Relapse prevention plays a vital role in the recovery from drug and alcohol addictions because treatment that ignores the real possibility of relapse is unlikely to succeed in the long term.
A relapse is a return to addictive behaviors after a period of abstinence. In the early stages of recovery, relapse is likely because the withdrawal symptoms may seem worse than the effects of the addiction. In later stages, relapse commonly occurs either because the recovering addict’s coping mechanisms have involved substance abuse, because they are surrounded by other people with similar addictions, or a combination of factors. Relapse prevention strategies include dealing with all these possibilities and teaching the recovering addict new ways of handling life events and crises.
Relapse prevention therapies are designed to address the stages that occur in the relapse process. These include addictive emotions and thoughts that may arise long before a physical return to drug use.
According to the National Institute on Drug Abuse (NIDA) relapse in drug addiction is extremely common, with about 60 percent of people returning to drugs and/or alcohol if effective prevention therapies are not in place.
Relapse is a process that occurs in stages rather than as a single event such as taking the first drink or dose of drugs. These stages can last for weeks or months.
The first stage in relapse is a return to unhealthy emotions, such as hostility to the withdrawal process and its symptoms or to the treatment center personnel who are trying to help. The person may have been using their drug as a way of dealing with stressful situations and may begin to feel their best option for dealing with the withdrawal is to return to their drug taking. They may be irritable and experience sleeping difficulties, and may be unwilling to ask for help.
The second stage is a mental relapse in which addictive thought patterns emerge. The person may go into denial or develop erratic thoughts or behaviors. The feeling of loss of control becomes deeper as this stage progresses, and they may begin to withdraw from their recovery programs and distance themselves from family, friends, and the rehab center staff who are helping in their recovery. The urge to return to drugs or drinking begins to appear more often in this stage, and the recovering person may start to seek opportunities to return to their old habits in secret.
The third stage of relapse is physical, and the progression from mental to physical relapse can be rapid. In this stage the person may develop a range of compulsive behaviors such as over-exercising, working excessively, or becoming obsessed with food. As their mental anguish continues to worsen, they may become overbearing and almost impossible to live with.
The last stage is a complete loss of control, a return to the addiction and withdrawal from recovery programs. A trigger of some kind often occurs just before this final stage, but it is important to realize that the trigger is not the cause of the relapse.
Relapse prevention strategies are designed to address all the stages of relapse, and recognize that the process begins long before the return to addiction. Treatments include cognitive behavioral therapy to help the person recognize warning signs that the process is beginning. Individual and group counseling is often effective, and the family may be involved in this process to help them also recognize the symptoms.
Other therapies and programs such as SMART Recovery aim to help the person to learn new skills for coping with the stresses and situations they previously handled by turning to substance abuse, and to live a more balanced life.