How to Create a Successful Relapse Prevention Plan

Relapse prevention is a key aspect of addiction recovery, with 40-60% of people recovering from substance use disorders relapsing at some point. [1]

The rate of relapse for alcohol addiction has been found to be around 60% for those who did not seek treatment and 40% for those who did.

Relapse can be one of the most difficult things to deal with as an addicted person in recovery, and there are several reasons that relapse happens.

However, by understanding the underlying reasons for relapses and knowing the preventative measures one can take, relapse can be much less likely to occur.

If you or your loved one are looking to learn more about the different aspects of addiction recovery, then a relapse prevention plan should be an essential part of the recovery process.

What is a Relapse?

A relapse occurs when someone who has struggled with addiction returns to using the substance after a period of abstaining from it. Relapses occur more than once or continue for a prolonged period.

Lapses, on the other hand, are when someone returns to an addictive substance for a brief period, such as a day or two before the person then remains abstinent again.

Part of a relapse prevention plan involves making sure that initial lapses are prevented, and that any lapse that does happen does not result in a full relapse.

Relapse itself is a process, rather than an isolated event, therefore understanding the reasons behind each stage of the process and preventing it can help aid addiction recovery.

Is Relapsing Normal & How Common Is It?

Relapses are very common for people recovering from alcohol addiction, and as aforementioned occurs in 40-60% of cases.

However, although common, relapses should be regarded as a serious event which can result in loss of employment, family and even life. [2]

Although there is a high risk of relapse for many people in recovery, with a proper relapse prevention plan in place, the reasons for lapses and relapses can be successfully handled well before a relapse occurs.

Why Do People Relapse During Recovery?

There are several factors that have been associated with relapsing, including co-occurring conditions a person might have, health conditions, social factors and stress. [3] [4]

The availability of alcohol, coupled with the social pressure to drink alcohol, can make it difficult for those wishing to abstain.

Many environments encourage drinking and it becomes part of their culture. For example, college binge drinking sees young adults often encouraged to drink large amounts when hanging out with friends, and in many cultures worldwide alcohol plays a large part in their social interactions.

When it comes to alcohol addiction, as alcohol is widely accepted and available within society, it can often be challenging for those in recovery to avoid environments where alcohol is present. It is readily available and therefore people thinking of relapsing can get it easier than any other drug.

There are many comorbid mental health conditions such as social anxiety, depression or bipolar disorder which are often exhibited by patients with alcohol use disorder and substance use disorder.

If you or your loved one has a comorbid condition, or other factors which may contribute to a relapse occurring, then seeking help for these factors can help prevent a relapse.

What Are the Stages of Relapse?

The stages of rehab describe the gradual process by which relapse occurs, which begins before an individual even engages with the addictive substance.

These stages help individuals to recognise when they might be heading down the road to relapse and use coping skills to prevent it. [3]

1. Emotional Relapse

This is the first stage of relapse, which can occur well before a person begins to use the substance again.

An emotional relapse happens when someone may recall the last time they used the addictive substance and does not want to use the substance again.

When it comes to alcohol use, this may be focusing on the hangovers rather than the time spent drinking or the impact that drinking has had on the person’s life and loved ones.

They are not plagued with cravings but rather, focus on negative thoughts from their past and their addiction, leading to an emotionally vulnerable state.

As they are emotionally vulnerable, their behaviour may begin to change, with eating and sleeping habits becoming unhealthy, social isolation and depressive symptoms.

What To Do at This Stage: This stage needs psychological intervention whereby a professional can help the individual to discuss their emotions, engage in self-care and recognise emotional triggers.

If psychological intervention can occur at this stage, then relapse is far less likely to happen. Friends and family can also provide support, encouraging the person to socialise, talk and do activities that they enjoy.

2. Mental Relapse

The mental relapse stage describes the period of time when a person experiences a psychological struggle between the desire to use again and the desire to remain sober.

During this time, the person may experience cravings, have thoughts about the places or times when they would drink, focus on the positive aspects of drinking and even plan a relapse.

These thoughts of using may lead to signs such as the person speaking positively about their experience drinking, meeting with old friends that they used to drink with and lying about where they are going.

What To Do at This Stage: If you are a family member, then speaking to the person calmly to discuss their thoughts and feelings can initially be a useful step. Similarly, if you are having urges to drink alcohol, speaking to someone for support can help relieve the mental strain of cravings.

Distracting oneself and waiting for 30 minutes for the urge to pass can also help prevent a relapse.

For urges that keep occurring, speaking to an addiction specialist regularly can give you tools to help.

Finally, going through recovery one day at a time, and cutting your recovery into smaller time chunks can help, as then recovery can be seen as less overwhelming for the mind.

3. Physical Relapse

This is the final stage when one actively seeks out their addictive substance. This includes going to meet the dealer, going to the shop to get alcohol, going to the pub and the active use of the substance/s.

