4. The person relapses and commits the undesired actions. The Pithers model identifies only one pathway that leads to high-risk situations and the undesired behavior. The cognitive behavioral chain is characterized by a sequence of “apparently irrelevant decisions”.

These decisions interfere with the person’s self-control mechanism. A high-risk state is typically characterized by a negative emotional state, interpersonal conflict, or external conditions. The model postulates that the person is initially in an abstinent state with relatively high self-efficacy beliefs. However with the advent of apparently irrelevant decisions, a high-risk situation emerges and if not coped with results in a lapse or relapse. During the period of time after the lapse (thinking about the undesired behavior) but preceding a relapse, is when the AVE is experienced. There is a conflict in the person’s self-image and how it is resolved determines whether their behavior proceeds to a relapse or returns to a commitment to abstinence. The problem of immediate gratification (PIG) results when the person focuses their thinking too much on the presumed positive effects of the addictive behavior and not enough on the known negative consequences. In the Pithers model the PIG occurs as part of the AVE and facilitates the transition from a lapse to a relapse, whereas for Marlett, it mediates the transition from a high-risk situation to a lapse.

The criticism of both Pither’s and Marlett’s model include that they both rely on the presupposition of associated mechanisms and stages where no clear connection as to sequence exists. Pithers defines lapse in terms of thinking and fantasizing and does not account for feedback loops that eventually may lead to relapse. Both models tend to focus more on skills deficit rather than on decision-making. Further research has shown that most people experience AVE (remorse for violating their commitment to abstinence) only after a lapse or relapse. Further there is no distinction in the models with regard to the frequency of the return to addictive behavior, or the level of use if the return is to a pattern of substance use. Likewise there is little account for impulsive behaviors where a sudden opportunity presents itself and is mediated by the individual’s level of self control.

 

Self-Regulation Model (Ward & Hudson, 200)

Suggest a self-regulation model of relapse prevention that has its foundations both in theoretical and empirical work. They incorporated Pither’s concept of an addictive pathway, but expanded their theory to include three major pathways, a positive one, a negative one, and a mixed pathway. The positive pathway is characterized by a positive mood in the beginning, followed by direct and explicit behavior planning.  The negative pathway is characterized by negative emotions associated with the addictive behavior and throughout the process, with implicit planning featured as the precursor to the addictive behavior. A mixed pathway begins with a negative emotional state but as the frequency of thoughts about the addictive behavior increase the affect changes to a positive state as the person’s cognitive dissonance is resolved and their planning increases. Post behavior evaluations may be remorse, fear of further consequences, regret, negative self-attributions, and a commitment to refrain from the addictive behavior. The self-regulation model focuses on the use of internal and external processes that enable the individual to engage in goal-directed behavior; this can refer to the achievement or avoidance of desired goals.

  • Phase I: Life Event Desire to avoid addictive behavior. Some kind of life even occurs. The event is appraised and initiates a pattern of thinking, feeling, and intentions (but no actions yet).
  • Phase 2: Desire for addictive behavior The individual feels bad and wants to feel good. They have a desire for the addictive behavior which they believe will temporarily relieve their negative emotional state. This negative emotional state may initiate a behavioral script (pattern of behavior) that has led to the completion of the unwanted addictive behavior in the past. It involves the mental rehearsal of the addictive behavior, the lowering of inhibitions against indulging in the addictive thinking, contemplating or actions. The person’s emotional state actually improves even though the addictive behavior has not yet happened.
  • Phase 3: Behavior related goal is established – a plan A plan to engage in the undesired behavior is established and a goal identified. Negative attributions are outweighed by positive ones.
  • Phase 4: Strategy selected • Avoidant-passive: Desire not to act, but the person feels that they cannot avoid it. Under-regulation or dis-inhibition pathway, loss of control, impulsiveness, lack of coping skills, covert planning.

• Avoidant-active: Person tries to control their thoughts and actions, but the strategies they use are ineffective or counterproductive. Mis-regulation, and possible substitution of addictions.
• Approach-automatic: The person simply follows behavioral scripts and experiences no negative affects. It is also under-regulation and dis-inhibition. • Approach-explicit; The person’s behavior is deliberate and chosen, and involves finely tuned strategies. The person’s self-regulation skills are intact. The issue revolves around the nature of their underlying goals which encourage and support the addictive behavior. 

Persons following an avoidant strategy will experience more shame, guilt or remorse, for their behavior as they will have the attribution that they failed to abstain. However, those following an approach strategy will likely maintain a positive affect as they have succeeded in attaining their desired goal.

  • Phase 5: High-Risk situations The opportunity for addictive behavior exists, and a choice must be made.
  • Phase 6: Lapse The lapse is the immediate precursor to the addictive behavior where the person’s intention is to engage in the addictive behavior. (It is suggested that people with an avoidance strategy temporarily switch to an approach goal. The person gives up his attempts at self-control and allows him or herself to be guided by situational stimuli in a haphazard fashion. The approach strategy persons will demonstrate a follow through of their carefully planned actions.
  • Phase 7: Addictive behavior Phase
  • Phase 8: Post addictive behavior evaluation Avoidance – guilt, shame, failure, Approach – no remorse,
  • Phase 9: Attitude towards future engagements in addictive behaviors.
  •  Recommit to abstinence,
  •  Continue with behavior,
  •  Switch to an approach goal
  •  Approach – reinforce their addictive behavior, refine their strategies
  •  Approach-automatic: Teach self-regulation strategies, and awareness of goals.
  •  Approach-explicit: Moral issue, not a skills problem
  •  Need to deal with the person’s core schema (issues of self, intimacy, sexuality, sense of being wronged and   blamed)
  •  Reconditioning of inappropriate preferences.
  • • Focus on cognitive distortions and disclosure of offence related thoughts, feelings and motivations, with the major therapeutic challenge being the challenging of explicit goals.

What Now?

Now that you know what led up to and maybe even why you relapsed, it is now time to get it on paper.  Please fill out the worksheet in located at the below link!

And Then What?

The next step is to make a plan so you do not repeat this mistake!

Relapse Prevention Plan- If you Relapse

If you Relapse…
Remember you are human, and it is highly possible that you may slip and use some mind–altering substance or other addictive behavior at some point in your recovery.  If you do relapse… remind yourself of the following facts:

  •  To err is human. A change from your desired abstinence plan is not unusual. Yes
  • “$hit happens” and even the best recovery will not be perfect.
  •  It does not mean that you have lost control or that you have no willpower.
  •  It does not mean that all previous drug–free days were in vain (wasted). Recovery is a PROCESS not a BADGE of how many drug-free days you have.
  •  It does not mean that you will slip again, and again. Perhaps this time will be the
  •  Do NOT CATASTROPHIZE. Your world will not end, just get back on your program or return to your RELAPSE PLAN and make some modifications.
  •  You do have to pay attention carefully to the thoughts and feelings that led up to your using. What can you do differently so that it does not happen again?
  •  Be honest and admit that you made a mistake. Now decide that you are capable of learning from what happened, and make a plan to avoid the particular situation in the future. Imagine a better way to deal with a similar situation in which you do not go out and use.
  •  Once you have thought through what happened – let it go. Do not dwell on your failures, but use your energy to plan for your future successes.
  •  Try not to feel guilty, frustrated, or discouraged. If you do, remind yourself that these feelings will pass. Let your mistakes be a source of learning, not a source of self–punishment.
  •  Get back to your program NOW. Not tomorrow, or next week but right NOW.

