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Therapy for Relapse Prevention: How Effective Is It?

Relapse Prevention is considered a skills-based, cognitive-behavioral approach that requires a client and their clinicians to determine situations that place them at risk of relapse. These experiences can be internal experiences, which are seen as positive thoughts related to substance abuse, or negative feelings toward sobriety. These external cues can be indicators that someone has decided they want to start using drugs again before they relapse.

The client and clinician will work to design strategies, which may be cognitive and behavioral to address specific high-risk situations. When someone has a more effective coping strategy, the client will develop increased confidence to handle adverse conditions without drugs or alcohol.

After committing to enter treatment and achieve sobriety, the thought of relapse can be very scary and disheartening. While no one really wants to relapse, accepting that relapse is a possibility that may occur as part of the recovery process can help an individual to put steps in place to not only help prevent relapse but to not be so hard on themselves if it happens. 

Learning about the stages of relapse and the five rules of recovery can help someone to be better prepared to recognize relapse early and know how best to handle it.

What Is Relapse Prevention?

After someone has become sober, there may be a temptation to use again or difficult situations may come up, and it may be hard to resist a lapse into old habits of using as a coping mechanism. It’s important to understand that relapse occurs in clear stages. Learning to recognize the early stages of relapse can help someone to prevent relapsing. 

The recovery process is a process of personal growth, and many developmental milestones occur along the way. As someone progresses through the stages of recovery, there are risks of relapse. 

The main types of relapse prevention are cognitive behavioral therapy (CBT) and what’s known as “mind-body relaxation.”  These techniques help to change negative thinking patterns and develop new, positive coping skills. 

What Happens in Relapse Prevention?

During Relapse prevention, the client and their clinician work to determine what situations will lead to drinking or drug use. The circumstances may include emotional states or social pressures that may lead to thoughts about abusing substances, which can lead to cravings or urges to use.

These situations are known as triggers, and the client will aim to identify lifestyle factors that affect the odds of encountering these triggers. Clinical protocols call for 12 weekly sessions and have been proven to deliver in that time frame.

Relapse Prevention Therapy

Relapse occurs slowly. It can begin several weeks or months before someone decides to drink or take drugs and relapse prevention therapy (RPT) can help someone in recovery recognize the early stages and put coping skills in place.  

Cognitive behavioral therapy (CBT) is a common therapy technique used by therapists to help clients manage addiction recovery and develop coping strategies to help avoid relapse. 

They work with clients to help them recognize negative thinking and learn how to reframe those thoughts and take practical steps to break old ways of thinking and damaging habits and replace them with positive tools for better health and empowerment. 

They help their clients to understand the personal growth process and learn to be “comfortable with being uncomfortable” as they go through this process. They help clients learn from setbacks and not see them as failures as well as find new ways to have fun and enjoy a life that doesn’t involve drug or alcohol use. 

The three basic stages of relapse are: emotional, mental, and physical. 

While someone is in the emotional stage, they still remember the difficulties of substance abuse or how difficult their last relapse was. They don’t want to go through that experience again. During this stage, someone may not want to deal with uncomfortable feelings about using or relapse, and they may be in denial. They may bottle up their emotions, avoid 12-step meetings, isolate themselves, or not reach out for help. 

Often during this stage, someone’s self-care may begin to suffer, which can further set them up for relapse. It’s critical during this stage of therapy to help the client see how important their self-care is to their recovery and relapse prevention. 

People in a group therapy setting

What self-care means to someone can vary on an individual basis, but there is an acronym to help recognize whether or not someone is meeting their need for self-care: HALT. This stands for “hungry, angry, lonely, tired.” Are they meeting their basic physical needs as well as emotional needs for positive social connection and support and doing things they enjoy?

During the emotional stage, it’s also important for the therapist to help the client identify their denial. 

If someone continues not to meet their needs for self-care, it’s a natural transition into the mental relapse stage. At this point, they become irritable and “uncomfortable in their own skin.” 

This leads to tension and restlessness and a desire to escape these feelings. While someone is in the mental stage, they will wrestle internally between cravings for the substance and guilt about their cravings. They will likely reminisce and sugarcoat their past use or consequences of using. 

Other behaviors that are common during this stage are lying, bargaining, looking for opportunities, and/or planning to use again.

It’s important to understand that these thoughts are a normal part of the recovery process, and they don’t necessarily mean that someone will relapse. This is why it’s key to know how to recognize these signs and build strong coping skills while continuing to see a therapist for support and guidance with coping strategies.

The last stage is the physical relapse stage. This is when the individual slips into using again. This may be a lapse where the individual uses again once, or it may mean that they start using again more frequently, which is relapse. This last stage is usually when the individual is faced with a situation to use and the choice to say “no.” Having prepared by learning to recognize signs of relapse and building strong coping skills, including rehearsing situations such as these, can help someone be stronger and able to say “no” and avoid relapse. 

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Other Methods of Relapse Prevention

An important method or approach to relapse prevention is to follow the “five rules.” Doing this, along with going to therapy can help an individual be better-positioned to avoid relapse. The five rules are:

  1. Make healthy changes. Change the parts of your life that have contributed to abusing drugs or alcohol in the past. For example, avoid places where you used in the past or find new interests or hobbies that don’t involve using substances.
  2. Be honest. Lying is a key part of addiction. Practice being honest even in small ways. Or in bigger ways, like asking for help and not denying it if you need help.
  3. Ask for help. Following along with being honest, don’t be afraid to ask for help. Social support from friends and family, a support group, or a therapist can go a long way to helping you remain sober.
  4. Practice self-care. It’s important to take care of yourself and meet not just your basic needs for physical survival, such as food and shelter, but also your needs for emotional well-being. This may mean something as simple as exercising, making time for a hobby you enjoy, taking a relaxing bath, or going on a relaxing walk. 
  5. Make sure you follow the rules. This may sound simple and repetitive, but No. 5 is just about making sure you stick to rules one through four. Doing this will help you take care of yourself, grow, and be prepared to manage cravings positively.

Conclusion

Deciding to get sober is an important step in the recovery journey. Maintaining your sobriety can be a challenge, but with coping skills and relapse prevention strategies in place, you can take the steps you need to be able to recognize signs of relapse early and keep yourself healthy. 

Recovery is a journey of personal growth and development, so it’s important to understand that cravings, lapses, or relapses are not signs of failure but rather setbacks that an individual can learn from and grow as they continue their recovery journey.



Sources

Melemis, S.M. (2015, September) “Relapse Prevention and the Five Rules of Recovery.” In Yale Journal of Biology and Medicine. from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4553654/

Parks, G. A. and Marlatt, A. (2000, September 1) Relapse Prevention Therapy: A Cognitive-Behavioral Approach. from https://nationalpsychologist.com/2000/09/relapse-prevention-therapy-a-cognitive-behavioral-approach/10491.html

Sinha, R. (2008, October). Chronic stress, drug use, and vulnerability to addiction. from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2732004/

Treatment, C. for S. A. (1999, January 1). Chapter 4-Twelve-Step-Based Programs. from https://www.ncbi.nlm.nih.gov/books/NBK64351/

Hofmann, S. G., Asnaani, A., Vonk, I. J. J., Sawyer, A. T., & Fang, A. (2012, October 1). The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses. from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3584580/

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