Ultimate Guide to Relapse Prevention

Health. Prevention is Better than Cure card with colorful background with defocused lights

This is a post from Tim Wood. Tim is a writer for several recovery blogs. You can follow him on Twitter.

People in recovery often struggle with the urge to relapse.  Traumatic events are often to blame. However, most of the time those in recovery simply slip up due to the lack of a solid game plan.

Since I work at a residential rehabilitation centre nothing is more heartbreaking than to learn a former patient has relapsed.  However, relapse should really be considered a natural part of long-term recovery and an ongoing possibility which needs to be consistently tendered to.

To help those in recovery avoid this slip up we have asked industry influencers to list their top tips for staying in recovery/avoiding relapse.  I’ve called this post ‘The Ultimate Guide to Staying in Recovery’ and I consider this a special addition to the blog.

Relapse Prevention Tips

The below tips may be controversial and repetitive in places.  I’ve tried to list all the submissions I received at each point will speak louder to different people depending on their circumstances and experiences.

I hope you enjoy reading the below points and feel free to add a comment in the comment box below.  Any input is sincerely valued.

So without further ado…

Strategy #1: Utilising Others

#1.  Surround yourself with a good support system (i.e., join a group or organisation)

#2. Finding a new group of sober friends or moving to a new city can help maintain sobriety. Stay away from the people or environment where you were using and where you may be triggered.

#3.  Spend times with others in recovery.

#4. Discipline yourself into going to the right places at the right times to be with the right people to do the right things for the right reasons – you cannot simply relapse in that atmosphere

#5.  A key component of remaining sober is to identify allies and confidantes who support a drug/alcohol-free lifestyle.   Allies are persons whom you would spend time within shared activities (going to a restaurant; a recreational event such as bowling, tennis, or softball; or a community service focused meeting) in which no alcohol or drug use is completed.

#6.  Consider attending a local SMART Recovery or AA/NA group

#7.  Try to attend outpatient group 1-3 times per week for at least the first 3 months after getting out of a sheltered treatment program.  It is in an outpatient setting that they start dealing with the real world stuff—how to deal with cravings, what to do about old persons, places, and ideas.  Outpatient groups are essential in order to identify the specific relapse triggers and developing a relapse prevention plan for each of those triggers in the outside world

#8.  Engage in a mutual support program and make recovery a “we” program in which you help and support is both given and received from others

#9. Choose a treatment centre with alumni support services

#10. Joining a walking group or meeting friends to walk and chat is a great way to banish feelings of isolation and loneliness.

#11. Continue with treatment. Frequent check-ups or appointments are necessary to preventing relapse

#12.  Stay in touch with your rehab centre for as long as possible.  This way you’ll have professional support should you relapse or come close to doing so

#13.  Schedule a session with a rehab professional or other support group as soon as you experience an emotional pull to relapse

#14. Following rehab, put systems in place so that you have the most support possible after returning home from rehab. Try to slowly transition, don’t jump right back into your old life and habits

#15. If you’re feeling like you’re going to relapse, call a trusted, sober friend

#16.  Don’t be scared to share your recovery goals with others.  Don’t be shy about being in recovery.  Be proud of it.  Informing others of your recovery will strengthen up your commitment

#17.  Attend all outpatient sessions made available to you.  Never miss a session

#18.  Do not let pride or denial get in the way of preventing relapse. If you feel like you cannot maintain your current state of sobriety, do not be ashamed to reach out for help.

#19. Get your ‘sober network’ partners on speed dial.  This means storing their phone number of your mobile phone.  Also, ensure you have written copies of their contact detail.  This may sound minor but if you near a relapse situation a lack of contact details of those who can help could be fatal.

#20. Download an app such as Sosh to find events taking place in your town. This helps keep you busy so boredom doesn’t lead to relapse.

#21.  Get a ‘sponsor’.  This is a person who is also in recovery but with more experience at staying in recovery than yourself.

#22. Re-clarify your recovery goals before you go on holiday/vacation.  Consider meeting or calling with your sober network.  If you plan to travel to an English-speaking country, consider hooking up with a recovery network whilst on holiday/vacation.  You will gain a slightly different perspective on recovery.  It will be well worth the effort.