Letting Go

  • To let go does not mean to stop caring, it means I can’t do for someone else.

  • To let go is not to cut someone off, it’s the realization I can’t control another.

  • To let go is not to enable, but to allow learning from natural consequences.

  • To let go is not to try to change or blame another, it is to make the most of myself.

  • To let go is not to care for, but to care about.

  • To let go is not to fix, but to be supportive.

  • To let go is not to judge, but to allow another to be a human being.

  • To let go is not to be in the middle arranging all the outcomes, but to allow others to affect their own destinies.

  • To let go is not to be protective, it is to permit another to face reality.

  • To let go is not to nag, scold or argue, but instead to search out my own shortcomings and correct them.

  • To let go is not to adjust everything to my desires, but to take each day as it comes and herish myself in it.

  • To let go is not to regret the past, but to grow and live for the future. 

  • To let go is to admit powerlessness, which means the outcome is not in my hands.

  • To let go is to fear less and love more!

Building Character: Who are you?

When you have walked a long way out from some very difficult situations in your life, and feel like you still have so far to go—it is ok to look back for a bit. If you take a moment to reflect on how far you have come, and the obstacles that you have surpassed you will realize that you are stronger, more capable, and more resilient than you think.  Character is not something that happens over night. It is not an exam that you can study
for, it takes time and effort to develop. Good character is doing the right thing—despite everything else in your life that seems wrong. So take a moment to look back at all that you have accomplished, and then realize that the mountain ahead is really just one step after another—and you will get to the top and where ever else you want to go.

Who Are You?
Watch your thoughts…because they become your words.
Watch your words…because they become your actions.
Watch your actions…because they determine your friends.
Watch your friends…because they determine your character.
Watch your character…because it determines your destiny!

The choices that you make in life…will show your friends, family & the world, what kind of a person you are becoming.
Success is realizing what an amazing person you are, and then acting like you know this to be true!

 

What motivates you to change?
Take a moment and write down what it is that you want to do with you life—that you will
not be able to do if you keep using.
________________________________________________________
________________________________________________________

Making a decision and a plan:
Now write down five small things that you can do to start to work towards making your
life into the kind of life you really want and “deserve” to life. 

_______________________________________________________________________
_______________________________________________________________________

Common Personality Traits of those who Relapse
(Ciauzzi, 1990, 1991)

1. Personality Traits: Such relapse-prone personality traits include:

  • Compulsivity – such individuals do not adjust well to changes in routine.
  • Dependency – such individuals may have trouble asserting their wish to maintain a recovery program in the face of peer pressure or opportunities to use alcohol or drugs.
  • Passive-aggressive – where the individual may have a tendency to blame others for their own behavior.
  • Narcissistic – where individuals may have difficulty admitting they need help.
  • Antisocial – where individuals may have an internal desire to rebel against what they view is the common path taken by others.

2. Substitute Addictions: Where individuals may simply substitute another drug or a behavioral addiction as their central activity. For example, a person substituting methamphetamine for cocaine, or Doctor prescribed medication for alcohol.

3. Having a Narrow View of Recovery: For example equating abstinence with recovery. “I am not drinking, therefore I am recovered, or because I was able to quit – that means that I was not really addicted.” Such people are at risk because they are not actively working to change the personality structure or interpersonal problems that contributed to the development of the addiction in the first place.

4. Unable to seem the Warning Signs or recognize the Minidecisions that contribute to relapse: Through a series of seemingly irrelevant decisions the newly recovering individuals will often place themselves in a high risk situation without being aware of more than the last decision in a chain of choices that ultimately results in relapse. A common minidecisions might be to attend a support group less frequently, or not to call a supportive person when upset. 

5. Maladaptive Thoughts “Stinking Thinking”:
These are the “mind-games” individuals play with themselves. Examples might be:

  •   “I deserve to be able to ___ after how ____ treated me!”
  •   “I am just testing to see if I can handle it.”
  •   “Just one won’t hurt.”
  •   “All my friends are still _____, so why can’t I. It’s not fair!”

First Relapse Prevention Plan

  • I’m tired, I’m scared, I’m all alone. —  Come with me friend, I will show you my home.
  • I’m a druggie, I’m addicted, I want to be free.  —  Come with me friend, there is something you need to see.
  • I can’t, I don’t want to, I need to get high.  —  Please, I am here for you, I don’t want you to die.
  • Why do you care? Who are you really?  What can you give?  —  I am you, you are me, and I want us to live!
  • I’m in trouble, It doesn’t matter, Who cares about me?  —  I do, let me help you I am RECOVERY!

Relapse Plan: Are you ready for the Real World?

Hey, you planned when you wanted to USE drugs. Knew exactly where, when, how and how much you needed for the day or the weekend! It is just as important now that you PLAN to stay clean. The following outline will help you to determine your plan of action.  Put careful thought into it; you want as much as possible going for you in maintaining your cool…

My first Relapse Prevention Plan

1. Name three people you can talk to if you get the urge to get stoned or loaded:

First Choice: ____________________________

Second Choice: __________________________

Third Choice: ___________________________

2. Now, talk to these people ahead of time – as soon as possible – and make sure you can call them when you need to! Your healthy future may depend upon it.

3. What three things can you do instead of using?

First Choice: ___________________________

Second Choice: _________________________

Third Choice: __________________________

4. Name three ways you can reward yourself for not using.

First Choice: ___________________________

Second Choice: _________________________

Third Choice: __________________________

5. Write down three things that trigger your wanting to use; and write down what you can do to take your mind off each of the triggers, or what you can do to keep
yourself busy so that you do not go out and use.

Worst Trigger: _____________________________

Preventative Action: _________________________

Other Trigger: _____________________________

Preventative Action: _________________________

Other Trigger: _____________________________

Preventative Action: _________________________

6. What are your worst fears about old situations that you associate with using?

7. What is your best reason to live a clean and sober life?

8. Remember, relapse is a common occurrence. Sometimes success can only be measured in baby steps. If you go out and use again – Don’t give up on yourself.  When you sober up… figure out what triggered you to drink or use, and make a plan to prevent it from happening any more. What have you learned from past relapses?

9. Maybe you think you can go out and drink or use drugs again and that it is: No  Big Deal – You Can Handle it! Well, only you can determine if your substance use is truly a problem for you. Be honest with yourself. Living healthy is hard work, but you are worth it!

When you decided to quit drinking, using other drugs or gambling, you took the first step towards recovery. This step was the beginning of an important change in your life.  You may have expected all your problems to go away when you quit, but somehow many problems are still with you. Recovery is building a new life, and like any major change it takes time. It also involves mixed feelings. One moment you can feel good about the new possibilities, and the next you can feel sad to leave old friends and habits behind. It can be confusing. It can even make you doubt your commitment to this new direction that you know in your heart is right for you.  A technique called Relapse Prevention Planning can help. In fact, it can make all the difference in the world. By thinking ahead, and by working out ways to handle the pressures that might lead you back to your drinking, drug use or gambling, you can approach your new life with a greater sense of confidence.

Relapse Prevention Planning is planning for success!
Relapse Prevention Planning is based on the experiences and successes of many people just like you who have already traveled the road to recovery. It recognizes that the road often has many rough patches, and that to succeed on this road you will need a relapse prevention plan.

