Relapse Prevention

By David Vaughan, BA, LCDC, ACRPS (Advanced Certified Relapse Prevention Specialist)

A lot has been researched, written, and talked about on the topic of how a recovering person can prevent relapse back to alcohol or drug use. Research statistics continue to show that most people who have received alcohol or drug treatments and/or are in recovery, still have difficulty not relapsing. There is no mystery in that. “Between 80% and 90% of people treated for alcoholism relapse, even after years of abstinence (1).” I know that relapse is painful, and I also know it is preventable. No one has to go back to using alcohol or other drugs. I will share with you the “how” and “why” of the phenomena of relapse, and how you can prevent it.

Scientists of addiction and relapse—researchers and physicians—tell us that alcoholism, drug addiction, and other behavioral disorders are brain diseases. Many addicts are deficient in neurotransmitter chemicals which drive us in primal ways to seek relief from pain or to gain pleasure. A.D.A.M., Inc., accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org), states:

Researchers are particularly interested in systems of neurotransmitters (chemical messengers) in the brain that are affected by alcohol (or drug use). Some research is focusing on the way these neurotransmitters…after long-term alcohol (or drug use)…adapt to the cravings and pain of withdrawal. Such chemical changes may lead to dependency or to relapse after quitting in two ways:

–They increase the need to reduce agitation, and
–They increase the desire to restore pleasurable feelings.

Reducing Agitation. When a person who is dependent on alcohol or other drugs (AODs) stops using, chemical responses create an overexcited nervous system and agitation. This hyperactivity in the brain produces an intense need to calm down and to use more AODs. One study, in fact, suggested that the need to relieve agitation may be the more important factor in causing a relapse than restoring mood.
Restoring Pleasure. Alcohol and other drugs stimulate the release of neurotransmitters and other chemicals that produce pleasurable feelings. Over time, however, heavy AOD use appears to deplete the stores of dopamine and serotonin. (2)

Recovery is a process of movement away from addictive thinking, feelings mismanagement and behaviors. Recovery is typically found to be most effective via active participation in long-term treatment and the AA program. Unfortunately, many people who strive to abstain from relapse. Some AA and disease advocates anticipate frequent relapse—hence the mantra: “addiction is a chronic, relapsing disease.” Relapse is not a part of the disease, it is the disease. Why do so many get stuck, and make poor decisions that lead them into deeper and deeper pain, misery, and discontent from a stable recovery? The process often ends with the person believing that alcohol or drug use is a better choice than feeling this bad. Many believe they are going crazy, and that something is wrong with them. They may believe these statements, but they may be mistaken.

Relapse is a process of movement away from stable recovery-based thinking, feelings management and healthy behaviors, and towards addictive (stinking) thinking, feelings mismanagement, and compulsivity—eventually making alcohol and drug use seem like a positive choice.

An overexcited, agitated nervous system and the lack of adequate dopamine and serotonin leave one feeling anxious and depressed. A self-defeating lifestyle, co-existing disorder, being an Adult Child of an Alcoholic, and/or situational life problems often strain and stress the early recovering person, and then they act out. And all the while the brain is demanding relief or pleasure restoration.

Relapse has two levels, eleven phases, hundreds of high-risk situations, and forty-nine warning signs. The primary focus of early relapse problems is on high risk situations, where you recognize the need to abstain from alcohol and other drugs in order to resolve your current problems and face situations which could cause you to use alcohol or drugs in spite of your commitment to abstain. Things like going to a sporting event without any recovering people with you, where there is beer and fun; going to concerts, parties, etc. The main goal here is to immediately identify when you are at risk of using. Do not minimize thoughts of using or being over-confident about your recovery. Simply use your recovery tools to prevent relapse. Competency in this area will allow you to get back on track and continue to prevent your problems from getting worse. You must be able to abstain from alcohol and other drugs before you can successfully work on psychotherapy issues for long-term recovery.

The secondary focus in relapse prevention is on core personality problems and core lifestyle problems.

The self-defeating habits of thinking, feeling, acting, and relating to self and others creates unnecessary stress, pain, and problems. Core personality problems are built upon a system of mistaken beliefs. A mistaken belief is something that we assume to be true but is actually false. Most of these beliefs are learned in childhood, and are accepted as true without evidence. They become “the truth as I see it.” This forms a set of assumptions about you, others, and the world. Often these are created in a family system or cultural taboo which states: Don’t talk, Don’t trust, Don’t feel. These mistaken beliefs then create a set of unconscious life and decision rules, called a lifestyle. Core lifestyle problems are the dysfunctional relationships and habits of daily living that support and justify our core personality problems. (3)
We can’t ignore core personality and lifestyle issues or communicate that these issues are not important. These issues will have to be resolved if you are to learn how to maintain long-term abstinence. The issue is this: You recognized that you were addicted, learned primary recovery skills, and learned how to identify and manage high risk situations first. Now that you have a solid foundation in recovery, it is time to explore and change your personality and primary lifestyle problems.

Drug use and other addictive behaviors override our brain chemical deficiencies by tricking our brain cells into dumping massive amounts of Pleasure chemicals—at the expense of depleting them in the long run. Think back to when you stopped using alcohol or other drugs, and try to remember what you felt like. You probably felt down/depressed, angry, lustful, and sometimes had a panicky mixture of terror and despair. Who would want to return to that? Patients and their caregivers should understand that relapses of alcoholism are analogous to recurrent flare-ups of chronic physical diseases. It is a spiritual malady with a spiritual solution, but we need to consider the medical aspects and how science can assist in high-risk reduction. There is one certain way you will not relapse, and that is to go after your recovery with complete abandon, letting go absolutely, and depend on God.

Relapse Prevention Plan

What is a relapse?

Substance and alcohol abuse addiction are complex diseases characterized by different components that need to be addressed when trying to achieve recovery. Relapsing into drug or alcohol abuse can occur even after long periods of abstinence. This is why drug use is considered a chronic, though treatable, disease. Statistically, relapses into drug and alcohol abuse occur at rates similar to those of other chronic illnesses such as asthma, diabetes, and hypertension. Like these other chronic illnesses, drug use may require repeated treatments before abstinence is achieved and recovery is sustained. Identifying the user’s needs and redesigning recovery programs until a successful one is found is the key factor in preventing a relapse.

A relapse should not be viewed as a negative concept. In fact, it is a clear indication that the initial program that was developed was not sufficient or that there may be a co-occurring disorder that was not identified and the recovery program needs to be redesigned to take this into account.

What is a relapse prevention plan?

A relapse prevention plan involves preparing for the possibility of a relapse and identifying ways to avoid one. A successful plan entails networking with every available resource. This may include attendance at individual and group therapy sessions; regular contact with sponsors; attendance at 12 Step programs such as AA or NA; family assistance and support, or any measure that can be taken to help keep recovery on track. Most relapse prevention plans involve addressing the following areas:

Adjusting environment of the one in recovery – This many entail changing residence, job, neighborhood, circle of friends and acquaintances, or addressing any environmental factor that may lead to a relapse.

Use the new life skills acquired in therapy – These were presented as a means for addressing and replacing the old behaviors that contributed to addiction.

Identify the shortcomings of the current relapse prevention plan –If an old method did not work, find another one.

Develop a network of support communities – Recovery is difficult alone. Accessing individuals and processes who understand the problems of trying to live a sober will help prevent a relapse.