#23. Spend quality time with your loved ones.

#24. Educate others who are in recovery.  Become a ‘sponsor’. Educating others reinforces what you already know.

#25. Don’t isolate yourself. If you are down and alone, relapse becomes ever riskier.

Strategy #2: Knowing & Avoiding Triggers

#26.  Reduce the amount of time spent with past users/enabler friends

#27. Recognize the people who are unhealthy or triggering and avoid them. This doesn’t mean they’re bad people, it just means you’re taking care of yourself

#28.  Identify high-risk situations and people.  These are situations and people who will make staying sober a struggle. Identify these people and place and try to avoid them.  Also, try develop strategies to handle such influences without resorting to alcohol/drug use.  Be able to successfully anticipate high-risk situations and develop a plan to cope with them.

#29. Learn your triggers: these are thoughts and feelings that precede substance use. When you notice them do something positive

#30.  Avoid triggers (e.g., stress)

#31.  Give up hobbies and interest which encourage drug or alcohol use.  This could include going to certain nightclubs and watching certain TV programmes and the like

#32. Visualize and mentally rehearse what you can do to get out of tempting situations. It’s like muscle memory- it’s easier if you’ve developed the muscle first.

#33. Plan ahead of time what you will do if you run into a situation that might be trouble for you (i.e. if relapse becomes a risk). Knowing what you will do in advance will give you a course of action and empower you to control your own situation.  Above all, have a plan for when things get tough because things are likely to get worse at some point.  This could include losing your job, losing a loved one or running into money troubles

#34. Make sure your schedule is full after being discharged from rehab. Whilst being in inpatient your day is very structured and full, and coming home to days where you do nothing but stay at home often times heightens the risk of reverting back to problem behaviours. Finding an intensive outpatient or some sort of regular daily treatment is really important after inpatient

#35. Recognise preventing relapse starts from the beginning of the recovery process

#36. Replace negative behaviours with positive behaviours

#37. Rehearse answering awkward questions from relatives or friends, especially at holiday parties and other social situations when alcohol is freely available

#38. Have a standard response ready for people who ask why you’re not drinking

#39. Have an “escape” plan if you’re attending a holiday party or event. If the situation becomes uncomfortable for you, be sure to have your own vehicle or a plan for public transportation to leave if you don’t want to stay. Don’t feel obligated to stay if you are in a situation you don’t want to be in that could trigger a relapse

#40. Find an Alternative Non-Alcoholic Drink. If you have a drink in your hand, others who are unaware of your situation are less likely to ask if you want a drink

#41.  Attend events with sober friends and family

#42. Be the designated driver when you go out

#43. Utilize the GORSKI-CENAPS Model for relapse prevention, a 9-step process for identifying and stopping early warning signs of relapse.

#44.  If you close to relapsing, try to wait until the urge subsides.  Try to distract yourself for at least 40 minutes and the cravings will likely reside

#45.  Understand the science of cravings.  Above all remind yourself cravings come and go.  Just don’t give into them.  Know you are more powerful than your cravings.  This is something you can beat!

#46. Identify relapse traps by completing this sentence: I know my recovery is in trouble when I______.  List everything you can think of to manage these relapse traps.  Get your sponsor and others in good recovery to help with interventions that have worked for them too.

#47. Know that relapse does NOT start with picking up that first drug or drink. It starts with thoughts like:  *I’m too tired to go to a  (AA or NA)meeting tonight; *My problem was heroin, not alcohol or marijuana, *I miss my old friends—I will just stop by the old place and say hello, * I am ok now I don’t need these (AA/NA) meetings.

#48. Be continuously mindful of the relapse warning signs you closely identify with while sober. Keeping a list is helpful.

#49.  If you suffer from complex psychological issues such as depression know you will need addiction safeguards to others in order to prevent

relapse

#50.  If you travel abroad, ensure you bring along recovery literature with you. This could include books, workbooks, medication tapes, relaxants or prayers.  These materials could be vital if you relapse or come close to doing so whilst travelling abroad.

#51. Read as must as you can on relapse prevention.  Look up the topic online and use the library of a local university or college who are likely to carry books on the subject.