Your Goal is Recovery
Your use of alcohol, drugs or gambling probably caused you many problems – at home, at work, with the law. Still, you may have been afraid to face everyday life without them.  That is why your decision to stop was so difficult and important. Recovery involves finding new ways of taking care of your self, and new ways of acting with friends, with family, and at work. It also involves avoiding relapse—falling back into your habits of using alcohol, drugs or gambling to deal with problems and stress.  You can stay in control by setting goals in important areas of your life and by working towards these goals. You will need to plan to achieve your goals in each of your major life areas such as: your physical and emotional health, your relationships, your job, your
recreation and the things you do for relaxation. Reaching these goals is a matter of making it happen rather than just wishing it might happen. It is a matter of creating a set of plans for yourself to deal with situations that may interfere with your recovery.  Old ways of behaving need to be replaced with new carefully planned actions.  As is often said: “Doing the same old thing and expecting different results is insanity.”  So, decide here and now that you are going to learn how to do “new things” and to put the effort into every aspect of making your “new habits” a reality. Decide to be the “new you”. Can you do this? Yes, of course you can. Now go out and make it happen!

What Is Relapse?
Relapse is a process that begins when you start slipping back into old behaviour patterns.  A relapse begins long before you take your first drink, drug or gamble. Some things that can lead to relapse include:
• Feeling that you have the problem under control and taking a chance to use or gamble again.
• Not working out stresses and problems at home, work or school, and when these build up or a crisis happens, you go back using or gambling.
• Not dealing with stresses such as problems with your finances, with your health, or with the legal system.
• Not handling negative feelings such as boredom, loneliness or anger.
• Giving in to cravings or urges to use or gamble.
• When under stress you don’t see any other way to cope other than to use or gamble. Not working on your recovery plan (e.g. not going to self-help meetings).

To Avoid Relapse:
1. Handle day-to-day feelings and problems as they happen. Your plans should involve handling feelings and problems as they happen. This way, pressure and stress do not build up. The stress you may already feel will only get worse if you put off dealing with problems with family, friends or work.

2. Keep your life in balance… A way to reduce stress. It is important to find ways to balance work and relaxation. Having fun with family or friends, without including alcohol, drugs or gambling, can be challenging. Be kind to yourself. Give yourself simple rewards that give you pleasure – a walk, time with a hobby, a chance to read a book. Writing out a plan for your day may help you find a balanced routine. Fill in free time with a variety of activities. Try a few new ones; you will find some you enjoy. What you eat can affect how well you cope with pressure. Lots of good basic foods like fruit, vegetables, cheese, whole grain cereals and breads, fish, and meat help cut down stress. Food rich in B vitamins helps to reduce craving for alcohol and to keep stress manageable. Caffeine (coffee, soft drinks), nicotine (cigarettes, cigars) and too much sugar can make you tense.

3. Gain support and trust. Family, friends, your boss, a co-worker, a support group or a counselor can talk with you about the pressures you are feeling in recovery. They can watch with you for the warning signs of relapse and help you handle the stress. Let them know your goals and your plans so that they can help you out.

4. Identify and plan for high-risk situations. Everyone faces high-risk situations at some time – you will find yourself in situations where you are more likely to drink, use drugs or gamble. These situations can be handled more easily if you know ahead of time what they will be. Have at least three ways to handle them, so that if one does not work, you do not give up. Practice what you will do or say, so you do not worry about what to do under pressure. You can stay confident and in control.

You have come a long way in recognizing that your use of drugs or alcohol has caused some major consequences in your life. You may not even be reading this right now if it wasn’t for the fact that you did something that had a big impact on your own life or people you care about. You have probably hurt some pretty important people in your life; but most important, continued use will continue to hurt you!

Recovery does not just Happen
Congratulations on getting through the “dry” time if you are reading this in a clean and sober state. Just getting clean even for a short time, may have been hard for you. Now
that you are clean and facing the consequences of your behaviour, it is easy to feel that you will never go back to your old “habits” and that you will be able to avoid further
problems. You may think that you can get your girl (wife) or boyfriend (husband), or partner back, get a great-paying job and get on with your life. I wish with all my heart
that things really will go well for you in the future. Unfortunately real progress and recovery often take hard work and that is where the information on Addicts Helping Addicts can really help!

Wishing or Hard Work?
But wishing hasn’t been proven to be overly effective. I’ve wished for the lottery for quite some time but still end up at work every day! How can you help yourself to avoid
“relapse”, that is a return to drugs and alcohol, even when you know that “$hit will happen” if you do so? I’m going to try to help you to understand the relapse process,
because sometimes, just by knowing what to look out for can help you avoid the inevitable. You’re going to need to do some work with me, but I know you are worth
saving.

Relapse Prevention Planning
It doesn’t matter how long you have been sober, you need to make relapse prevention planning a part of your recovery. You might still be in recovery, still thinking that you
can just control your use, especially after you haven’t been around the stuff for some time. It seems like it would be easy to say “No thanks, I’ll pass”. Well, you might find
very soon that: You do not control the drug, the drug controls you.

Relapse is a Process
Relapse is a process of returning to the use of alcohol and other drugs after a period of abstinence. You are actually in a state of relapse before you even succumb to actually drinking, smoking, popping or shooting up your drug of choice. There are clues, or warning signs that relate to your behaviour, attitudes, feelings, thoughts or combination of these. You should be “on the alert” when changes occur with you to examine whether or not these are indications that you are headed for a relapse.

Clues that a Relapse is about to Happen
Let’s take a look at these clues:

1. Behaviour Changes: Increased episodes of arguing with others for no apparent reasons; decreasing or stopping support group meetings; socializing in places where drugs and alcohol are being used by others; increased stress symptoms such as smoking more cigarettes or eating more than usual.

2. Attitude Changes: Not caring about being “sober”, not caring about what’s happening in your life, being very negative about life and how things are going.  Being very critical of others who use drugs or alcohol.

3. Changes in Feelings or Moods: Increased moodiness or depression; strong feelings of anger at oneself or another; increased feeling of boredom; or sudden feelings of euphoria (feeling “on top of the world”).

4. Changes in Thoughts: Thinking alcohol or drugs are “deserved” because you have given them up for so long; thinking it wouldn’t be harmful to substitute one drug for another; thinking that your alcohol or drug problem has been “cured” and that you can “control” it now!

These are just a few examples, which may or may not relate to you. The important thing to be aware of the changes you notice in your behavior, feelings, attitudes thoughts. They could indicate that your relapse process is set in motion. The attached recovery worksheets are provided for you to remind you of the advantages and disadvantages of your own drug use and to look at designing an individualized plan to help you deal with relapse struggles. Please be as honest as possible with yourself in doing these exercises.

If you are trying to obtain long-term sobriety and avoid having a relapse along the way, it is important to recognize the following warning signs and take action to keep them from progressing into a full-blown relapse.

11 Steps to a Relapse

Change in Attitude – For some reason you decide that participating in your recovery program is just not as important as it was. You may begin to return to what some call “stinking thinking” or unhealthy or addictive thinking. Basically, you are not working your program as you did previously. You feel something is wrong, but can’t identify exactly what it is.

Elevated Stress – An increase in stress in your life can be due to a major change in circumstances or just little things building up. Returning to the “real world” after a stint in residential treatment can present many stressful situations. The danger is if you begin over-reacting to those situations. Be careful if you begin to have mood swings and exaggerated positive or negative feelings.

