Relapse Prevention

Relapse Prevention

Whether new to sobriety or sober for many years, relapsing is always a possibility. Due to this, it is vital to understand the stages of relapse and which factors may put you at risk. Knowing what to look out for and how to help yourself is critical to successful recovery. Additionally, creating a relapse prevention plan for alcoholism can help you maintain sobriety and avoid relapsing.

The National Institute on Alcohol Abuse and Alcoholism estimates that 90 percent of people recovering from alcohol use disorder will experience at least one relapse within the first four years following treatment.

Stages of Relapse

A relapse typically doesn’t occur as a spur-of-the-moment event. In most cases, there are three main stages of relapsing. Understanding these stages, and what to do when they occur, can help stop a relapse before it takes effect. These three stages include: 

mental health

Emotional Relapse

During an emotional relapse, a person is not consciously thinking about drinking. However, their emotions and behavior are setting the stage for a relapse. During this stage, denial plays a big role. In addition, many of the signs that occur during emotional relapse are also symptoms of post-acute withdrawal (PAWS). To help minimize the risk of relapse, it is important to recognize that many of the uncomfortable feelings you experience in early recovery could be symptoms of PAWS. Common symptoms of PAWS include:

  • Foggy thinking/trouble remembering
  • Urges and cravings
  • Irritability or hostility
  • Sleep disturbances, such as insomnia or vivid dreams
  • Fatigue
  • Issues with fine motor coordination
  • Stress sensitivity
  • Anxiety or panic
  • Depression
  • Lack of initiative
  • Impaired ability to focus
  • Mood swings

Symptoms of emotional relapse include:

  • Anxiety
  • Restlessness
  • Intolerance
  • Discontent
  • Anger and Irritability
  • Defensiveness
  • Mood swings
  • Bottling up emotions
  • Isolation and not asking for help
  • Not attending support groups (or attending and not sharing)
  • Poor self-care (not eating, sleeping, or practicing good personal hygiene)

During an emotional relapse, the main goal should focus on self-care. The acronym HALT– hungry, angry, lonely, and tired–is an important thing to keep in mind during this stage. Ask yourself questions like, “are you feeling exhausted or mentally drained?” or “are you taking time for yourself?” If the answer to these questions is no, it might be time to take a step back and practice self-care. You might also want to share your feelings with a support group or counselor.  

headache2

Mental Relapse

During a mental relapse, a person is at war with their mind. A part of them knows they shouldn’t use, while the other part is looking for excuses to use. As this stage progresses, a person’s resistance to alcohol diminishes and their need to escape through alcohol use increases. Symptoms of mental relapse include:

  • Thinking about people, places, and things associated with past use
  • Spending time with users
  • Cravings for alcohol
  • Glamorizing past use
  • Minimizing the consequences of their past use
  • Bargaining
  • Lying
  • Thinking of ways that they could better control their alcohol use
  • Looking for opportunities to relapse
  • Planning a relapse

During this stage, it is critical to seek help in order to prevent a relapse. You can do so by talking to non-using friends, attending a meeting, or speaking to a counselor. In addition, you can find something to distract yourself. It takes 15 minutes for craving urges to go away, so it’s important to stay busy and use coping skills.

decline in physical health

Physical Relapse

Physical relapse is the act of taking a drink and then using again, as well as the act of driving to the liquor store and purchasing alcohol. If you are unable to address the problems of emotional and mental relapse, it doesn’t take long to progress to physical relapse. For this reason, understanding and recognizing the signs of emotional and mental relapse is crucial.

Knowing Your Recovery Stage and How to Avoid Relapse

Research shows that there are three main stages in the recovery process. Each stage has specific tasks that can assist in preventing an alcohol relapse. Although, recovery is a personal process, and the length of each stage varies from person to person. The three stages include:

withdrawal

Abstinence Stage

The abstinence stage starts immediately after alcohol cessation and can last for one to two years. During this stage, the main focus is fighting cravings and avoiding alcohol use. Other goals of abstinence include personal self-care and development. It is also common for PAWS and relapse to occur during this stage. Some key tasks of this stage include:

  • Accept that you have an addiction
  • Be honest with yourself and in your life
  • Develop coping skills to address cravings
  • Become an active member of your support groups – be willing to share
  • Focus on self-care and be kind to yourself
  • Change your group of friends – stay away from friends that still use
  • Develop healthy alternatives to drinking
  • See yourself as a non-user
trauma

