Those with a history of drug or alcohol addiction know that getting sober is tough, but staying sober is even harder. That’s where planning the specific ways you’ll prevent a relapse — meaning an episode in which you go back to using the substance(s) or behavior(s) to which you’re addicted — can be a tremendous help. When you plan, you’re able to better understand yourself and the specific challenges you face, and you can in turn recognize and respond to the early warning signs of relapse much more quickly — hopefully before things spin out of control. A plan can also spell out how to stop a relapse quickly if it does happen.
That last part is crucial, says Terence T. Gorski, MA, a key figure in the relapse prevention field and an internationally recognized expert on substance use disorders and mental health. Statistics show that about two-thirds of people attempting recovery for the first time will relapse. The key is to get back into sobriety as quickly as possible to minimize the damage. “Some disagree with the whole notion that you should do anything to put an emergency plan in place because they believe that could lead people to think they can drink [or use] again when they want,” says Gorski, whose work includes development of the CENAPS (Center for Applied Science) model of relapse prevention. The reality, though, is that relapse blindsides most people. But when those in recovery prepare for this possibility and have a plan in place to address it, that translates to shorter, less harmful relapses, he says.
How to Create a Plan
Crafting a plan to prevent relapse is an increasingly common part of addiction treatment and it’s also used in mutual-support and 12 step groups. You can create a plan on your own, too; books like Gorski’s Relapse Prevention Therapy Workbook can serve as helpful guides. Still, it’s preferable not to go through the planning process completely alone, simply because others can help you see things you may not realize about yourself and they can also be a source of support.
Your relapse prevention plan doesn’t necessarily need to be a written document, by the way. Sometimes it’s verbally hammered out in counseling for relapse prevention. But a written plan can act as a valuable guide and inspiration, and it has the benefits of being easily at hand when it’s most needed and shareable with others. “As a colleague of mine many years ago said, ‘a relapse prevention plan is a plan that you make in a moment of sanity to use in a moment of insanity,’” says Gorski. So what should yours have in it? Every version will be as unique as the person it’s designed to help, but some effective ingredients include:
- A hard look at your history of use and any previous relapse(s)
Once you’re stabilized and sober, start the planning process by looking at every stage of your life and your patterns of using drugs, alcohol and/or other compulsive behaviors. How much did you use and how often? What were the consequences, both good and bad? Look for patterns. Have you relapsed before? When and where did it happen? The questions to ask yourself at this stage, Gorski explains, might include: What did you want your substance use to do for you? Perhaps it provided relief from depression, anxiety or boredom. Or maybe it helped you feel more comfortable socially, or made it easier to deal with some kind of trauma. Once you have your answers, you can seek healthier ways to get the same feeling, Gorski explains.
- Warning signs and specific ways to manage them
Gorski’s Phases and Warning Signs of Relapse is a comprehensive list of red flags; you will probably recognize a number of your own. For example, you may know that in the past feeling lonely or irritable or eating erratically often preceded your using. Once you know what your main triggers are, it’s possible to create a specific strategy to manage them. If loneliness is a big trigger for you, making more plans with sober friends may become a crucial part of how you prevent a relapse. It’s important to realize that relapse doesn’t begin with the first drink or drug use; it starts with small, subtle changes that can domino. “Relapse is a process. It is not an event,” Gorski explains. That means it can creep up on you, but it also means that addressing warning signs as soon as they appear offers a chance of stopping the process in its tracks.
- A support network
If you don’t already have one, build a team you can turn to and depend on — family, friends, therapists, counselors, a relapse prevention specialist, mutual support groups, addiction specialists — whoever and whatever will help you maintain your sobriety. Conversely, it’s important to remove yourself from people and situations that are triggers to use — those weekend parties, for example, or the friend who isn’t comfortable unless he has a drink in his hand.
- An emergency relapse plan
Creating a detailed plan of what should happen if you feel yourself relapsing isn’t jinxing yourself; you’re being smart. Strategies could mean authorizing others beforehand to step forward and help get you get back into treatment, accompanying you to daily 12 step meetings or driving you to appointments with a therapist. Talk to those who would help you if a relapse did happen, and be sure they have a copy of your plan.
- Specific ways to prioritize your overall well-being
Plan activities and lifestyle changes that will improve your physical and mental health. Take up hiking or swimming, for example, or learn how to cook healthy foods. Consider adding meditation and yoga to your daily routine — both help control stress, a key relapse trigger. Because mental health issues often go hand in hand with substance use, it’s also a good idea to schedule a visit with a mental health provider to help you rule out or treat issues such as depression, anxiety and bipolar disorder.Once your approach to relapse prevention is complete don’t tuck it away. “You should have the warning signs and the strategies on the mirror of your bathroom, and you should review it every day,” Gorski urges. “Do an inventory: Ask yourself, what are my positive activities for the day? What are my goals for today to make my life better? And then, which of these warning signs could go wrong for me today? And, am I going into any high-risk situations?”
Don’t expect the first version of your plan to be your last, either. Gorski recommends to his clients that they frequently talk over their plan with their support network and revise what doesn’t feel quite right anymore. “It’s always a work in progress,” he stresses.
Most important, if you do relapse, remember that this is not a sign of failure or of moral weakness. It’s simply an indicator that your relapse plan needs adjusting, says Gorski. “People who relapse are sick people who need to get well, not people who need to be punished or sinners who need to be good.”