Reactivation of Denial – This is not denial that you have a drug or alcohol problem, it’s denial that the stress is getting to you. You try to convince yourself that everything is OK, but it’s not. You may be scared or worried, but you dismiss those feelings and you stop sharing those feelings with others. This is dangerous because this denial is very similar to denial of drug addiction or abuse.

Recurrence of Postacute Withdrawal Symptoms - Anxiety, depression, sleeplessness and memory loss can continue long after you quit drinking or doing drugs. Known as postacute withdrawal symptoms these symptoms can return during times of stress. They are dangerous because you may be tempted to self-medicate them with alcohol or drugs.

Behavior Change – You may begin to change the daily routine that you developed in early sobriety that helped you replace your compulsive behaviors with healthy alternatives. You might begin to practice avoidance or become defensive in situations that call for an honest evaluation of your behavior. You could begin using poor judgment and causing yourself problems due to impulsive behavior without thinking things through.

Social Breakdown – You may begin feeling uncomfortable around others and making excuses not to socialize. You stop hanging around sober friends or you withdraw from family members. You stop going to your support group meetings or you cut way back on the number of meetings you attend. You begin to isolate yourself.

Loss of Structure – You begin to completely abandon the daily routine or schedule that you developed in early sobriety. You may begin sleeping late, or ignoring personal hygiene or skipping meals. You stop making constructive plans and when the plans you do make don’t work out, you overreact. You begin focusing on one small part of life to the exclusion of everything else.

Loss of Judgment – You begin to have trouble making decisions or you make unhealthy decisions. You may experience difficulty in managing your feelings and emotions. It may be hard to think clearly and you become confused easily. You may feel overwhelmed for no apparent reason or not being able to relax. You may become annoyed or angry easily.

Loss of Control – You make irrational choices and are unable to interrupt or alter those choices. You begin to actively cut off people who can help you. You begin to think that you can return to social drinking and recreational drug use and you can control it. You may begin to believe there is no hope. You lose confidence in your ability to manage your life.

Loss of Options – You begin to limit your options. You stop attending all meetings with counselors and your support groups and discontinue any pharmacotherapy treatments. You may feel loneliness, frustration, anger, resentment and tension. You might feel helpless and desperate. You come to believe that there are only three ways out: insanity, suicide, or self-medication with alcohol or drugs.

Relapse – You attempt controlled, “social” or short-term alcohol or drug use, but you are disappointed at the results and immediately experience shame and guilt. You quickly lose control and your alcohol and drug use spirals further out of control. This causes you increasing problems with relationships, jobs, money, mental and physical health. You need help getting sober again.

Relapse Is Preventable
Relapse following treatment for drug and alcohol addiction is common and predictable, but it is also preventable. Knowing the warning signs and steps that lead up to a relapse can help you make healthy choices and take alternative action.  If a relapse does happen, it is not the end of the world. If it happens, it is important that you get back up, dust yourself off and get back on the path to recovery.

Sources:
National Institute on Drug Abuse. “Principles of Drug Addiction Treatment: A Research Based Guide.” Revised 2007.
National Institute on Drug Abuse. “An Individual Drug Counseling Approach to Treat Cocaine Addiction: The Collaborative Cocaine Treatment Study Model.” Accessed May 2009.
Miller, WR, et al. “A Simple Scale of Gorski’s Warning Signs for Relapse.” Journal of Studies on Alcohol. 1 September 2000.

Developing a Relapse Prevention Plan

An option for an addict in recovery is to develop a relapse prevention plan to help them stay on track towards their ultimate goal of life long sobriety.  This prevention plan consists  of the 4 steps which are discussed below!

Step 1: Stabilization

The first step is obviously  for the addict to detox and have a few days of sobriety in order to clear their head and be able to make a conscious and educated decision on how they want to proceed in their quest to attain a sober and happy life.  During the beginning stages of recovery it is vital to go slow and focus on short term goals as opposed to the long term goals which can be discussed and concentrated on later on in the recovery process as to not overwhelm or deter the addict from achieving lifelong sobriety.  It is vital to focus on the present and what the addict needs to maintain their sobrity, wether it be on day at a time or just one hour at a time, the longterm can be focused on eventually,  once they have some sober time under their belt and are more confident in themselves and their ability to achieve lifelong sobriety.

Step 2: Assessment

The assessment of the addict and their past behavior is vital in order to prevent future relapses.  One must take an assessment or “inventory” of their past relapses including their behavior, thoughts, feelings and the pain associated with their life and drug abuse which lead up to past relapses so they are able to recognize these past problems.  Once you are able to recognize the behaviors and feelings your were having  which lead to a relapse, you will be able to see these problems coming up and act accordingly so they do not lead to another relapse.

 One must assess and reconstruct:
• Presenting problems
• Life history
• Alcohol and drug use history
• Recovery relapse history

Reconstructing the presenting problems, or the addicts here and now issues is extremely important because these are the issues which ultimately pose an immediate threat to the addicts sobriety.  Once they are identified and recognized, the crisis plans that were developed can be immediately implemented to resolve the issues and stop a potential relapse.

The life history will explore each developmental life period including childhood, grammar school, high school, college, military, adult work history, adult friendship history and intimate relationship history.  Reviewing the addicts life history is important in that it can bring to the surface any unresolved and painful memories which could ultimately be hindering the addict from reaching and maintaining sobriety.   It is important the addict has someone they feel safe talking with about these memories and they must go slow and discuss all the feelings that accompany these memories.

Step 2(A): Detailed Review of Alcohol & Drug History

After the life history is reviewed, a detailed alcohol and drug use history needs to be constructed.  In order to do this effectively, the addict must review each life period (which were listed above) and ask four questions for each of these periods:

1. How much alcohol or drugs did you use?
2. How often did you use it?
3. What did you want alcohol and drug use to accomplish?
4. What were the real consequences, positive and negative, of your use?

This part of the processes is asking the addict if the alcohol and drugs did for them what they wanted them to do for them or accomplish for them during each period of their life.

Step 2(B): Creation of Alcohol & Drug History

Lastly, a history of the addicts recovery and relapses is constructed.   The addict must start with the first serious attempt at sobriety each period of chemical use and each period of abstinence needs to be carefully explored.  The main goal of this part of the assessment is to find out what happened during each period of sobriety or abstinence which ultimately lead to relapse for the addict.  This may be difficult for the addict because during times of relapse, the addict is preoccupies with their drinking or drug use and try to avoid thinking or talking about what happened during these periods of sobriety.

Comprehensive assessments have shown that most addicts who have relapse problems are relapsing because they encounter the same recurring pattern of problems and use those problems in order to justify their next relapse.  A very informative quote states ” it is not one things after the other, it is the same thing over and over again!”

Step 3: Relapse Education

Relapse education is vital for a recovering addict, as well as for the family and close friends and loved ones of the addict.  It is very important for the family to be involved in the recovery and continued success of their loved one, as well as a sponsor if the addict has chosen to use a twelve step recovery program.  The relapse education needs to reinforce four major messages:

1. Relapse is a normal and natural par of the recovery process from chemical dependence.  There is nothing to be ashamed about if the recovering addict does relapse.
2. People are not suddenly taken drunk.  There are progressive patterns of warning signs that set the addict up to use again.  These warning signs can be recognized during times of sobriety.
3. Once these pattern’s and warning signs are identified, recovering people can learn to manage the relapse warning signs while sober.
4. One must remember there is HOPE.  A new counseling procedure called relapse prevention therapy can teach recovering addicts how to recognize and manage these warning signs so they are able to take the necessary steps to stop a relapse before it happens so a return to substance use and abuse becomes unnecessary.

