In January, people all across the United States come up with long lists of tasks they’d like to accomplish in the coming year. They might vow to lose weight, exercise more, stick to a budget, or purchase more organic food. But when February comes around, many of these same people have relapsed to the behaviors they vowed to change.
Clearly, a return to old habits isn’t all that unusual, especially if people who hope to change don’t have concrete plans that can help them to do so. That’s what separates people who have addictions from those who make simpler resolutions. Those who have addictions often have tools that can help them to prevent a relapse, as long as they remember to lean on those tools day in and day out.
How a Relapse Works
For addiction treatment professionals, preventing a relapse is a key activity. In fact, it’s so important that some professionals have even developed long worksheets full of questionnaires they can use in order to determine how likely their patients are to relapse. One such worksheet, made available by CASA, has 28 questions pros can use to determine the likelihood of a slip.
All of that data and emphasis can make the relapse process seem really complicated, as though it’s something only the skilled can predict and/or prevent. In reality, almost anyone can understand how a relapse works. They just need to know a little about thought processes and behaviors.
According to addiction expert Terence T. Gorski, a relapse tends to come about due to one of three types of thinking: euphoric recall (in which the person thinks fondly of the drug use of the past), negative abstinence (in which the person associates bad things with sobriety), and exaggerated thinking (in which the person thinks that all the bad things going on now would go away if the drugs came back).
These thinking shifts can be subtle, as the conversations could be taking place deep within the person’s mind.
The idea that drugs are good and sobriety is bad could begin to grow and grow, and when that happens, the person might begin to test the boundaries of sobriety and start to put some of those ideas into practice in real time.
An article in Everyday Health suggests that early addiction relapse acts could include:
- Displaying moodiness, anger or anxiety
- Eating less or more
- Talking about drugs, or relaying stories about the good times had during drug use
- Spending time with people who are currently using drugs
- Avoiding ongoing treatment steps, including going to group meetings or seeing a counselor
- A relapse can work a little like a test of bravery. At first, the person just thinks about taking drugs. Then, the person starts talking about drugs. Next, the person starts rehearsing the act, by spending time with others who are using. Finally, the person dips a toe in the water and uses.
Relapses like this usually don’t happen on a spur-of-the-moment basis. Instead, they often progress slowly over a long period of time. But that can be good news, as it gives people many opportunities to change course, long before the urge to use moves into an actual relapse.
In a study of relapse published in the journal Addiction, researchers found that many people who returned to alcohol abuse after three years of sobriety did so because they had relied on so-called “avoidance coping.” In other words, instead of learning how to cope with the triggers that can spark a relapse, they hoped to structure their lives so that they were never tested.
Unfortunately, it’s virtually impossible to build a life that holds no relapse triggers. These little prompts are almost everywhere, from the people we meet to the movies we watch to the places we go. Temptation is everywhere, but it doesn’t have to be overwhelming. Therapy and rehab are designed to provide the skills required for excellent coping in a challenging world.
That’s why the easiest and most effective relapse prevention technique is also the most obvious: continue with the work done in rehab. For some, that means continuing to work with a counselor in followup sessions. For others, that means taking medications. For still others, both elements are in play. That plan can’t seem like something the person can use or not use. The plan should be something the person considers critical at all times.
In addition to following the treatment program, some people find that there’s a great benefit in attending regular support group meetings. According to Cocaine Anonymous (CA), it’s advisable for newcomers to attend a meeting every single day. But those who are in active recovery should go to a meeting at the moment in which he/she doesn’t think the meeting is necessary, CA says. That’s because the need to skip could be driven by relapse-prone thinking, and a meeting could stop that train of thought.
While following a structured program and going to support group meetings is an advisable way to keep the need to relapse at bay, there are other tips that are considered equally effective. And many of those tips have to do with structuring a life that’s so full and fulfilling that there is no need for drugs.
Scheduling plays a big role in this, research suggests, because impulsivity is common among those who have a history of addiction. In a study of the issue, published in the journal Addiction Biology, researchers combed through published journal articles and determined that people who abuse drugs early in life tend to have impulsive traits. That’s what makes them use drugs in the first place. But as the drug use goes on, that trait is magnified, until it reaches the point at which the person is much more likely to make snap decisions than he/she would be had drugs never entered the picture.
Impulsivity like this is best combatted with a very full day. A tight schedule, full of work, fitness, addiction care, and relationships, leaves little time left over to run out and buy drugs. And it leaves virtually no time left for recovery from a drug binge.
Good tasks to include in that schedule, according to writers for Psychology Today, are those that the person considers enjoyable. That might involve:
- Ice skating
These are the soul-enhancing activities that often fall by the wayside when drugs are introduced. There’s no time for fun for an addict, as everything revolves around getting more drugs and using them. Putting these tasks back means reminding the brain of the natural highs that fun can bring, and that might make the thought that sobriety is uncomfortable a little less compelling.
Looking for ways to reduce stress is another excellent lifestyle choice, when it comes to relapse prevention. A study in the journal Current Psychiatry Reports underlines that message. Here, researchers found that portions of the brain associated with addiction lit up when people were exposed to cues involving stress. When the brain is under attack, it calls for drugs. Reducing those attacks is therefore quite wise.
Everyone has different stress-busting techniques. Some people talk when they’re stressed, reaching out to friends and family for a little boost when they’re down. Others use exercise to keep their stress responses from raging. Still others meditate. Anything that works is a good technique to try.
Finally, staying connected with helpful and loving people can be a real boon. There are bound to be difficult emotions, new experiences, and old memories to rehash as sobriety takes hold. It can be a little overwhelming to deal with all that data alone, and sometimes those thoughts can be hard to process without the help of an outsider. Maintaining connections can help people to process their thoughts.
Planning for Success
According to the National Institute on Drug Use, about 80 percent of people who are sober five years after treatment tend to stay that way for good. That means any work people do to extend the amount of time in which they’re sober is good for their long-term health.
But it’s also important to remember that one little slip doesn’t need to turn into a complete downward spiral and a formal return to drug use. In fact, a little slip could be nothing more than a momentary loss of nerve that brings people into a deeper sense of sobriety and commitment.
For example, a person who had been sober for a month who drinks a glass of wine at a wedding is, technically, relapsing to alcohol use after rehab. But if that person follows up the wine with a visit to the therapist to discuss what prompted the drinking, what emotions took hold, and what thoughts were floating by, that person could get deeper insight into what happened during that mistake. And those lessons could help the person to avoid making the same mistake at the next event.
The key is to forgive a tiny slip, and to get right back on the path to sobriety as soon as possible. That way, the downward slide is stopped, and the person can continue to lead a happy, healthy, addiction-free life.
If you’d like to learn more about how addiction treatment facilities help their patients to prepare for the challenges of recovery, we’d like to help. Please call the number at the top of the page, and our admissions coordinators can tell you more about how rehab works, and what families need to do to get someone they love on the path to sobriety.
David W. Newton is a board certified pharmacist and also has been a board member for boards of examiners for the National Association of Boards of Pharmacy since 1983. His areas of expertise are primarily pharmaceuticals as well as cannabinoids. You can read an article about his expertise in CBD on the National Library of Medicine.
Reviewed by: Kim Chin and Marian Newton