#52. Bring your own non-alcohol drinks to a party.  This ensures you’re not caught off-guard if only alcoholic drinks are served.

#53. If you go to a party or nightclub, plan to leave early.

#54. Stay away from ‘old haunts’. This includes clubs, bars and pubs where you used to drink/use.

#55. Change your phone number

#56. Deal with cravings as part of your overall recovery plan.  Know what to do if you have cravings e.g. places to go, what can calm you down, sources of distraction, people to call etc.

#57. Learn the ’emotional cues’ of relapse/cravings.  This could be anxiety, anger or frustration.

#58. Read Terence Gorski’s books on relapse prevention. Learn about the steps involved: Stabilization, assessment, relapse education, and warning sign identification

#59. Learn about Gorski’s concepts of (1) euphoric recall (where the person in recovery thinks positively about their past drug user), (2) negative abstinence (where the person  associates negative feelings with sobriety), and (3) exaggerated thinking (where the person believes all the bad things happening to them would go away if alcohol/drug use was to return)

Strategy #3: Develop coping mechanisms & psychological strength

#60.  Make sure you have a safety plan for at least five easy things you can do whenever your feelings are likely to overwhelm you and carry the safety plan with you because under stress, humans don’t think very well.

#61.  Plan for harm reduction should relapse occur.  Know your tolerance levels to alcohol/drugs will have weakened during recovery.

#62. Do not feel ashamed if relapse occurs.  Seek out help immediately. Don’t allow a lapse to turn into a relapse!

#63. Give yourself grace for the setbacks you face. They don’t mean everything you’ve worked for is for nothing.

#64.   Above all don’t give up if you do relapse.  Understand your prior progress was not all for nothing.  But know a lapse is not a valid excuse to go on a binge.  If you relapse say to yourself “I made a mistake. Now I must work even harder at getting sober”.

#65.  Learn the art of relapse management.  This helps where relapse has occurred. Ensure you cover relapse management techniques during rehab or with your designated support group

#66.  Kill complacency.  After a while, you may assume you’re ‘cured.’  However, once you’re ‘in recovery’ you’re never really out of it.  Complacency may lead to the dreaded ‘one cup of beer’ leading to relapse

#67. Keep a daily journal that is only for you – but makes sure you read what you wrote

#68. Allow yourself to ponder all of the people, places, things, and experiences that you have lost over the years and provide yourself with methods for grieving those losses without shame

#69. Convincing yourself that you can have the first drink (only). The first ‘hit’ (only), the first pill, snort, etc. (only) is when you are on your way to RELAPSE.  It is only a matter of time from that FIRST STEP that you are back from whence you came, helpless and hopeless, at the bottom looking up

#70.  Know that there is no quick fix for a stable recovery—it takes work.  And if the person with addiction is not working on achieving a stable recovery, there is NO quick fix for avoiding relapse. Relapse occurs because the person stopped working on their recovery

#71.  Keeping stress levels low is vital. If you know you are overstressed, look at what factors are causing you to feel this way and make some adjustments.

#72. Read up on the emotional, mental and physical model of relapse

#73.  Regulate your physical and emotional needs.  Minor negative emotions such as anger or loneliness could act as power relapse triggers.  Also, ensure your physical needs are being met.  This could include ensuring you are well fed and receive enough sleep each night.  Ensuring your health and emotional needs are being met is a staple of any well thought out long-term recovery strategy.

#74.  Acquaint yourself with the abstinence violation effect (AVE) and ensure you do not fall foul of this effect.  This is when people equate relapse with total failure.

#75. Don’t feel guilty having some ‘me’ time.  This could include reading a book, spending the entire weekend watching movies or just resting in bed all day!  Sometimes ‘empty time’ is just what the doctor ordered.  At least you’ll feel well-rested come Monday morning.

#76.  Work on your refusal skills/assertiveness.  Learn to say NO!  This helps if a peer encourages drug/alcohol use. Say ‘no’ rapidly.  Have strong eye contact and be clear.   Exit the conversation as soon as you’ve said ‘no’.   Practice ‘refusal skills’ on an ongoing basis.  Enact situations through role plays during recovery meetings so you can practice refusal skills.

#77. Don’t expect all your problems to magically go away when you enter recovery. Know your recovery efforts are a ‘work in progress’.