Step 4: Warning Sign Identification

Substance abusers who have a history of relapse need to identify the problems which caused or contributed to their previous relapses.  A major goal of developing a relapse plan is to write a list of personal warning signs that the addict has become aware of which lead them from a stable recovery, back to substance abuse or a relapse.

For the most part, there is not just one warning sign which can be identified by the addicted or those close to the addict that will show the potential for a possible relapse, rather there is usually a series of warning signs which build on top of each other and eventually lead to the relapse of the recovering addict.  For many addicts, it is the cumulative affect that will wear them down to their breaking point, which will lead to a relapse.  The final warning sign is usually just the addicts breaking point, not the pure casue of the relapse.  This issue may hinder an addict from recognizing all the other warning signs which lead up to their relapse because they are so focused on the final problem they encountered before their relapse.

When an addict is in recovery they must identify all the warning signs of a relapse.  This list of warning signs will outline for the addict the typical sequence of problems that lead them from a state of recovery back to alcohol and drug abuse. By understanding and discussing these warning signs, the addict can learn a new way of thinking about and a new way of dealing with the things that happened during their past periods of sobriety which lead to a relapse so these same issues will not set them up to use again once sobriety is attained again.  Phases and warning signs of relapse are outlined below:

 

THE PHASES AND WARNIGN SIGNS OF RELAPSE
By: Terence Gorski

RETURN OF DENIAL: During this phase the dependent person becomes unable to recognize and honestly tell others what he or she is thinking or feeling. The most common symptoms are:
1. Concern about well being.
2. Denial of the concern.

AVOIDANCE AND DEFENSIVE BEHAVIOR: During this phase the dependent person doesn’t want to think about anything that will cause painful and uncomfortable feelings to come back. As a result, he or she begins to avoid anything or anybody that will force an honest look at self. When asked direct questions about well-being, he or she begins to become defensive. The most common symptoms are:
1. Believing “I’ll never drink again.”
2. Worrying about others instead of self.
3. Defensiveness.
4. Compulsive behavior.
5. Impulsive behavior.
6. Tendencies toward loneliness.

CRISIS BUILDING: During this phase the dependent person begins experiencing a sequence of life problems that are caused by denying personal feelings, isolating self, and neglecting the re-covery program. Even though he or she wants to solve these problems and work hard at it, two new problems pop up to replace every problem that is solved. The most common symptoms are:
1. Tunnel vision.
2. Minor depression.
3. Loss of constructive planning.
4. Plans begin to fail.

IMMOBILIZATION: During this phase the dependent person is totally unable to initiate action. He or she goes through the motions of living, but is controlled by life rather than controlling life. The most common symptoms are:
1. Daydreaming and wishful thinking.
3. Feeling that nothing can be solved.
3. Immature wish to be happy.

CONFUSION AND OVERREACTION: During this phase the dependent person can’t think clearly. He or she becomes upset with self and those around her or him and is irritable and overreacts to small things.
1. Periods of confusion.
2. Irritation with friends.
3. Easily angered.

DEPRESSION: during this phase the dependent person becomes so depressed that he or she has difficulty keeping to normal routines. At times there may be thoughts of suicide, drinking, or drug use as a way to end the depression. The depression is severe and persistent and cannot be easily ignored or hidden from others. The most common symptoms are:
1. Irregular eating habits.
2. Lack of desire to take action.
3. Irregular sleeping habits.
4. Loss of daily structure.
5. Periods of deep depression.

BEHAVIORAL LOSS OF CONTROL: During this phase the dependent person becomes unable to control or regulate personal behavior and daily schedule. There is still heavy denial and no full awareness of being out of control. His or her life becomes chaotic and many problems are created in all areas of life and recovery. The most common symptoms are:
1. Irregular attendance at AA and treatment meetings.
2. Development of an “I don’t care attitude.”
3. Open rejection of help.
4. Dissatisfaction with life.
5. Feeling of powerlessness and helplessness.

RECOGNITION OF LOSS CONTROL: The dependent person’s denial breaks and suddenly he or she recognizes how severe the problems are, how unmanageable life has become, and how little power and control he or she has to solve any of the problems. This awareness is extremely painful and frightening. By this time he or she has become so isolated that it seems that there is no one to turn to for help. The most common symptoms are:
1. Self-pity.
2. Thoughts of social drinking.
3. Conscious lying.
4. Complete loss of self-confidence.

OPTION REDUCTION: During this phase the dependent person feels trapped by the pain and inability to manage his or her life. There seem to be only three ways out–insanity, suicide, or drug use. This person no longer believes that anyone or anything can help him. The most common symptoms are:
1. Unreasonable resentment.
2. Discontinues all treatment and AA.
3. Overwhelming loneliness, frustration, anger and tension.
4. Loss of behavioral control.

THE RELAPSE EPISODE: During this phase the dependent person begins to use alcohol or drugs again, typically struggling to control or regain abstinence. This struggle leads to shame and guilt when the attempt ultimately fails. Eventually all control is gone and serious bio-psycho-social problems develop and continue to progress. The most common symptoms are:
1. Initial use (the lapse).
2. Shame and guilt.
3. Helplessness and hopelessness.
4. Complete loss of control.
5. Bio-psycho-social damage.

After learning and developing the tools to identify warning signs as they come up in the addicts life, we are then able to guide ourselves through the process of dealing with these warning signs appropriately and not let our lives get so out of control that we once again abandon recovery for our drug of choice.

Relapse is a process that begins when you start slipping back into old behaviour patterns.  A relapse begins long before you take your first drink, drug or gamble. Some things that can lead to relapse include:

• Feeling that you have the problem under control and taking a chance to use or gamble again
• Not working out stresses and problems at home, work or school, and when these build up or a crisis happens, you go back using or gambling
• Not dealing with stresses such as problems with your finances, with your health, or with the legal system
• Not handling negative feelings such as boredom, loneliness or anger
• Giving in to cravings or urges to use or gamble
• when under stress you don’t see any other way to cope other than to use or gamble
• Not working on your recovery plan or letting it slide (e.g. not going to selfhelp meetings)

To avoid Relapse:

1. Handle day-to-day feelings and problems as they happen. Your plans should involve handling feelings and problems as they happen. This way, pressure and stress do not build up. The stress you may already feel will only get worse if you put off dealing with problems with family, friends or work.

2. Keep your life in balance… a way to reduce stress. It is important to find ways to balance work and relaxation. Having fun with family or friends, without including alcohol, drugs or gambling, can be challenging. Be kind to yourself. Give yourself simple rewards that give you pleasure – a walk, time with a hobby, a chance to read a book.  Writing out a plan for your day may help you find a alanced routine. Fill in free time with a variety of activities. Try a few new ones; you will find some you enjoy. What you eat can affect how well you cope with pressure. Lots of good basic foods like fruit, vegetables, cheese, whole grain cereals and breads, fish, and meat help cut down stress.  Food rich in B vitamins helps to reduce craving for alcohol and to keep stress manageable. Caffeine (coffee, soft drinks), nicotine (cigarettes, cigars) and too much sugar can make you tense.

3. Gain support and trust. Family, friends, your boss, a co-worker, a support group or a counselor can talk with you about the pressures you are feeling in recovery. They can watch with you for the warning signs of relapse and help you handle the stress. Let them know your goals and your plans so that they can help you out.

