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Relapse Prevention
Stages of Readiness for Change
Preparation
Counselor can
Clarify goals and strategies
Offer menu of options
Action-Counselor can
Negotiate action plan
Acknowledge difficulties and support attempts
Identify risky situations and coping strategies
Help client find new reinforcers
Support perseverance (“Sticking to the plan”)
Stages of Relapse
Emotional
Anxiety
Intolerance
Anger
Defensiveness
Mood swings
Isolation
Mental
Thinking about people, places, and things you used with
Glamorizing your past use
Lying
Hanging out with old using friends
Physical
Intense cravings
Use
Relapse Pitfalls
H.A.L.T.
Physical, psychological, social hunger
Anger and irritability
Lonliness and an inability to be by yourself
Tired due to lack of sleep, irritability, or just being “over it.”
Identify triggers and relapse traps in the past
Devise at least 3 healthy ways of dealing with them
Incorporate a healthy lifestyle into the plan
Plan for upcoming triggers and traps (i.e. Holidays)
Review weekly
Principles of Relapse Prevention
Principle 1: Self-Regulation
Stabilization
Detoxification from alcohol and other drugs
Solving the immediate crises that threaten sobriety
Learning skills to identify and manage Post Acute Withdrawal and Addictive Preoccupation
Establishing a daily structure that includes
Proper diet
Exercise
Stress management
Regular contact with treatment personnel and self-help groups.
Principle 2: Integration
Self-Assessment
Taking a detailed reconstruction of the presenting problems and the alcohol and drug use history.
Identifying critical issues that can trigger relapse.
find the sequence of warning signs that led back to drug or alcohol use.
Principle 3: Understanding
Relapse Education
Learning accurate information about what causes relapse and what can be done to prevent it.
This information should include, but not be limited to
Common “stuck points” in recovery
Complicating factors in relapse
Warning sign identification
Relapse warning sign management strategies
Effective recovery planning
Principle 4: Self-Knowledge
Warning Sign Identification
Learning to identify the sequence of problems that has led to alcohol and drug use
When patterns of addictive thinking that justify relapse are reactivated, a return to using alcohol and drugs occurs.
Principle 5: Coping Skills
Warning Sign Management
Learning how to manage or cope with their warning signs as they occur.
Management on three distinct levels.
#1 is the situational-behavioral level. Patients are taught to avoid situations that trigger warning signs, and how to modify their behavioral responses when needed
#2 is the cognitive/affective (thoughts and feelings) level, where patients challenge their irrational thoughts and deal with their unmanageable feelings when triggered
#3 is the core issue level, where patients are taught to identify the core addictive and psychological issues that initially create the warning signs
Principle 6: Change
Recovery Planning
Development of a schedule of recovery activities that will help patients recognize and manage warning signs as they develop
Reviewing each warning sign on the final warning sign list and ensuring that there is a scheduled recovery activity for each.
Principle 7: Awareness
Inventory Training
Completing daily inventories to monitor compliance with the recovery program and check for the emergence of relapse warning signs.
Principle 8: Significant Others
Involvement of Others
Individuals cannot recover alone.
Family members, 12-step program sponsors, counselors, and peers are just a few of the many recovery resources available.
Principle 9: Maintenance
Relapse Prevention Plan Updating
Updated on a monthly basis for the first 3 months, quarterly for the remainder of the first year, twice a year for the next 2 years, annually thereafter
Nearly two thirds of all relapses occur during the first 6 months of recovery.
Less than one quarter of the variables that actually cause relapse can be predicted during the initial treatment phase.
A relapse prevention plan update session involves the following:
A review of the original assessment, warning sign list, management strategies, and recovery plan.
An update of the assessment with progress or problems since the previous update.
Incorporation of new warning signs and management strategies for them
Elimination of activities that are no longer needed.
Relapse Prevention Summary
Look at the past to identify reasons for past use
Plan for future stressors
Assist patient in developing sober social support system
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