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.
What Causes Relapses And Lapses?
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:
- Helping the person avoid situations that may trigger cravings
- Teaching the person how to cope with cravings when they do occur
- Focusing on long-term goals instead of concentrating on short-term desires
- Making successful recovery the focus of the person’s life
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.
Breaking Down Triggers, Cravings, And Relapses
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:
- The cognitive or thinking component, which includes the initial thought to use a substance
- The emotional or affective component, which includes stimulation, excitement, or other feelings associated with the prospect of engaging in substance use
- The behavioral component of the experience, which would be the choice to indulge in use or to engage in a behavior that prevents one from indulging
Relapse prevention therapy addresses all three of these components.
Relapse Prevention Therapy
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.
- ReVia (naltrexone) can be used to reduce urges or cravings for opiate drugs and alcohol.
- Certain types of opiate replacement medications are used to treat withdrawal from opiate drugs and can also reduce cravings, such as Suboxone (naloxone and buprenorphine).
- Campral (acamprosate) and Topamax (topiramate) are anticonvulsant medications that appear to have utility in reducing cravings for alcohol and other drugs.
- Gablofen (baclofen) is a muscle relaxant that has been found to be useful in reducing cravings for alcohol.
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.
- Psychoeducation is always an important component of any recovery program. Individuals need to understand addiction from an objective point of view instead of their own subjective belief about their use of drugs or alcohol.
- The understanding of the person’s triggers and how to identify them is an integral component of any behavioral intervention.
- There are numerous formal coping strategies to deal with urges and cravings. For example, with urge surfing, the individual focuses on the negative aspects of their substance use instead of the positive aspects.
- The use of stress management techniques, such as diaphragmatic breathing, meditation, and progressive muscle relaxation, is often taught.
- The development of a strong social support network to help the person, and to allow the person to help others, is crucial in recovery.
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.
Does Relapse Prevention Therapy Work?
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.
- Those who are not in recovery programs tend to continue to relapse, whereas those in treatment are more likely to learn, adjust, correct their behavior, and move forward.
- People in treatment programs are taught to view relapses as learning experiences to strengthen their recovery, whereas individuals who are not in recovery often consider relapses to be failures.
- People in recovery programs believe they have control over their situation to a greater extent than individuals who are not in recovery programs.
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:
- Offer the option to use medications under the supervision of a physician
- Involve a significant therapeutic component where the individual is taught how to deal with cravings, educated about addictive behaviors, and given a chance to practice new skills
- Utilize an empirically validated method (research-based) that is also flexible enough to be adjusted to the person’s needs
- Encourage support from family members
- Foster involvement in therapy groups or peer support groups like 12-step meetings
- Be accessible for as long as the person needs the program (There is a direct relationship between the length of time one spends in treatment and the long-term success of the person’s recovery program.)