Repair Stage

The repair stage focuses on repairing the damage caused by alcohol addiction. In many cases, it can last two to three years. During this stage, recovering alcoholics must confront the damage their addiction caused to relationships, their careers, their finances, and how they feel about themselves. This stage is where a person works to overcome guilt and negative self-labeling in order to move forward. Some helpful tasks during this stage include:

  • Understand that a person is not their addiction
  • Begin repairing personal relationships with family and friends
  • Work to improve self-care and make it an integral part of your daily life
  • Continue to be active in support groups
  • Continue to develop healthy alternatives to drinking
group

Growth Stage

The growth stage is all about moving forward and typically begins three to five years after alcohol cessation. This is the start of a new lifelong path to sobriety. In some cases, this is the time to address and confront any underlying cause of your initial addiction. While many may want to address this sooner, they typically do not have the coping skills necessary to do so without increasing their relapse risk. Some recommended tasks during this stage include:

  • Identify and begin to repair self-destructive patterns and negative thinking
  • Understand how familial patterns and past trauma may have contributed to your use and begin to move forward
  • Set healthy boundaries
  • Give back and try to help others
  • Take time on a regular basis to reevaluate how you are living
  • Take care of yourself in order to keep moving forward

Create A Relapse Prevention Plan

Whether on your own, with a rehab counselor, or through your support group, you should create an alcohol relapse prevention plan. While every relapse prevention plan is unique, there are some major points you should always address. These include:

  • Triggers – Begin by creating a list of all possible relapse triggers. These can be people, places, events, or emotions. While you may not know all of your possible triggers at the beginning, it can be a list that evolves over time.
  • Healthy Coping Skills and Preventative Tools – Create a list of healthy coping skills and tools you can use when cravings or thoughts of relapse occur. This can include building a healthy support system of friends and family you can turn to. Activities, such as exercising or journal writing, can also provide a distraction when triggering events occur. Another coping skill is to create a list of consequences, should you relapse. Often times, this is enough to redirect your thoughts and get you back on track.
  • Find and Participate in a Support Group – Support from others is a crucial part of relapse prevention. Having the ability to talk to others that understand your recovery process can help. Finding a sponsor or counselor that you can turn to in times of crisis is also beneficial. While 12 Step programs work for many people, other options are available.
  • Lifestyle Changes – Recovery involves more than not drinking. For example, you must create a life that makes it easier not to turn to alcohol. Look for new activities and hobbies. Set new career goals. Meet new people and create new social circles that encourage your recovery.
  • Don’t Be Afraid to  Ask for Help – Recovery is not something you have to do alone. Asking for help is not a sign of failure, but rather a sign that you understand what is happening and that you need assistance. Self-help groups and support groups are a great place to start.

Resources

Melemis, Steven. “Welcome.” Steven M Melemis MD PhD FRSM, www.stevenmelemis.com/.

Melemis, Steven M. “Relapse Prevention and the Five Rules of Recovery.” The Yale Journal of Biology and Medicine, YJBM, 3 Sept. 2015, www.ncbi.nlm.nih.gov/pmc/articles/PMC4553654/.

Moos, Rudolf H, and Bernice S Moos. “Rates and Predictors of Relapse after Natural and Treated Remission from Alcohol Use Disorders.” Addiction (Abingdon, England), U.S. National Library of Medicine, Feb. 2006, www.ncbi.nlm.nih.gov/pmc/articles/PMC1976118/.

National Institute on Drug Abuse. “Treatment and Recovery.” NIDA, www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery.

“Post-Acute Withdrawal Syndrome (PAWS).” Post-Acute Withdrawal Syndrome (PAWS) | Semel Institute for Neuroscience and Human Behavior, www.semel.ucla.edu/dual-diagnosis-program/News_and_Resources/PAWS.

Updated on: August 6, 2020
Author
Alcohol Rehab Help Writing Staff
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Medically Reviewed: May 13, 2020
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Annamarie Coy,
BA, CADACII/ICADC, ICPR, MATS
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All content created by Alcohol Rehab Help is sourced from current scientific research and fact-checked by an addiction counseling expert. However, the information provided by Alcohol Rehab Help is not a substitute for professional treatment advice. For more information read out about us.
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