#78. Keep a list of negative consequences which will occur if relapse takes place.

#79. Draw up a ‘Stress Management Plan’

#80. Be able to ‘wait out’ cravings/urges. Cravings for drugs/alcohol last for around 15 minutes and then subside. However, this waiting can ‘feel like an eternity’. During this 15 minutes, you’re likely to feel uncomfortable.  Distract yourself by writing in your diary, going for a walk, or calling a good friend for a chat.  Know your cravings come and go.  Accept cravings for what they are and learn to ‘ride them out’.

#81. Avoid being ‘overconfident’, especially when you first finish addiction treatment.  Feeling overconfident means you are vulnerable to relapse. You will feel prepared for recovery when you are not. When you are over-confident, you are likely to expose yourself to triggers of addiction. These triggers will shatter your resolve, and relapse is likely to follow.

#82. Avoid ‘self-pity’.  Recovery is not a punishment, but a reward for your hard work and determination.

#83. Know that sobriety will not always equal happiness. Above all, be able to accept that sobriety is a rollercoaster of emotions. Some days you will be the pigeon, whilst other days you will be the statue.

#84.  Never take your recovery for granted. Taking your recovery for granted leads to complacency.   Complacency means you are likely to forget or neglect your coping strategies.

#85.  Avoid recalling the ‘good times’ you had with drugs and alcohol

#86. Use ‘DEADS.’ Each letter stands for a useful approach to relapse prevention: D = Delay. This is based on the notion that cravings and urges disappear when you shift your attention elsewhere. You must refocus your attention for around 10-15 minutes. E = Escape. This requires you to remove yourself from the urge provoking situation. This could be a pub or supermarket where alcohol is readily available. It’s key you focus your attention elsewhere. A = Accept. Accept that cravings and urges are a natural part of living in recovery. Accept these emotions for what they are without judging them negatively. Don’t punish yourself for having these urges/cravings. D = Dispute. Identify past addictive situations and develop tactics for disputing them when they occur again. S = Substitute. This requires you to substitutes urges with fun or productive activities.  This could mean going for a run or a walk, or reading a book or listening to a radio station. Make a list of activities you could perform when urges/cravings arise.

Strategy #4: Goal Setting

#87. Make realistic goals. Success happens in baby steps, not leaps and bounds.

#88.  Keep a list of what you’re grateful for

#89.  Reward yourself for your progress.   Map out ‘recovery goals’ and reward yourself when you hit them.

#90.  Ask yourself “If Recovery were a crime, would there be enough evidence to convict me?”  If not, you’re not making a true effort to stay in recovery

#91.  Know hard work required during recovery is not unique to addiction.  People with other chronic illnesses (heart disease, hypertension/stroke. cancer) all have to work on their recovery and the first 1-2 years is hard.  But the end result is well worth it—they are alive, feel better than they have for a long time, and don’t have the symptoms that were so debilitating.

Strategy #5: Lifestyle

#92. Know that a busy schedule full or work, activities, fitness, addiction work and relationships will mean you are occupied and less likely to return to drugs/alcohol.

#93.  Find healthy outlets for stress (e.g., meditation, journaling)

#94.  Eat well (give your body exactly what it needs)

#95.  Exercise (which can both be an outlet and help you build a stronger body)

#96.  Get plenty of sleep (which will help you to have a clear mind for decision making)

#97.  Engage in adventure recovery (i.e., fun activities like skiing, hiking, etc.)

#98.  Now you’ve gotten clean you’ll find lots of time to invest in a healthier hobby.  Occupy your time wisely so you don’t get bored and relapse. Consider taking up a sport or perhaps sign up for a local night class at college

#99.  Allow yourself to practice or learn some form of expressive activity – drawing, writing, painting, singing, playing music, acting, etc. – that you can do regularly but especially when you are upset, scared, angry

#100.  Regularly practice some meditative activity – learn formal meditation, yoga, prayer, or whatever works for you

#101. Spend time with nature

#102. Keep yourself busy by cleaning up your home, garden or garage.  An uncluttered living and working space make for a healthy and clear mind where you can make rational and sound decisions.  There’s nothing more satisfying than a job well done.

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