Relapse Prevention

The Stages of Relapse

Relapse is a process, it's not an event. In order to understand relapse prevention you have to understand the stages of relapse. Relapse starts weeks or even months before the event of physical relapse. In this page you will learn how to use specific relapse prevention techniques for each stage of relapse. There are three stages of relapse.(19)

• Emotional relapse
• Mental relapse
• Physical relapse

Emotional Relapse

In emotional relapse, you're not thinking about using. But your emotions and behaviors are setting you up for a possible relapse in the future.

The signs of emotional relapse are:

• Anxiety
• Intolerance
• Anger
• Defensiveness
• Mood swings
• Isolation
• Not asking for help
• Not going to meetings
• Poor eating habits
• Poor sleep habits

The signs of emotional relapse are also the symptoms of post-acute withdrawal. If you understand post-acute withdrawal it's easier to avoid relapse, because the early stage of relapse is easiest to pull back from. In the later stages the pull of relapse gets stronger and the sequence of events moves faster.

Early Relapse Prevention

Relapse prevention at this stage means recognizing that you're in emotional relapse and changing your behavior. Recognize that you're isolating and remind yourself to ask for help. Recognize that you're anxious and practice relaxation techniques. Recognize that your sleep and eating habits are slipping and practice self-care.

If you don't change your behavior at this stage and you live too long in the stage of emotional relapse you'll become exhausted, and when you're exhausted you will want to escape, which will move you into mental relapse.

Practice self-care. The most important thing you can do to prevent relapse at this stage is take better care of yourself. Think about why you use. You use drugs or alcohol to escape, relax, or reward yourself. Therefore you relapse when you don't take care of yourself and create situations that are mentally and emotionally draining that make you want to escape.

For example, if you don't take care of yourself and eat poorly or have poor sleep habits, you'll feel exhausted and want to escape. If you don't let go of your resentments and fears through some form of relaxation, they will build to the point where you'll feel uncomfortable in your own skin. If you don't ask for help, you'll feel isolated. If any of those situations continues for too long, you will begin to think about using. But if you practice self-care, you can avoid those feelings from growing and avoid relapse.

Mental Relapse

In mental relapse there's a war going on in your mind. Part of you wants to use, but part of you doesn't. In the early phase of mental relapse you're just idly thinking about using. But in the later phase you're definitely thinking about using.

The signs of mental relapse are:

• Thinking about people, places, and things you used with
• Glamorizing your past use
• Lying
• Hanging out with old using friends
• Fantasizing about using
• Thinking about relapsing
• Planning your relapse around other people's schedules

It gets harder to make the right choices as the pull of addiction gets stronger.

Techniques for Dealing with Mental Urges

Play the tape through. When you think about using, the fantasy is that you'll be able to control your use this time. You'll just have one drink. But play the tape through. One drink usually leads to more drinks. You'll wake up the next day feeling disappointed in yourself. You may not be able to stop the next day, and you'll get caught in the same vicious cycle. When you play that tape through to its logical conclusion, using doesn't seem so appealing.

A common mental urge is that you can get away with using, because no one will know if you relapse. Perhaps your spouse is away for the weekend, or you're away on a trip. That's when you're addiction will try to convince you that you don't have a big problem, and that you're really doing your recovery just to please your spouse or your work. Play the tape through. Remind yourself of the negative consequences you've already suffered, and the potential consequences that lie around the corner if you relapse again. If you could control your use, you would have done it by now.

Tell someone that you're having urges to use. Call a friend, a support, or someone in recovery. Share with them what you're going through. The magic of sharing is that the minute you start to talk about what you're thinking and feeling, your urges begin to disappear. They don't seem quite as big and you don't feel as alone.

Distract yourself. When you think about using, do something to occupy yourself. Call a friend. Go to a meeting. Get up and go for a walk. If you just sit there with your urge and don't do anything, you're giving your mental relapse room to grow.

Wait for 30 minutes. Most urges usually last for less than 15 to 30 minutes. When you're in an urge, it feels like an eternity. But if you can keep yourself busy and do the things you're supposed to do, it'll quickly be gone.

