Marlatt (1980, see also Marlatt [1996]) organized these risk factors into a taxonomy of high-risk situations for relapse. The taxonomy consists of three hierarchical levels of categories used in the classification of relapse episodes. The first level of the hierarchy distinguishes between intrapersonal and interpersonal precipitants for relapse. Drawing from this taxonomy, Marlatt proposed the first cognitive behavioral model of relapse (Marlatt & Gordon, 1985), which is shown in Figure 11.1. The goal of treatment is to help individuals recognize the early stages, in which the chances of success are greatest [1].

Shiffman and colleagues [68] found that restorative coping following a smoking lapse decreased the likelihood of a second lapse the same day. Exactly how coping responses reduce the likelihood of lapsing remains unclear. One study found that momentary coping reduced urges among smokers, suggesting a possible mechanism [76].

Relapse Prevention (RP) (MBRP)

Individuals use drugs and alcohol to escape negative emotions; however, they also use as a reward and/or to enhance positive emotions [11]. In these situations, poor self-care often precedes drug or alcohol use. For example, individuals work hard to achieve a goal, and when it is achieved, they want to celebrate. But as part of their all-or-nothing thinking, while they were working, they felt they didn’t deserve a reward until the job was done. Since they did not allow themselves small rewards during the work, the only reward that will suffice at the end is a big reward, which in the past has meant using.

• Sharing the list with the treatment team can provide them with needed information to prevent relapse in the patient.
• When it comes to drug and alcohol addiction, many consider a lack of total abstinence from drugs and/or alcohol to be a relapse.
• Relaxing and taking time to do things that make you happy is another important part of self-care.
• Elucidating the “active ingredients” of CBT treatments remains an important and challenging goal.
• But in the repair stage of recovery, it is not unusual for individuals to feel worse temporarily.
• If you find yourself having a desire to drink or get high and you are debating what to do, a great tool is playing the tape through first.

It is remarkable how many people have relapsed this way 5, 10, or 15 years after recovery. A missing piece of the puzzle for many clients is understanding the difference between selfishness and self-care. Clinical experience has shown that addicted individuals typically take less than they need, and, as a result, they become exhausted or resentful and turn to their https://ecosoberhouse.com/article/types-of-relapse-triggers/ addiction to relax or escape. Part of challenging addictive thinking is to encourage clients to see that they cannot be good to others if they are first not good to themselves. Despite its importance, self-care is one of the most overlooked aspects of recovery. Without it, individuals can go to self-help meetings, have a sponsor, do step work, and still relapse.

Step 2: Make a plan to manage cravings and triggers by naming specific challenges and methods for overcoming them.

I have also included a link to a public service video on relapse prevention that contains many of the ideas in this article and that is freely available to individuals and institutions [5]. You may have completed rehab, be enrolled in sober living, and feel great about your recovery, but that doesn’t mean you’re in the clear. Addiction recovery is something that requires consistent work and daily effort, and it’s all too easy to fall into the trap of over-confidence.

• Since they’ve likely been in your shoes, they may have some insight and suggestions.
• Personality, genetic or familial risk factors, drug sensitivity/metabolism and physical withdrawal profiles are examples of distal variables that could influence relapse liability a priori.
• When non-addicts do not develop healthy life skills, the consequence is that they may be unhappy in life.
• Getting enough sleep and eating healthy can aid in setting up a strong foundation to build from.

Setbacks can set up a vicious cycle, in which individuals see setbacks as confirming their negative view of themselves. Eventually, they stop focusing on the progress they have made and begin to see the road ahead as overwhelming [16]. Remind yourself why you gave up the addictive behavior in the first place. Think about adding some form of physical activity to your schedule. Open yourself up to something you never thought you’d do, like yoga or even rock climbing. The hormones produced during physical activity can leave you feeling good and less prone to relapse.

Collaborate to Create an Individualized Relapse Prevention Plan

One technique that is commonly used is the decisional balance tool, which provides the client with the opportunity to discuss the pros and cons of using a substance, as well as the pros and cons of not using a substance. This activity can help the practitioner identify discrepancies among a client’s thoughts, feelings, and actions. If necessary, the practitioner can discuss the issue of maladaptive thoughts and how to challenge cognitive distortions (e.g., “I am worthless and never will be able to quit”). The final component of relapse prevention is addressing lifestyle balance and encouraging clients to identify healthy alternative activities that do not involve the addictive behavior. As described in the last section of this chapter, mindfulness meditation can serve as a rewarding, healthy, and helpful alternative to substance use.

A relapse prevention plan that is written down can serve as a handy and concrete physical guide that can be referenced as needed. This plan is often discussed and ironed out during counseling and therapy sessions as part of a complete addiction treatment program; however, it can be created in any setting at any time. Expectancy research has recently started examining the influences of implicit cognitive processes, generally defined as those operating automatically or outside conscious awareness [54, 55]. Recent reviews provide a convincing rationale for the putative role of implicit processes in addictive behaviors and relapse [54, 56, 57]. Implicit measures of alcohol-related cognitions can discriminate among light and heavy drinkers [58] and predict drinking above and beyond explicit measures [59]. One study found that smokers’ attentional bias to tobacco cues predicted early lapses during a quit attempt, but this relationship was not evident among people receiving nicotine replacement therapy, who showed reduced attention to cues [60].

From this standpoint, an initial return to the target behavior after a period of volitional abstinence (a lapse) is seen not as a dead end, but as a fork in the road. While a lapse might prompt a full-blown relapse, another possible outcome is that the problem behavior is corrected and the desired behavior re-instantiated–an event referred to as prolapse. A critical implication is that rather than signaling a failure in the behavior change process, lapses can be considered temporary setbacks that present opportunities for new learning to occur. Given its focus on long-term maintenance of treatment gains, RP is a behavioral intervention that is particularly well suited for implementation in continuing care contexts. Many treatment centers already provide RP as a routine component of aftercare programs. However, it is imperative that insurance providers and funding entities support these efforts by providing financial support for aftercare services.

Are you ready to take back your life and approach every day with confidence? Although many developments over the last decade encourage confidence in the RP model, additional research is needed to test its predictions, limitations and applicability. Relapse prevention is a challenging problem in treating AN, and longitudinal studies demonstrate that AN is a chronic disorder. As long as you’re willing to keep seeking help from others and work your program, recovery is possible. If you or a loved one are struggling with addiction, contact The Recovery Village today.

Learning from Setbacks

It enables a person to develop key coping skills and strategies to help you through high-stress times in your life. These are the times that, in the past, you may have turned to drugs and alcohol to help you overcome. You’ll learn new ways to manage stress and how to deal with people who do not understand your addiction.