Relapse Prevention for Addictions
Many
studies have explored relapse in persons with substance use problems. Relapse
prevention describes the process of developing skills to continue your choice
of health-promoting behaviours. In much of the literature this is assumed to be
a choice to remain abstinent. Relapse prevention principles, however, can apply
to any choice intended to reduce the harmful consequences of your behaviour.
You are
most likely to relapse in the first three months after making a change. Your
overall chance of relapsing is high. A relapse is not the end of the world -- it
is part of the natural cycle of change, a step on the way to lasting recovery.
How Does Relapse Happen? Relapse does not begin with a
return to old behaviours. Falling back into your old pattern is the last step
of the relapse process. Outlined below is one model of how a relapse happens.
It is important to think about your own behaviour and previous relapses that
you may have experienced. If you are able to recognize the different steps of
your relapse you will be better prepared to address this risk in the future.
What is most important to recognize is that the process provides you with
opportunities to intervene at several points along the way.
Something happens: Sometimes referred to as a
"trigger" the initial something can be an event, a feeling, a
situation, or a person. It can literally be anything - good or bad, inside or
outside you. A bad day at work, running into one of your old "using"
friends, or achieving a goal and feeling proud and hopeful are all examples of
the "something" that happens.
You interpret it: The something that happens triggers
a core belief that you hold about yourself. This often comes in the form of a
message that you say to yourself, consciously or subconsciously. These message
beliefs are unique from person to person, but could be statements such as
"I am a complete failure", "I don't deserve success" or
"I need to celebrate."
Cravings: These self-destructive
interpretations lead to cravings. Cravings are the psychological and physical
desire to engage in your old harmful behaviour (this may be smoking a
cigarette, having a drink, going to the casino or any other harmful response
you want to avoid). Your cravings could lead you to thoughts that allow you to
give yourself permission to engage in the old behaviour. These thoughts can
take many forms. A few examples might be: "I need to smoke a joint to calm
down", "I've been exercising pretty well. This weekend I'll just sit
in front of the TV", "I deserve to treat myself, I've had a bad
day", or "I have not been drunk for 3 months. I'm strong enough to
handle going to that party."
Action: At this point in the cycle, you
take the steps necessary to engage in the old pattern or give yourself an
excuse for not engaging in your new pattern. This could be calling your old
dealer, stocking up for the weekend, "dropping in" on a friend you
know is always supplied, or inviting an old friend over so that you cannot make
it to your exercise class.
Harmful behaviour: You finally engage in the old
pattern (e.g. using a drug you had been abstaining from, getting drunk at a
party, wasting the weekend in front of the TV). The most important thing that
you can do to avoid relapse is to develop a plan for your recovery. The most
successful businesses have a clear mission statement, as well as a very focused
plan for how they will achieve their goals. It is equally important for an
individual, striving to live a healthy lifestyle, to develop a plan to guide
them towards success. A significant part of this plan, particularly early in
the recovery process, is minimizing your risks for relapse.
High Risk Situations
Just
about anything can be a relapse risk, and what may be the highest risk areas
will differ greatly from person to person. The first step to take in your
relapse prevention plan is to begin to identify those situations or
circumstances that will be the highest risk factors for you. High risk
situations can be that "something" that happens in the relapse cycle
outlined above.
High
risk situations can be internal or external in origin. Some examples of
internal high risk situations can include: feeling depressed, boredom,
loneliness, being tired, having that Friday afternoon excitement at the end of
the day on payday, or pride over an accomplishment achieved. Some examples of
external risk factors could include: an argument with your partner, a call from
an old using friend, money stress, hearing a radio commercial, or a sporting or
social event.
As you
begin to reflect on your own life, it would be a good idea to make a list of
your risk factors as you think of them, which you can continue to add to as
time goes on. What things are most likely to happen in your life? What
circumstances or events have been associated with your harmful behaviour? Your
list doesn't need to be inclusive at this point; perhaps listing the first 5 or
10 risks that come to mind may be a good place to start.
Once you
have created a list of your personal risk factors, it is time to develop a plan
for each of these. Your plan should be very specific, and can consist of more
than one response to each high-risk situation that you have identified. Here is
an example of how this might look:
Phone
call from Bob: I will state my abstinence commitment, and tell Bob I cannot see
him any longer; I will take a clean friend with me and meet Bob at Starbucks
for 30 minutes only; I will discuss with my sponsor.
Feeling
Depressed: I will go for a 30 minute walk; I will call people on my phone list,
until I reach someone to talk to; I will write a list of 10 things that I am
grateful for.
Developing
a written plan helps in more than one way. It gives you an opportunity to
commit your actions in writing to yourself. It allows you to be prepared, thus
increasing your sense of control over the course of your own life. It also
minimizes the likelihood that you will be caught off guard, which can be the
most dangerous time for a relapse to occur.
Cravings
Cravings
can occur in response to high-risk situations, or can be triggered by a
physical or psychological cue. Cravings are most often associated with
substance use. Cravings can occur while you sleep and are referred to as "using
dreams." This is when you may wake up and have the feeling that you have
used your drug of choice. It is important for you to understand that when you
experience physical cravings, the chemicals in your brain are involved. These
chemicals can change in the same way they do when you use your drug of choice.
Therefore, you may feel like you do either right before, or during drug use. It
is common for people to feel their heart racing, experience a change in the
taste in their mouth, or begin to sweat. It is important to understand this,
and to know that these feelings will pass in a short period of time.
What is
most important when you experience cravings is to have a clear plan for how you
can respond to these cravings. Cravings are a natural and ongoing part of the
recovery experience. They can continue to occur long after you have stopped
using your drug of choice. Your brain needs time to develop new responses to
the situations and events that triggered your drug use. The only way for these
new responses to develop is for you to practice doing something different than
using each time you experience a craving. Over time and with practice, cravings
will occur less often, and feel less powerful, because you have developed
different ways to respond to them.
Useful Web Sites:
12 Step
Cafe
www.12steps.org
National
Institute on Drug Abuse
www.drugabuse.gov/
Canadian
Centre on Drug Abuse
www.cc.sa.ca