Do your recovery one day at a time. Don't think about whether you can stay abstinent forever. That's a paralyzing thought. It's overwhelming even for people who've been in recovery for a long time.

One day at a time, means you should match your goals to your emotional strength. When you feel strong and you're motivated to not use, then tell yourself that you won't use for the next week or the next month. But when you're struggling and having lots of urges, and those times will happen often, tell yourself that you won't use for today or for the next 30 minutes. Do your recovery in bite-sized chunks and don't sabotage yourself by thinking too far ahead.

Physical Relapse

Once you start thinking about relapse, if you don't use some of the techniques mentioned above, it doesn't take long to go from there to physical relapse. Driving to the liquor store. Driving to your dealer.

It's hard to stop the process of relapse at that point. That's not where you should focus your efforts in recovery. That's achieving abstinence through brute force. But it is not recovery. If you recognize the early warning signs of relapse, and understand the symptoms of post-acute withdrawal, you'll be able to catch yourself before it's too late.

The Golden Rule of Recovery

You must change your life. You don't recover from an addiction by simply stopping using. You recover by creating a new life where it is easier to not use. If you don't create a new life, then all the factors that brought you to your addiction will eventually catch up with you again.

The fact that you have to change your life makes recovery both difficult and rewarding. Recovery is difficult because you have to change your life, and all change is difficult, even good change. Recovery is rewarding because you get the chance to change your life. Most people sleepwalk through life. They don't think about who they are or what they want to be, and then one day they wake up and wonder why they aren't happy.

Your addiction has given you the opportunity to change your life. If you make use of this opportunity, you'll look back and think of your addiction as one of the best things that ever happened to you. People in recovery often describe themselves as grateful addicts. Why would someone be grateful to have an addiction? Because their addiction helped them find an inner peace and tranquility that most people crave. Recovery can help you change your life.

There are a few basic things most people need to change in order to achieve recovery. Here are the three most common.

Avoid High-Risk Situations

Some common high-risk situations are described by the acronym, HALT:

• Hungry
• Angry
• Lonely
• Tired

How do you feel at the end of the day? You're probably hungry because you haven't eaten well. You're probably angry because you've had an argument at work or a tough commute home. You may feel lonely because you're isolated. You don't have to be physically alone to feel lonely. And you're tired. That's why your strongest cravings usually occur at the end of the day.

Of course, you can't always avoid those situations. But if you're aware of them, they won't catch you off guard, and you can prevent little craving from turning into major urges.

How can you avoid those high-risk situations? You can take better care of yourself and eat a healthier lunch so that you're not as hungry at the end of the day. You can join a 12 step group so that you don't feel isolated. You can use relaxation techniques to let go of your anger and resentments. You can practice better sleep habits so that you're less tired. Recovery isn't about one big change. It's about lots of little changes.

Some other high-risk situations to look out for are:

• People
• Places
• Things

For example, you have to avoid your drinking friends, your favorite bar, and having alcohol in the house. You have to avoid people who you used cocaine with, driving by your dealer's neighborhood, and cocaine paraphernalia. Avoiding those things helps you create a new life where it's easier to not use.

Learn to Relax

There are only a few reasons why people use drugs and alcohol. They use to escape, relax, and reward themselves. In other words, people use drugs and alcohol to relieve tension.

The golden rule of recovery is that you must change your life. What do you need to change? If you understood the previous paragraph, then you need to change the way you relieve tension. Everyone needs to escape, relax, and reward themselves. Those are essential coping skills for a happy life. But addicts don't know how to do those things without using.

If you manage to stop using for a while, but don't learn how to relax, your tension will build until you'll have to relapse just to escape again. Tension and the inability to relax are the most common causes of relapse.

I know relaxation will help. I have treated thousands of patients. Many of them have told me that relaxation has changed their life. There is only one reason why people don't relax because they think they're too busy to relax. It goes something like this, "I know it makes sense, but I've got so many other things I have to do."

Ask yourself how much time you spend on your addiction. If you add up all the time it takes to get your drug, use it, deal with its consequences, and plan your next relapse, you'll realize that relaxing for twenty to forty minutes a day is a bargain.

