Relapse Prevention For Drug And Alcohol Recovery

What relapse prevention plan can reduce the chance of a slip and give you clear steps to cope should relapse occur?

What Is Relapse Prevention?

Relapse prevention is “a skills-based, cognitive-behavioural approach that requires patients and their clinicians to identify situations that place the person at greater risk for relapse”. These situations include internal experiences, for example, automatic thoughts such as “positive thoughts related to substance use or negative thoughts related to sobriety”. However, these situations are often based on external cues for example, people a person used to use with or coming into contact with the actual problem substance, be it drugs or alcohol.

Once these situations are identified as potential triggers to relapse, the client and their treatment professional will work on developing coping strategies for these triggers. These include both cognitive and behavioural strategies.
As a client is able to cope better with triggers, he or she develops greater confidence when handling challenging situations without the use of drugs or alcohol.
A relapse prevention plan is a written set of triggers, coping skills and support contacts that a person in recovery follows to avoid going back to alcohol or drugs. The plan is built with a clinician, names the situations most likely to cause a slip, and sets out exact actions for each one.

A Relapse Prevention Plan

Between 40 and 60 percent of people relapse at least once after treatment. A written plan does not remove the risk, but evidence shows it reduces both the chance of a slip and how severe a slip becomes when it happens.

The United States’ National Institute on Drug Abuse (NIDA) defines addiction as “a chronic, relapsing disorder characterized by compulsive drug seeking, continued use despite harmful consequences, and long-lasting changes in the brain”.

According to NIDA, between 40 and 60% of people experience at least one relapse after completing rehabilitative treatment. Importantly, these rates are similar to other chronic conditions.

But research shows that including a relapse prevention plan in rehab programmes greatly reduces the likelihood of a relapse. Relapse prevention can also help clients overcome a relapse more quickly and return to recovery sooner with fewer negative consequences.

Five Rules Of Relapse Prevention

Steven Melemis, writing in the Yale Journal of Biology and Medicine, distilled relapse prevention work into five rules that clients can hold in their head when therapy is not in the room.

• Change your life: Recovery is not just about stopping use, it is about building a life where use is not the answer to stress, boredom or loneliness.
• Be completely honest: Addiction requires secrecy to survive. Honesty with your clinician, your family and yourself starves it of oxygen.
• Ask for help: Isolated recovery fails. Recovery that uses a network, a sponsor, a therapist and family, holds.
• Practice self-care: Sleep, exercise and nutrition are not optional. A sleep-deprived body in recovery is a body closer to relapse.
• Do not bend the rules: Early in recovery, small rationalisations (“I can go to the bar and just drink Coke”) are how relapses start.

The Four D’s For Coping With Cravings

Cravings pass. They peak at around 20 to 30 minutes and then fade on their own if you do not feed them. The four D’s are four actions to take in the moment a craving hits, in order, until the urge is gone.

1. Delay. Set a timer for 30 minutes. Commit to making no decision about using or drinking until it rings.
2. Distract. Do something incompatible with using. Wash dishes, phone a sponsor, walk around the block or take a shower.
3. De-stress. Slow your breathing. Four counts in, six counts out. Stress is the fuel a craving runs on.
4. De-catastrophise. Notice the thought telling you this craving will never end or that one drink will not matter. Name it as a craving thought, not a fact.

Addiction is often described as a relapsing condition and many people relapse after treatment, which is why relapse prevention is important.

The United States’ National Institute on Drug Abuse (NIDA) defines addiction as “a chronic, relapsing disorder characterized by compulsive drug seeking, continued use despite harmful consequences, and long-lasting changes in the brain”.

According to NIDA, between 40 and 60% of people experience at least one relapse after completing rehabilitative treatment. Importantly, these rates are similar to other chronic conditions: Between 30 and 50% of individuals with diabetes relapse after treatment.

But research shows that including a relapse prevention plan in rehab programmes greatly reduces the likelihood of a relapse. Relapse prevention can also help clients overcome a relapse more quickly and return to recovery sooner with fewer negative consequences.

Spotting The Warning Signs

Relapse is rarely about willpower in a single moment. Researchers typically describe three stages of relapse, and most of the work of prevention happens in the first two, long before a drink or drug is in the room.

