Technically, a relapse refers to a return to a previous type of behavior, such as substance abuse. In this case, a relapse qualifies the person to be re-diagnosed with an active substance use disorder.
A lapse is a temporary return to former substance use, but the person can self-correct and return immediately to active recovery.
Thus, relapses involve a complete turnaround that disrupts recovery, whereas a lapse is a slip that the person can correct without outside help. Therapy can help to prevent both from occurring.
Professional sources, such as the treatment guide Relapse Prevention: Maintenance and Strategies in the Treatment of Addictive Behaviors, are careful to document the types of situations that can lead to a relapse. These sources provide guidelines for treatment professionals so they can help individuals address these issues in recovery from substance use disorders.
At the center of the problem are the inevitable urges or cravings that individuals in recovery will most often experience at some point.
Cravings can be triggered by factors that were formally associated with the person’s abuse of drugs or alcohol, such as emotional states, environmental conditions, stress (one of the most common triggers), and numerous other factors.
They may seem to just appear out of nowhere, and the individual may believe they are almost being hijacked by these desires.
Cravings represent very emotional and and vivid memories associated with the pleasant effects of the previous substance use.
Most people will experience the strongest or most powerful cravings in the early stages of recovery, and the intensity of cravings or urges will diminish over time.
Many individuals, even those who have been abstinent for years, report experiencing occasional cravings to use their substance of choice.
Relapse prevention programs will focus on:
Experiencing any type of craving or urge to use one’s substance of choice, even if one has been in recovery for years, does not represent a failure of a recovery program. It is actually quite common.
The goal of a relapse prevention program is not to expect one to totally be free of any types of urges or cravings. Instead, it is to understand how to reduce these instances and how to handle the inevitable cravings that most everyone will experience at some point in recovery.
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A trigger can be defined as any situation that leads to urges or cravings to use drugs or alcohol. A trigger can be very specific to the person, or it can be a general situation that may increase the probability of an urge or desire to use drugs or alcohol in many different people.
The actual experience of a craving or urge to relapse includes the three major components of any behavior:
Relapse prevention therapy addresses all three of these components.
When relapse prevention therapy is discussed, most people will automatically think of behavioral interventions like therapy. A complete program of relapse prevention therapy may also include certain types of medications that can help one resist cravings or urges.
Other medications may also be utilized. For instance, the widely known medication Antabuse (disulfiram) does not directly reduce cravings, but it induces a state of extreme nausea when a person drinks alcohol. This feeling becomes associated with alcohol use and is designed to reduce both cravings and the use of alcohol in individuals who take this drug.
The use of medications alone is only moderately successful.
Their effectiveness is enhanced if the person also learns strategies and compensatory behaviors.
Behavioral interventions have the effect of addressing all three components of a craving and relapse mentioned above, but they are designed to teach the person compensatory skills they can use in any situation, with or without medications.
Most individuals will find the combination of medications and behavioral interventions is more effective than either alone, but many individuals in recovery do not want to use medications to assist them. This often reflects their need to feel in control.
Behavioral interventions to address relapse may certainly give the person a sense of control over their situation.
Formal relapse prevention therapy will often be heavily based on techniques from cognitive behavioral therapy (CBT), a therapeutic technique that addresses the dysfunctional components of a client’s thinking, feeling, and behavior. CBT helps them to analyze their feelings and thoughts and then restructure these to more applicable and constructive approaches.
Relapse prevention therapy is not the only option. Individuals are also encouraged to use a combination of approaches that can include exercise programs, healthy dietary habits, goal-setting, and other activities that can replace prior substance use.
Per data from the National Institute on Drug Abuse (NIDA), relapses for individuals with substance use disorders occur at similar rates as relapses for other chronic disorders like hypertension or asthma.
Individuals who do not enter formal treatment programs for any of these conditions and attempt to address them alone will relapse at higher rates than those who are in treatment for these conditions, but relapses are relatively common, even with treatment.
Relapse prevention programs do work. Becoming involved in a formal relapse prevention program increases the chances of a successful recovery.
A relapse prevention program should:
(March 2013). Addiction: Craving: a Core Issue. Nature Reviews Neuroscience. Retrieved January 2019 from https://www.nature.com/articles/nrn3483
(February 2013). Mindfulness-based Relapse Prevention for Substance Craving. Addictive Behaviors. Retrieved January 2019 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3408809/
(September 2015). Medication and Counseling Treatment. Substance Abuse and Mental Health Services Administration. Retrieved January 2019 from https://www.samhsa.gov/medication-assisted-treatment/treatment
(July 2018). Drugs, Brain, and Behavior: The Science of Addiction. National Institute on Drug Abuse. Retrieved January 2019 from from https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery
(January 2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition). National Institute on Drug Abuse. Retrieved January 2019 from https://www.google.com/search?q=NIDA+prinicpples+of+effective+treatment&rlz=1C1EJFA_enUS679US679&oq=NIDA+prinicpples+of+effective+treatment+&aqs=chrome..69i57j69i60.8023j0j7&sourceid=chrome&ie=UTF-8