For alcohol addiction particularly, this stage can be easier to get to quickly due to the ease of purchasing alcohol.

This, for many researchers, would be a ‘lapse’ rather than a ‘relapse’ as at this stage it is not ongoing. However, this can very easily, and very frequently is the start of a full relapse.

Substance use disorder is categorised by difficulty controlling the amount of a substance they use and therefore a lapse does frequently become a relapse.

What To Do at This Stage: This is the final stage, and the most challenging to change both for the individual battling inside their own mind and any loved ones seeing them struggle.

Recognising and preventing the stages of relapse before this stage is the most effective relapse prevention tool.

What Is a Relapse Prevention Plan?

Relapse Prevention is a cognitive-behavioural approach to addiction recovery, designed to help reduce the risk of a full relapse in two main ways.

1. Prevent the initial lapse from happening
2. Manage a lapse if it does occur to reduce harm, minimise length of a lapse and prevent further lapses [6]

A Relapse Prevention Plan, therefore, is an individualised, structured plan containing strategies to help prevent a relapse. Addiction treatment includes a relapse prevention plan so that a person can remain free from substance use even after their addiction treatment has ended.

Because addiction recovery is a long process, and people often have to confront their addictive substance when they return to their home environment (especially when it comes to alcohol addiction), relapse prevention is one of the most important parts of addiction recovery and gives people tools they can use when facing thoughts of relapse no matter what environment they are in.

6 Steps to Create a Relapse Prevention Plan

Creating a relapse prevention plan can empower you to manage your recovery. Rather than having to battle your struggles with relapse alone, a plan can give you the tools to prevent a relapse yourself.

You can find relapse prevention plans to fill out yourself [7] as well as comprehensive Guides to Relapse Prevention which include general tips on preventing relapse in recovery.

1. Recognise your triggers and know how to come to terms with them

Relapse rarely happens out of nowhere, and recognising when you are compelled to drink, gives you the power to confront them.

For some people it might be being around certain friends they used to drink with, being in a certain environment such as a pub or bar, specific times of the year such as Christmas or times when they feel stressed or anxious.

Triggers can range from specific and predictable, such as a certain holiday which you know is coming up and can plan for, and general and unpredictable, such as when you smell alcohol or when you experience stress.

The relapse prevention plan should have tools to assist with each of these types of triggers which should be worked through with an addiction specialist.

2. Find alternative activities that you enjoy

When recovering from any addiction, having something else to do in place of it is incredibly important.

Addiction often consumes a lot of a person’s life, being one of the main things they think about or look forward to throughout the day. There are also usually times when they are routinely used to partaking in their drinking, for example, evenings and weekends.

Therefore, making sure that you have other things to occupy your mind and body throughout the day/night is important.

For example, engaging in activities or hobbies you enjoy, or placing yourself in a different environment during the times when a lapse is likely to occur by going for a walk or to a coffee shop.

If you often feel urges to go out and drink on the weekend with friends for example, find either an organised club, set up a time to do your hobby or engage in another form of entertainment.

This can be useful to distract the mind from the thought of alcohol, and can also curb the idea of drinking as a ‘reward’. In society, alcohol is often viewed in this way, which can make it even harder to abstain from.

Ensuring you have something else you can enjoy during these times means that you won’t feel like you are denying yourself a reward, but rewarding yourself in an alternative way.

3. Manage your withdrawal symptoms

Withdrawal from alcohol can be a difficult process and sometimes a dangerous one. Recovery is best done at an NHS or private rehab centre, and/or under the supervision of a medical professional.

However, withdrawal symptoms can still be difficult to manage, from the psychological such as anxiety, irritability and mood swings to the physical symptoms such as nausea and vomiting.

The delirium tremens (DTs) are a collection of severe withdrawal symptoms which can also occur if initial withdrawal symptoms remain untreated. This can include hallucinations, confusion, rapid heart rate and seizures. [8]

During the recovery process, withdrawal symptoms can be managed through a range of addiction recovery methods namely medication such as benzodiazepines.

However, during the later stages of addiction recovery, tools learned during Cognitive Behavioural Therapy, holistic therapy and counselling can also help with longer-lasting and less severe withdrawal symptoms.

Withdrawal symptoms often improve after 5 days, however, some people continue to experience some of these symptoms for weeks. Withdrawal symptom severity tends to lessen over time.

Writing down when withdrawal symptoms occur, discussing them with an addiction recovery specialist and knowing what healthy activities can lessen their impact of them can help relieve withdrawals.

Activities such as taking a cold shower, meditation, going for a walk, exercising or engaging in a creative hobby have been shown to improve some withdrawal symptoms by distracting and resetting the mind and body.

4. Consider your goals

Creating goals is a great way to stay focused, have something to aim for and feel a sense of achievement when you have managed to stick to or work towards those goals.