4. Identify and plan for high-risk situations. Everyone faces high-risk situations at some time – you will find yourself in situations where you are more likely to drink, use drugs or gamble. These situations can be handled more easily if you know ahead of time what they will be. Have at least three ways to handle them, so that if one does not work, you do not give up. Practice what you will do or say, so you do not worry about what to do under pressure. You can stay confident and in control.  Here is an example: At a dinner party with friends, alcohol is served. You want to relax
and enjoy yourself, but you do not want to drink.

With relapse prevention plans, you might:

• Carry a non-alcoholic drink with you to avoid being pressed to drink alcohol.
• Have an answer ready, such as:
• “No thanks, I don’t drink anymore.”
• “No thanks, I’m driving.”
• “No thanks, I’m on a diet.”
• “No thanks, I’m an alcoholic.”
• Agree with your spouse ahead of time that you will leave if you feel uncomfortable.

Abstinence: The Feeling

What Feelings Do You Have About Abstinence?
Emotions I have had in the first few months after stopping drinking/using drugs or gambling:

What Are the Advantages and Disadvantages of:
• Using alcohol/drugs or gambling:
• Not using alcohol/drugs or gambling:

Can you identify with these statements?  In the beginning, abstinence:
• is confusing and disorienting,
• is nothing like the way I believed it would be,
• can be lonely and overwhelming.

These negative feelings are usually worse when a person is under stress or is tired. The symptoms gradually go away. Because there is confusion and fear in the first few months, people are more likely to relapse. These are uncomfortable feelings, and it’s hard to resist taking the easy way to get out of dealing with them: a drink, drugs, or a bet. To help you “wait it out” you can:
• Talk about it
• Get plenty of sleep
• Eat well, exercise regularly
• Actively reduce stress

The following information can help you recognize stress in your life and suggests ways to
help reduce that stress.

Managing Your Stress
Stress is a common part of everyone’s life. We deal with most of our stressful experiences successfully. It’s the small percentage that we have difficulty managing that causes problems. Because stress is a part of life, it makes sense to develop a variety of ways of handling it. There are many ways – the following are some basic, common sense methods:

• Organize yourself. Take better control of the ways you’re spending your time and energy.
• Control what and who is surrounding you. Stay away from people who cause you to doubt your decisions.
• Develop a supportive network of caring people around you. Feeling alone or apart from others builds stress. Being in touch and talking to others reduces it.  Family, friends and self-help sponsors can help.
• Build up your strength. If you’re in good physical condition, you’ll be better able to stand up against your stress.
• Find ways to laugh each day. Laughter is one of the purest and most total releases of tension.
• Learn to relax. Do something relaxing for 20 minutes each day. You will think more clearly and will be better prepared for decision-making.

Managing Your Cravings
When you quit using alcohol, drugs or gambling, you are likely to experience cravings.  Cravings are a normal part of recovery. They will lessen over time. Cravings may be stronger in high-risk  situations. An important part of relapse prevention is learning how to cope with these urges. One way to minimize these temptations is to focus on specific actions or thoughts in dealing with them. Examples of specific actions might include:

• Talking to someone who understands, carry a list of phone numbers of people you can call,
• Writing down your thoughts,
• Distracting yourself, do for a walk, work out, clean the house,
• Removing yourself from the situation,
• Trying relaxation techniques,
• Keeping a record of how you have coped in the past.

Examples of thoughts that might be helpful include:
• Thinking of the negative consequences of using/gambling (remembering how bad things were when you were using),
• Thinking of the reasons why you do not want to use/gamble any more,
• Reminding yourself that cravings are a normal part of recovery,
• Visualizing the craving as a wave that you are simply going to ride out
• using positive self-talk or picturing a STOP sign in your mind.

Resources:
Because stress affects the whole person, good stress management skills allow you to manage all parts of your life. The following list is things you can do to help keep stress under control:

  • • Get Physical: Build up your strength and stamina.
  • • Relax: Develop a list of activities you find relaxing and do them regularly.
  • • Eat Well: Eat good basic foods such as whole grain cereals and breads, fish, meat, fruits and vegetables. Avoid too much caffeine (coffee, soft drinks), nicotine (cigarettes and cigars), and sugar.
  • • Take Care of YOU: Treat yourself kindly. Don’t push beyond your limits.
  • • Exercise: Learn to get the benefits of regular exercise.
  • • Use Your Mental Skills: Use your mind to help cope with stress more effectively.
  • • Manage Your Time Well: Pause to think about what is really important and give time to those things.
  • • Organize: Seek order. Don’t let things pile up.
  • • Problem Solve: Address issues as they come up. Don’t hesitate to ask others to help.
  • • Build a Support Network: Develop a network of resources and people that you can count on.
  • • Use Family and Friends for Support: Your family and friends may help you solve problems and reduce stress.
  • • Keep Life in Balance: Make sure you set aside time for home as well as work commitments.
  • • Enjoy Time with Others: Spend time with those you care about, doing things that everyone enjoys.
  • • Settle Conflicts: Look for solutions where all sides win.
  • • Getting Along with Others: It’s important to build relationships that will help you in dealing with stress in your life.
  • • Try New Things: Discovering healthy new ways to have fun is a great way to reduce your tension level. Try new recreational activities and find new hobbies.
  • • Stay Open to Change: Try new approaches.
  • • Believe in Yourself: Trust others. Share and show feelings. Share your burdens with your family and friends. Be direct about your wants, needs, and feelings.
  • • Learning: Take a class. Exercise your mind.
  • • Enjoy Music: Play an instrument. Join a choir.
  • • Work: Volunteer for something worthwhile.
  • • Get Away: Spend more time alone.
  • • Play: Go out with a friend.

The easiest way to add to your methods for handling stress is to develop one new habit at a time. Remember you have the power and ability to decide to deal with stress.

Personal Stress Management Plan
You may want to draw from the stress management ideas outlined below when developing your own Stress Management Plan.

1. Maintain a Healthy Stress Level:
While some stress is good – it pushes us to learn and grow – too much can be dangerous to your health. The trick is establishing a healthy level of stress and maintaining that level. Identify the kinds of stress in your life.

2. Deal with pressure:
Stress is not pressure from the outside, as some people think. It’s the physical reaction within your body that prepares you to meet that pressure – and to fight back.
• What is causing you trouble?
• Analyze the area of pain – where is it coming from?
• Who is involved?
• What are you doing that contributes to the problem?
• How can you minimize or get rid of it?

3. Identify your Values and Goals:
• Define your goals – specifically, what do you want to change and when?
• Assess the importance of each goal.
• Identify blocks to goal achievement.
• Identify risks and/or consequences of each action.
• Are others involved? Can others help?

4. Have a Plan of action:
• Establish specific steps to reach your goals.
• Identify resources that can help you.
• Assess your progress – set a date to evaluate your success.
• Make an alternate plan if needed.
• Take time to reflect on your success – what have you learned?
• Can it work for you in other ways?

