Relapse Prevention: 101

Christy Hicks, CSW/CADC/CSS

What is Relapse Prevention?

Relapse prevention is a method of teaching recovering students to recognize and manage relapse warning signs.

Relapse prevention becomes a primary focus for students who are unable to maintain abstinence from alcohol or drugs despite primary treatment.

Relapse

Relapse episodes are usually preceded by a series of observable warning signs. Typically, relapse progresses from bio/psycho/social stability through a period of progressively increasing distress that leads to physical and emotional collapse.

The symptoms intensify unless the individual turns to use alcohol or drugs for relief.

Recovery and relapse can be described as related processes that unfold in 6 stages:

1. Abstaining from alcohol and other drugs2. Separating from people, places, and things

that promote the use of alcohol or drugs, and establishing a social network that supports recovery.

3. Stopping self-defeating behaviors that prevent awareness of painful feelings and irrational thoughts.

Continued

4. Learning how to mange feelings and emotions responsibility without resorting to compulsive behavior or the use of alcohol and drugs.

5. Learning to change addictive thinking patterns that create painful feelings and self-defeating behaviors.

6. Identifying and changing the mistake core beliefs about oneself, others, and the world that promote irrational thinking.

When recovery is stable and relapse signs happen you should reverse the order. In other words,

they:• Have a mistaken belief that causes irrational

thoughts.• Begin to return to addictive thinking patterns

that cause painful feelings.

Continued

• Engage in compulsive, self-defeating behaviors as a way to avoid feelings

• Seek out situations involving people who use alcohol and drugs

• Find themselves in more pain, thinking less rationally, and behaving less responsibly

• Finding themselves in a situation in which drug or alcohol use seems like a logical escape from their pain, and they use alcohol or drugs.

Principle 1: Self-Regulation

The risk of relapse will decrease as a student’s capacity to self-regulate thinking, feeling, memory, judgment, and behavior increases.

Stabilization

• Detox from alcohol and other drugs• Solving the immediate crises that threaten

sobriety• Learning skills to identify and manage post

acute withdrawal and addictive preoccupation• Establishing a daily structure that includes

proper diet, exercise, stress management, and regular contact with treatment personnel and self-help group

Principle 2: Integration

The risk of relapse will decrease as the level of conscious understanding and acceptance of situations and events that have led to past relapses increases.

Self-Assessment

• History of alcohol and drug use• Reconstruction of the presenting problem

(why)• Assessment of needs

Principle 3: Understanding

The risk of relapse will decrease as the understanding of the general factors that cause relapse increases.

Relapse Education

• Reading assignments• Writing assignments• Warning sign identification• Complicating factors in relapse• Relapse warning sign management strategies• Effective recovery planning• All should be tailored to specifically to fit your

individual students.

Principle 4: Self-Knowledge

The risk of relapse will decrease as the student’s ability to recognize personal relapse warning signs increases.

Warning Sign Identification

Develop a personal relapse warning sign list to identify the sequence of problems that has led from stable recovery to alcohol and drug use in the past and how those shape relapse in he future.

Principle 5: Coping Skills

The risk of relapse will decrease as the ability to manage relapse warning signs increases.

Warning Sign Management

• This involves teaching students how to mange or cope with their warning signs as they occur. The better they are at coping with warning signs, the better they are able stay in recovery.– Situational and behavioral– Thoughts and feelings level– Core issues

Principle 6: Change

The risk of relapse will decrease as the relationship between relapse warning signs and recovery program recommendations increase.

Recovery Planning

Each specific warning sign should be linked to a specific recovery activity or person.

Principle 7: Awareness

The risk of relapse will decrease as the use of daily inventory techniques designed to identify relapse warning signs increase.

Inventory Training

• Complete daily inventory– Identify daily goals– Monitor program compliance– Creation of a to-do list– Review the list both morning and night to make sure

you are on track• Whenever possible, these inventories should be

reviewed by someone who knows the student and who can assist him/her in looking for emergency patterns or problems.

Principle 8: Significant Others

The risk of relapse will decrease as the responsibility involvement of significant others in recovery and in relapse prevention planning increases.

Involvement of Others

• We can not recover alone, you need the help of others. – Family members– Program sponsors– Counselors– Peers– Churches– ………

Principle 9: Maintenance

The risk of relapse decreases if the relapse prevention plan is regularly updated during the first 3 years of sobriety.

Continued

• A revision of the relapse warning sign list is to incorporate new warning signs that have developed since the previous update.– The development of management strategies for

the newly identified warning signs.– A revision of the recovery program to add

recovery activities to address the new warning signs and to eliminate activities that are no longer needed.

Basic Relapse Prevention Techniques

• Centering – relaxation technique– Put both feet on the floor, sit up straight and close

your eyes– Breathe on through your nose and out through

your mouth– Breathe in deeply, hold it for a second, then

breathe out– Do this again and feel your lungs fill with air, then

empty

Relaxation Continued

• Slow your breathing to a steady rhythm.• See if any thoughts are entering your mind.• Ask yourself if you are feeling any body

tensions.• Open your eyes when you are ready.

Speak slowly as you give the instructions. This will help the student calm down.

Sentence Completion

• A technique used to help students identify thoughts that they have that may not be true, mistaken beliefs.

• Have the student form a sentence stem: – “I know my recovery is in trouble when…”– “When I think about drugs, I….”– “Right now, I am feeling …..”

• Repeat the different endings with each student. Repeat them all several times. You may want them to even right it down. Look for common themes you can use those common endings to start another stem.

Sentence Repetition

• Sentence repetition is a way for a student to become conscious of mistaken beliefs and the thoughts, feelings, and actions they cause.– “If I continue to believe this, the best that can happen

is…”– “The worst that can happen is….”– “The most likely to happen is…”– “If I change what I believe, the best that can happen is….”– “The worst that can happen is…”– “The most likely to happen is….”

Mistaken Belief

• I can’t tell others what I feel or they will look down on me.

Adolescent Risk

• Adolescents are at higher risk for relapse due to their developmental stage.

• Chemically dependency may have delayed normal development, making it difficult for them to function in an appropriate way.

Adolescent Risk

• Learning disabilities• Dual or multiple diagnosis• High stress personalities• Inadequate coping skills• Lack of a support system• Dysfunctional families• Lack of impulse control

Adolescent Risk

• Divorce or separation of parents• Moving away from old friends, changing

schools• Loss or death of family members• Breakup of relationship with boyfriend or

girlfriend

Questions?