In emotional relapse, the person is not thinking about using, but behaviour quietly sets up a relapse weeks or months ahead. Signs include bottling up emotions, isolating, skipping meetings, focusing on other people’s problems, and poor sleep or eating. A simple daily check-in is HALT: notice whether you are Hungry, Angry, Lonely or Tired and address the basic need before it escalates.

In mental relapse, part of the mind wants to use and part of it resists. Signs include cravings and obsessive thinking about old people and places. The person starts to bargain internally, lying about their intentions or beginning to plan a relapse.

In physical relapse, the person picks up. Most physical relapses happen in windows when the person believes they will not get caught, which is why the real work is done earlier.

Responding To A Relapse

Relapse prevention also includes how to respond to a slip up so that it doesn’t turn into a full-blown relapse as well as limiting the damage of a full-blown relapse should it occur.

But the reality is that relapse is common. Relapse prevention plans also explore ways a client can respond to a ‘lapse’ so it does not turn into a protracted relapse.

Research shows that a significant proportion of patients receiving treatment for alcohol use disorders, somewhere between 40 and 80 percent, have at least one drink or a “lapse” within the first year after treatment. Around 20 percent return to pre-treatment levels of drinking.

A common reaction to a lapse, in other words using the substance once after quitting, is thinking that it is a failure and, as such, ‘I might as well continue using because I have already failed’.

In relapse prevention treatment, this kind of thinking is explored and challenged, helping clients quickly get back on track instead of continuing to use or drink after a lapse.

Feelings of guilt and shame are also integral to a relapse becoming protracted and severe. These feelings are also explored in relapse prevention plans so clients are aware of how they can influence the severity of a relapse.

A relapse does not need to be seen as a failure. Seeking help soon after a relapse greatly reduces the harm and destruction. A relapse might mean you need to strengthen certain aspects of your recovery programme, and it can also be a sign that you need further treatment.
Ultimately, relapse prevention encourages the client to seek help before or during a lapse or relapse. Asking for help in recovery is one of the most important aspects of responding to a relapse or preventing one in the first place.

Relapse is common but not inevitable. Many people in recovery do not experience a relapse, and the statistics that tell you it is common do not say it is unavoidable. A prevention plan is what makes the difference.

Building your relapse prevention plan at Changes Rehab

A written relapse prevention plan is part of every discharge from Changes Rehab, not a leaflet handed over at the door. What varies is which parts of the continuum each client needs next.

The first 90 days after residential treatment carry the highest relapse risk. During this window, most people are still experiencing post-acute withdrawal syndrome or PAWS, a cluster of symptoms that includes mood swings, irritability, disturbed sleep and variable concentration. PAWS can last up to two years and is frequently mistaken for personal weakness or a sign the treatment has not worked. Ongoing clinical contact during this period is the single biggest protective factor against a slip.For most people leaving primary treatment, that contact means at least one of three things.

If primary treatment is ending and independent living feels too soon, secondary care at Changes extends structured therapeutic support while the client begins to reintegrate. The focus shifts from stabilising the substance use to rebuilding work, study and relationships under supervision.

If residential care is no longer appropriate but weekly counselling alone is not enough, the outpatient programme runs clinical sessions during the day while the client lives at home. This is the step-down phase where most relapse prevention plans meet real-world stress for the first time, and the plan gets tested and revised.

Relapse is rarely a solo event. Family dynamics, co-dependency and unresolved conflict are among the most common triggers, and our family support programme works with partners, parents and children so the home environment supports recovery instead of undermining it.

Longer-term, aftercare keeps the plan in motion for the 12 to 24 months after primary treatment, when relapse risk is highest. The first step is always a clinical assessment.

Ready to build your relapse prevention plan?

Call Changes Rehab on 081 444 7000 for a confidential conversation. Our admissions team can walk you through an assessment and explain what level of care makes sense. They can also check whether your medical aid will pre-authorise. Everything discussed stays in confidence.

Addiction and mental health treatment that connects the dots.

Changes Rehab Johannesburg has been in continuous operation since 2007, with a multidisciplinary team that treats substance use and co-occurring mental health issues under one roof.