Are These High-risk Situations for You?
High-risk situations are those situations where you are most likely to relapse. Check off the danger areas that apply to you:

• when I pass a pub, lounge or place I used to gamble,
• when I’m with others who are drinking, using drugs or gambling,
• when I feel no one really cares what happens to me,
• when I have to meet people
• when I feel depressed when there are problems at work,
• when I feel I am being punished unjustly,
• When I feel afraid
• When I’m on holidays
• When I feel happy with everything
• When I have money to spend
• When I remember the good times when I was drinking, using drugs or gambling
• When there are hassles and arguments
• When feel resentful
• When I feel irritable or tired
• When I’m at a party
• When I start thinking I am not really hooked on alcohol, drugs or gambling
• When I feel myself getting very angry
• When there are special occasions like Christmas, birthdays, etc.
• When I start feeling frustrated and fed up with life
• When I feel disappointed that other people are letting me down
• When I feel lonely or bored
• When I feel pressured by debt or lack of money
• When I remember the excitement of a “big win” or a “great high”

The following are major reasons for relapse:
• Not handling negative feelings such as boredom, loneliness, anger,
• Difficulty in handling social pressures to drink, use drugs or gamble, or just being around people who are engaging in those behaviours,
• Not resolving conflicts with others,
• Having urges or temptations to use alcohol, drugs or gamble,
• Difficulty in handling positive feelings,
• Problems dealing with withdrawal symptoms or health conditions,
• Testing to see if drinking, drug use or gambling can be controlled,
• Not keeping life in balance (not eating well, not sleeping regularly, not keeping active, spending too much time at work).

When Do Relapses Occur?
Consider the following information:
Approximately 2/3 of all relapses for any addiction (alcohol, drugs, gambling, smoking, diets) occur within the first 90 days. The reasons for relapse are the same whether the addiction is to alcohol, other drugs or gambling. During the first 90 days after withdrawing from alcohol, drugs or gambling people may experience some periods of
poor memory or concentration, or they may overreact to stress. This may lead to relapse.  The longer a person is abstinent, the better these things will get, but handling stress as it comes up is an important way to prevent relapse. Not coping with stress is a major reason for relapse.

Recognize the Danger Signals!
A return to alcohol, drug use or gambling does not just happen. There is a process leading to the return. When you begin to backslide or “slip,” you go through changes that could lead to a possible relapse. Some of the danger signals might be:

• You begin to isolate yourself from others and feel bored and lonely much of the time.
• You find yourself easily irritated and relationships become strained.
• You doubt your ability to stay abstinent.
• You act impulsively under stress, which causes even more stress.
• You think you will never use alcohol, drugs or gambling again, so you don’t need a recovery program – you don’t attend support groups or counseling, and you reject offers of help.
• You try to impose abstinence on others.
• Your eating and sleeping patterns are disturbed and you cannot get things done.
• You cover up your feelings of unhappiness and helplessness.
• You frequently feel sorry for yourself.
• You begin to think that you can handle alcohol, drugs or gambling again and it will help you feel more at ease.

There are also other danger signals. What are yours?

A. Figure out the high-risk situations that might lead you to start drinking, using drugs or gambling.

  • What days are you most likely to start to drink, use drugs or gamble?
  • What times of the day are you most likely to start drinking, using drugs or gambling?
  • In what locations are you most likely to start to drink, use drugs or gamble?
  • Who are you most likely to start drinking, using drugs or gambling with?
  • What moods or feelings are most likely to lead you to start drinking, using drugs or gambling?
  • What positive things do drinking, using drugs or gambling do for you?

a. List some high-risk situations that may result from the above.

Creating a Plan to Deal with High Risk Situations:

B. For each high-risk situation, think of three things you can do to handle the situation so you won’t start to drink, use drugs or gamble to feel good. Here is an example high-risk situation – Staff party where there will be drinking.

• Plan 1. Order a non-alcoholic drink before joining the group.
• Plan 2. Arrange to leave the party early.
• Plan 3. Have three responses ready for when you are asked if you want a drink.

Handling Relapse
Sometimes you just cannot control everything in your life, or handle every situation the way you plan to. There is a possibility that you might relapse and start drinking, using drugs or gambling again.  Think about how you would feel if you relapsed. Some people have overwhelming feelings of guilt, anger, shame, or fear. These feelings could drive you to continue to use or gamble after a slip. How would you deal with a relapse? It is important that you do not give up. You have other choices.  There are ways you can regain control and prevent a slip from becoming a full relapse. If you relapse, you could talk to a counselor or friend about it. You can learn from the situation and find different ways of handling the pressures that led to the relapse.  If you use a relapse as a learning opportunity rather than viewing it as a failure,  you can prevent it from happening again.  Plan to stop a slip from becoming a relapse. Don’t let a slip be an excuse to keep on drinking, using drugs or gambling.

1. Figure out how you feel about relapse ahead of time. Record your feelings.
2. Figure out the best way for you to handle those feelings and how you would stop drinking, using drugs or gambling.

Record your ideas.  Relapse Prevention Is Important Now
The first months after you stop drinking, using or gambling are filled with change and unfamiliar feelings. Withdrawal causes feelings of confusion and tension, which may
leave you feeling incapable of handling problems. Throughout your recovery you will be faced with many situations that will be difficult to deal with. This is why it is important to make a Relapse Prevention Plan now. You can successfully negotiate the road to recovery. Planning for a flat tire or a thunderstorm does not decrease the chance of either happening, but if it should happen, you’ll be ready! You are vulnerable. Protect and care for yourself.

• Deal with your problems and feelings as they come up.
• Build a balance in your daily routine to reduce stress.
• Talk to friends, family or a professional counselor. Let them help.
• Think through ways to handle high-risk situations.
• Plan and work for success!
The Journey is the Destination!

Common Signs & Symptoms of Upcoming Relapse

Experiencing Post Acute Withdrawal:
I start having problems with one or more of the following; thinking difficulties, emotional overreaction problems, sleep disturbances, memory difficulties, becoming accident prone, and/or starting to experience a serious sensitivity to stress.

Return To Denial: I stop telling others what I’m thinking/feeling and start trying to convince myself or others that everything is all right, when in fact it is not.

Avoidance And Defensive Behavior: I start avoiding people who will give me honest feedback and/or I start becoming irritable and angry with them.

Starting To Crisis Build: I start to notice that ordinary everyday problems become overwhelming and no matter how hard I try, I can’t solve my problems.

Feeling Immobilized (Stuck): I start believing that there is nowhere to turn and no way to solve my problems. I feel trapped and start to use magical thinking.

Becoming Depressed: I start feeling down-in-the dumps and have very low energy. I may even become so depressed that I start thinking of suicide.

Compulsive And/Or Impulsive Behaviors (Loss Of Control): I start using one or more of the following- food, sex, caffeine, nicotine, work, gambling, etc. often in an out of control fashion. And/or I may react without thinking of the consequences of my behavior on myself and others.

Urges And Cravings (Thinking About Drinking/Using): I begin to think that alcohol/drug use is the only way to feel better. I start thinking about justifications to drink/use and convince myself that using is the logical thing to do.

Chemical Loss Of Control (Drinking/Using): I find myself drinking/using again to solve my problems. I start to believe that “it’s all over ‘till I hit bottom, so I may as well enjoy this relapse while it’s good.” My problems continue to get worse.

**Adapted from Terence T. Gorski’s Warning Sign Identification Process

10 Most Common Relapse Dangers

1. Being in the presence of drugs or alcohol, drug or alcohol users, or places where you used or bought chemicals.

2. Feelings we perceive as negative, particularly anger; also sadness, loneliness, guilt, fear, and anxiety.

3. Positive feelings that make you want to celebrate.

4. Boredom.

5. Getting high on any drug.

6. Physical pain.

7. Listening to war stories and just dwelling on getting high.

8. Suddenly having a lot of cash.

9. Using prescription drugs that can get you high even if you use them properly.

10. Believing that you no longer have to worry (complacent). That is, that you are no longer stimulated to crave drugs/alcohol by any of the above situations, or by anything else – and therefore maybe it’s safe for you to use occasionally.

