9.2 Relapse prevention for substance use problems

A Family Guide to Concurrent Disorders - Part III: Treatment

A relapse is an expected part of the recovery process in substance use treatment. Usually there are warning signs that start long before the relapse. It is possible to identify these warning signs and take action to prevent a relapse.

If a relapse does occur, it is not a sign that treatment has failed, or that a person has a weak character, or that the caregiver is at fault in any way. A person with a substance use problem needs to learn and practise a variety of skills to prevent relapses. A relapse should be seen as an opportunity for the person to think about how to manage similar situations in the future. However, if someone relapses over and over again, it may be a sign of a more serious, undiagnosed disorder, such as posttraumatic stress disorder.

It’s common for people to have ongoing urges and cravings that they must deal with to prevent a relapse.

Risk factors

People may experience situations or feelings that put them at greater risk of relapsing. A person who has a stressful, demanding life may see substance use as the only way to get pleasure or escape stress. The following factors can increase the chances that a person will relapse:

• negative emotional states, such as anger, anxiety, depression, frustration or boredom
• conflict with others that leads to negative emotions
• social pressure from peers who use substances.

Positive occasions, such as birthdays, anniversaries or reunions may also increase the chances of a relapse if alcohol is part of the celebration. Any intense feelings, even happy ones, can be uncomfortable for some people. As a result, they may use substances to try and reduce the emotional intensity. Other people may use substances to try and intensify positive emotions.

Preventing substance use relapse

A person who copes effectively with high-risk situations is less likely to relapse. Also, a person who recognizes that substance use can lead to negative consequences, despite the fact that it may bring temporary pleasure, is less likely to relapse than a person who only acknowledges the pleasure.

When people have one relapse, their reaction to this “slip” can affect whether they go back to a pattern of heavy use. People who feel that they have no control over their use are more likely to use substances again. Those who see the relapse as a single event in which they didn't cope effectively, and as an opportunity to develop more effective ways to deal with similar triggers, are more likely to avoid using substances again.

Relapse prevention strategies for substance use problems

The following strategies can help your family member prevent a relapse:

• Become familiar with a return, or worsening, of symptoms of the person’s  mental health problems (such as manic behaviour, worsening of depression, self-harm behaviour) that have, in the past, frequently been associated with a substance use relapse.
• Identify situations in which the person may have problems coping (e.g., for many people, it is risky to be in places where they used substances before—such as in a bar—and to be around people they used to drink or use with).
• Develop strategies to deal with these high-risk situations. For example, a person could be prepared to refuse drinks in social situations by going to an establishment that offers interesting non-alcoholic drinks or going with friends who will support their decision not to drink and who do not drink to excess themselves.
• Remove items that might trigger use (e.g., someone who has a problem with alcohol could remove all alcohol, favourite drinking glasses, corkscrews and  bottle openers, at least temporarily, from the house).
• Practise techniques to deal with stressful situations (e.g., meditation, anger management, positive thinking and withdrawal from the situation)
• Pursue activities that increase a sense of balance in life, such as relaxation training, stress management, time management, pet ownership, exercise and yoga.
• Make a “relapse road map” that outlines and emphasizes choices available to cope with or avoid high-risk situations.

Be prepared for relapse. Try to understand what triggered it. Think of a relapse as an opportunity to plan for similar situations in the future, not as a mistake.

As people learn new skills and use them to avoid relapse and deal with stress, they develop a sense of mastery, which, in turn, decreases the risk of relapse.

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