When considering your recovery goals, including small increments such as abstaining from alcohol for one day, then two days, then perhaps a week and slowly increasing this as time goes on, can help you resist cravings, particularly during the first two stages of relapse.

Incorporating other goals into your recovery journey can help too, whether it’s broader goals such as starting your new hobby or smaller goals such as committing to certain self-care activities every day.

5. Prepare for the worst

Goals need to be realistic, and so does a relapse prevention plan. Preparing for the times when you know you are most vulnerable to cravings or temptations means that you are far less likely to relapse.

Although distractions and talking to family can help, sometimes professional intervention, a residential stay inside a facility or a physical distancing of yourself and a triggering environment is needed.

Include the worst-case scenarios in your prevention plan, with the details of local professional facilities, contact details for loved ones and a plan of action if a relapse may occur.

It is best to also include steps for if a lapse occurs so that it does not become a relapse. However, this should include a reminder of the withdrawal symptoms and negatives of the lapse itself in order to ensure that a lapse is not encouraged, and should only be looked at in a worst-case scenario.

6. Reach out for help

Finally, and perhaps most importantly, do not be afraid to reach out to help if you are struggling to put together a prevention plan that you feel will work, or if you believe that you might relapse.

A relapse prevention plan can include very useful tools for you to use in order to help you manage your recovery, but you are not alone.

If you are a member of an outpatient recovery community such as Alcoholics Anonymous, then contacting your sponsor can be helpful to ensure that you do not fall into relapse.

Friends and family can also provide a support network, distract you from negative or craving thoughts and help you remember your goals.

Addiction professionals such as rehab centre staff, your GP and addiction recovery charities can also provide help when you are struggling with relapse. Make sure you have their details on hand and include them in your relapse recovery plan in case you need to contact them.

What Help Is Available for Relapse Prevention?

A relapse prevention plan is just that, a plan of action to prevent a relapse. Within this plan, alongside the practical things that you can do such as contact a loved one or set out your goals, it is also advised to incorporate other relapse prevention tools and techniques.

There are a variety of relapse prevention tips for alcoholism which are also designed to help you feel confident in your recovery and have the tools to prevent relapse.

Workbooks

Workbooks are used in several psychological therapies, in order to help people work through the mental health disorder that they are struggling with.

CBT for example uses workbooks to help patients work through their thoughts and feelings, challenge negative thoughts and reframe their thought patterns.

Rehab centres may recommend workbooks to help you work through your recovery, and charities or peer support groups often use workbooks to help their visitors to share what they are experiencing.

Peer Groups

Peer support groups such as AA are a good way to get support throughout your recovery. You can discuss what you are going through with others who are having similar experiences.

This can also be a good place to make new friends and connections, especially as many people in society drink alcohol and several people who struggle with addiction only know people who are active in their addiction.

Alcohol addiction recovery has many challenges, and the process of relapse is one which can be hard to recognise.

However, understanding the stages of relapse as well as the tools that can challenge them, makes it easier to prepare for the emotional, mental and physical hurdles that addiction recovery can consist of.

Creating a successful relapse prevention plan means knowing how to recognise these stages, how to confront them and what tools are at your disposal. Whether it’s engaging with a hobby, talking to family or practising your self-care goals.

Finally, prepare for the worst and know that you are not alone. You can reach out to friends, family, rehabilitation professionals, peer support groups and addiction charities, all of whom are here to help you on the road to recovery.

Get Help Today

For more advice and information, please contact Rehab 4 Alcoholism on 0800 111 4108.

References

[1] Drugs, Brains, and Behavior: The Science of Addiction Treatment and Recovery (2007) National Institute on Drug Abuse, https://nida.nih.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery

[2] Nicholas Guenzel and Dennis McChargue (2022) ‘Addiction Relapse Prevention’, National Library of Medicine, https://www.ncbi.nlm.nih.gov/books/NBK551500/

[3] Wilco Sliedrecht et al (2019) Alcohol use disorder relapse factors: A systematic review, Psychiatry Research, https://www.sciencedirect.com/science/article/abs/pii/S0165178119303841

[4] J Stewart (2000) Pathways to relapse: the neurobiology of drug- and stress-induced relapse to drug-taking, Journal of Psychiatry & Neuroscience, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1408053/

[5]Steven M. Melemis, Relapse Prevention and the Five Rules of Recovery, Yale Journal of Biology and Medicine, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4553654/

[6] Jayakrishnan Menon and Arun Kandasamy, Relapse prevention, Indian Journal of Psychiatry, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5844157/

[7] Relapse Prevention Plan, https://dhhr.wv.gov/BBH/DocumentSearch/MAT/OBMAT%20Policy%20Templates/Relapse%20Prevention%20Plan.pdf

[8] A Rahman and M Paul (2022) Delirium Tremens, https://www.ncbi.nlm.nih.gov/books/NBK482134/#_NBK482134_pubdet_