Relapse Attitude

  • SOBRIETY IS BORING
  • I’LL NEVER DRINK/USE AGAIN
  • I CAN DO IT MYSELF
  • I’M NOT AS BAD AS …..
  • I OWE THIS ONE TO ME
  • MY PROBLEMS CAN’T BE SOLVED
  • I WISH I WAS HAPPY
  • I DON’T CARE
  • IF NOBODY ELSE CARES, WHY SHOULD I?
  • THINGS HAVE CHANGED
  • I CAN SUBSTITUTE
  • THEY DON’T KNOW WHAT THEY ARE TALKING ABOUT
  • THERE’S GOT TO BE A BETTER WAY
  • I CAN’T CHANGE THE WAY I THINK
  • IF I MOVE, EVERYTHING WILL CHANGE
  • I LIKE MY OLD FRIENDS
  • I CAN DO THINGS DIFFERENTLY
  • NOBODY NEEDS TO KNOW HOW I FEEL
  • I’M DEPRESSED
  • I SEE THINGS MY WAY ONLY
  • I FEEL HOPELESS
  • I CAN HANDLE IT
  • IF I HIDE BEHIND EVERYONE ELSE’S PROBLEMS, I WON’T
  • HAVE TO FACE MY OWN
  • I CAN’T DO IT
  • WHY TRY
  • THE EVENT: A RETURN TO THE USE OF ALCOHOL AND/OR DRUGS.

Strategies for Preventing Relapse

It’s no secret that a high percentage of recovering alcoholics and drug addicts relapse at least once, and many people have to go through the recovery process multiple times before it finally sticks.
But the fact that relapse is so common is no reason to accept it. People who relapse often end up getting hooked to drugs or alcohol to a greater degree than ever before, and they sometimes end up losing their jobs, relationships, families or even their lives. It’s not to be taken lightly. Every recovering addict should be aware of the dangers of relapse and have a plan for dealing with those inevitable moments of temptation.

Recognize the Warning Signs
During recovery it’s essential to be honest with yourself every step of the way. If you’re having cravings, there’s no need to deny or repress them. Cravings are just a part of the process, and while they will eventually become less frequent, you’ll probably experience them from time to time for the rest of your life. The key is to acknowledge them openly so that you can fortify your will until they pass – and they always do pass.

If you find yourself experiencing any of the following symptoms, talk to your sponsor, therapist or drug rehab support or alumni group immediately.

·        Loss of motivation for recovery: If you suddenly feel that attending your meetings is not worth the effort, then something has gone wrong in the recovery process. Go back through what you’ve learned in your recovery and try to identify where the process has failed.

·        High stress: Many people resort to drugs or alcohol when faced with stressful situations. For people who are new to recovery, it may be years since they’ve faced a stressful situation sober. In this precarious moment, make sure you’re staying positive.

·        Denial: If your recovery has hit a rough patch but you deny that it’s occurring, this may cause you to bottle up your feelings, which can come back to hurt you later on. It’s important to be open about how you feel and to be willing to discuss it with others.

·        Social withdrawal: Social isolation and secretive behaviors are common leading up to a relapse. Try to keep your communication pathways open, and keep talking to the people supporting your recovery even when it’s hard to do so.

·        Loss of control: Do you have trouble making healthy decisions, or do you find yourself making irrational choices that go against your recovery? If so, try to be mindful of these things so they don’t lead to bigger problems.

·        Temptation: Many relapses start out small, with the addict feeling that he or she can handle, say, one drink at a party. Remember that you have a disease and no matter how strong your will, you probably won’t stop after just one. If your thoughts of drinking or doing drugs become obsessive, talk about it with your therapist, doctor or sponsor.

Avoid People and Situations that Lead to Relapse

In recovery, you’ll hear about the importance of avoiding triggers. For example, if watching sports has always made you feel like drinking, then you might want to avoid watching sports until you’re further along in your recovery. Similarly, there may be certain people and places that you associate with your life of drinking or drug use, and these should be avoided until you’re in a better mental state.  While it’s always a good idea to avoid triggers early in the recovery process, this is far from the complete picture. After all, addiction comes from within, and these triggers are just external phenomena that cause the internal disease to flare up. In fact, many addicts find that avoiding triggers doesn’t work because new triggers are always waiting in the wings to replace the old ones.
In the end, the changes must come from inside yourself. If a trigger does arise, you must have a strategy to get through the situation without breaking down and having a relapse. And triggers will arise – you’ll run into old drinking or drugging buddies, you’ll find yourself in situations where you used to drink, you’ll experience emotional volatility, you’ll encounter stress, and so on. Recovery is all about moving toward an emotional place where you can encounter triggers without giving in to your disease. The Twelve Steps are designed to help you with this.

Move Forward with a Positive Attitude
It’s important to accept that there are going to be moments of weakness in which you feel on the verge of relapse. These moments are a normal part of recovery. The good news is that every time you make it through one of these moments, this small personal triumph will strengthen your recovery. Eventually, you’ll find that they happen less and less often.
There are different strategies for dealing with these difficult moments, but the most important thing is to keep moving forward. Sitting at home and brooding over your temptation is not going to help. Get out and do something. Call a supportive friend, do something creative, get some exercise – whatever works for you. Do whatever it takes to move beyond that moment.
Telling recovering addicts to have a positive attitude is always a little silly, because of course we would all have positive attitudes all the time if it were really that simple. But it’s something that needs to be emphasized again and again. Try to avoid wallowing in depression and self-pity, and if your negative feelings start to get the best of you, call your therapist or sponsor.

Have a Plan for Dealing with Temptation
Aside from avoiding triggers and watching for relapse warning signs, you might consider formulating a relapse prevention plan to help keep yourself moving forward with a positive attitude when your addiction rears its head. Some recovering addicts find that living a structured and ordered life helps. Schedule your daily routine to make sure that you always have something to do, and give yourself plenty of time for things like hobbies and exercise.

Finally, make sure you have someone you can call whenever you feel weak, at any time of the day or night. This could be your Twelve Step sponsor, someone from a drug rehab alumni group, a therapist, or a trusted friend or family member. Make it explicit with this person; tell them that you are going to call them whenever your temptation becomes strong, and keep your word.

LINKS HERE

 

  4 Responses to “Relapse Prevention Plan & Worksheets”

  1.  

    Very explanitory – most helpful

  2.  

    need workbook for sponcee

  3.  

    I have been working in the addiction recovery field for over 26 years and have seen way to many people relapse. The information you provided “Relapse Prevention Plan and Worksheets” was easy to read and very informative. I am starting a CD Intensive Outpatient Program at Lone Star Behavioral Health Services in Tomball, Texas and would like very much to have permission to share this information with my client’s. I am very familiar with Gorski’s and Dennis Daley’s work in relapse prevention and your information is right up there with theirs. May I have permission to use this information with my clients?

  4.  

    I just read your policies and procedures and License regarding use of your materials and will certainly abide by your policies. I made one copy of the “Relapse Prevention Plan and Worksheets” and will keep this copy for my reference only and will not provide copies for my clients. Thank you for this valuable information. I will make my clients aware of this website as a valuable resource for them to use.

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