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Alcohol and Substance Abuse Relapse Prevention

Mark Dombeck, Ph.D.

Relapse prevention (RP) is a type of coping-focused psychotherapy or psycho-education that strives to teach drug or alcohol dependent persons coping skills to help them avoid relapsing back to using drugs and/or alcohol. Goals of a relapse prevention program include: 1) teaching coping skills to allow the recovering person to "identify, anticipate, avoid and/or cope" with high risk situations (for relapse), 2) to help recovering persons learn how to keep a single 'lapse' from turning into a multiple 'relapse' situation, and 3) to help the recovering person feel as though he or she is really capable of controlling his or her own behavior.

Multiple skills are taught in a relapse prevention class. Such skills include:

  • Learning to discriminate a 'lapse' from a 'relapse'
  • Learning to identify stressful situations and objects ("people, places and things") in the environment that can trigger relapse
  • Once a stressful situation, person, place or thing is identified, learning coping skills which help people to avoid or defuse that situation, person, place or thing so that it doesn't trigger relapse
  • To learn how to identify, plan and participate in positive and fulfilling sober activities that can fill in time formerly devoted to using drugs or alcohol, or fill in blank spots in the addict's schedule (which would otherwise be filled with cravings and stress)
  • To learn how to identify and change unhealthy habits for healthier ones.

One of the first things taught is frequently, how to discriminate a lapse from a relapse. RP teaches that addiction is extremely powerful, recovery difficult (but not impossible), and reversion to drinking and/or drugging likely (at least at first). A single 'lapse' (use of drugs or alcohol on a single occasion), does not need to necessarily need to become a 'relapse' (multiple uses of drugs and/or alcohol) if the recovering person can catch him or herself and take corrective actions. Important parts of keeping 'lapses' from becoming relapses are 1) recognizing that lapses are likely to occur, 2) not shaming one's self or treating the lapse as an unforgivable failure, and 3) taking immediate steps to keep the lapse from repeating (e.g., removing the temptation, getting away from the stress, etc.).

One of the important coping skills which may be taught in a relapse prevention class is called mindfulness. To become mindful means to develop awareness, but to do so in a non-judgmental manner. Working on mindfulness skills helps addicted people learn to become more aware and accepting of the constant stream of subtle thoughts and triggers they are likely experiencing which push them towards relapse. Becoming aware and conscious of a trigger helps people to gain a degree of control over that trigger so as to be able to choose to not react to it.

Mindfulness skills develop as people learn how to pay attention to their internal thoughts and feelings. Various forms of meditation practice are helpful for developing mindfulness skills. The following 5 minute audio program is an introductory guided meditation sample from Mindful Solutions for Addiction and Relapse Prevention, by Drs. Stefanie and Elisha Goldstein. The full audio CD is available for purchase on their website. Daily repetition of mindfulness and meditation practice can help ground you in the present moment and reduce the distress you may feel that can push people towards relapse. Feel free to bookmark this page and return to listen to this guided meditation again and again. You may also explore more in-depth meditation instruction in your local community, or online through websites such as those offered by Shinzen Young through his basicmindfulness.org website.

The physical and social environments that recovering people live in play a very strong role in determining whether or not they will be tempted to relapse to drugs and/or alcohol. For instance, drug or alcohol dependent peoples' home environments are often littered with drugs or alcohol, empty bottles or drug containers, and drug preparation paraphernalia (needles, cookers, lighters, rolling papers, pipes, scales, baggies, vials, etc.). Returning home sober to a home full of such paraphernalia would be a major trigger towards relapse. Drug or alcohol dependent people need to make an inventory of all the things in their home that remind them of their drug or alcohol use, and to remove or make those things inaccessible, if they want the best chance at staying sober. Similarly, many friends and family members may be involved in substance abuse themselves, and should be avoided in the future (as much as that is feasible) to reduce the chance of relapse. None of this is obvious to the newly recovering person, however. Becoming aware of what the triggers in the environment are, and learning strategies for removing and/or avoiding them is an important skill taught in relapse prevention classes.

Getting a drug or alcohol dependent person to identify and remove triggering items, and to stop hanging out with actively using friends is not enough to keep them from temptation. It is also important to help them to learn how to fill their free time with healthy substitutes. Relapse prevention programs also teach time management skills, help recovering persons brainstorm ways to fill their time, and keep after them to see that they are following through with the required changes in lifestyle.

Relapse prevention techniques work best when the patient embraces them wholeheartedly, and makes a significant commitment to a healthy lifestyle change.