Relaxation is not an optional part of recovery. It's essential to recovery. There are many ways to relax. They range from simple techniques like going for a walk, to more structured techniques like meditation. Meditation is an important part of that mix because the simple techniques don't always work. If you're under a lot of stress, you may need something more reliable like meditation. Use any of these techniques, or any combination. But do something everyday to relax, escape, reward yourself, and turn off the chatter in your mind.

Numerous studies have proven that relaxation reduces the use of alcohol, tobacco, and marijuana.(20,21)

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post acute withdrawal 

There are two stages of withdrawal. The first stage is the acute stage, which usually lasts for a few weeks. During this stage, you may experience physical withdrawal symptoms. But every drug is different, and every person is different.

The second stage of withdrawal is called the Post Acute Withdrawal Syndrome (PAWS). During this stage you'll have fewer physical symptoms, but more emotional and psychological withdrawal symptoms.

Post-acute withdrawal occurs because your brain chemistry is gradually returning to normal. As your brain improves the levels of your brain chemicals fluctuate as they approach the new equilibrium causing post-acute withdrawal symptoms.

Most people experience some post-acute withdrawal symptoms. Whereas in the acute stage of withdrawal every person is different, in post-acute withdrawal most people have the same symptoms.

The Symptoms of Post-Acute Withdrawal

The most common post-acute withdrawal symptoms are:

• Mood swings
• Anxiety
• Irritability
• Tiredness
• Variable energy
• Low enthusiasm
• Variable concentration
• Disturbed sleep

Post-acute withdrawal feels like a rollercoaster of symptoms that come and go. In the beginning, your symptoms will change minute to minute and hour to hour. Later as you recovery further they will disappear for a few weeks or months only to return again. As you continue to recover the good stretches will get longer and longer. But the bad periods of post-acute withdrawal can be just as intense and last just as long.

Post-acute withdrawal usually lasts for 2 years. This is one of the most important things you need to remember. If you're up for to challenge you can get though this. But if you think that post-acute withdrawal will only last for a few months, then you'll get caught off guard, and when you're disappointed you're more likely to relapse.

Each post-acute withdrawal episode usually last for a few days. There is no obvious trigger for most episodes. You will wake up one day feeling irritable and have low energy. If you hang on for just a few days, it will lift just as quickly as it started. After a while you'll develop confidence that you can get through post-acute withdrawal, because you'll know that each episode is time limited.

How to Survive Post-Acute Withdrawal

Be patient. Two years can feel like a long time if you're in a rush to get through it. You can't hurry recovery. But you can do it one day at a time.

If you try to rush your recovery, or resent post-acute withdrawal, or try to bulldoze your way through, you'll become exhausted. And when you're exhausted you'll think of using to escape.

Post-acute withdrawal symptoms are a sign that your brain is recovering. They are the result of your brain chemistry gradually going back to normal. Therefore don't resent them. But remember, even after one year, you are still only half way there.

Go with the flow. Withdrawal symptoms are uncomfortable. But the more you resent them the worse they'll seem. You'll have lots of good days over the next two years. Enjoy them. You'll also have lots of bad days. On those days, don't try to do too much. Take care of yourself, focus on your recovery, and you'll get through this.

Practice self-care. Give yourself lots of little breaks over the next two years. Tell yourself "what I am doing is enough." Be good to yourself. That is what most addicts can't do, and that's what you must learn in recovery. Recovery is the opposite of addiction.

Sometimes you'll have little energy or enthusiasm for anything. Understand this and don't over book your life. Give yourself permission to focus on your recovery.

Post-acute withdrawal can be a trigger for relapse. You'll go for weeks without any withdrawal symptoms, and then one day you'll wake up and your withdrawal will hit you like a ton of bricks. You'll have slept badly. You'll be in a bad mood. Your energy will be low. And if you're not prepared for it, if you think that post-acute withdrawal only lasts for a few months, or if you think that you'll be different and it won't be as bad for you, then you'll get caught off guard. If you know what to expect you can do this.

Remember, every relapse, no matter how small undoes the gains your brain has made during recovery. Without abstinence everything will fall apart. With abstinence everything is possible.