Getting sober from mood altering substances is a huge accomplishment. Staying Sober requires ongoing and significant effort. The better one understands addiction and the relapse process, the more likely it is that he or she will engage in the activities that will help to maintain sobriety.
Chemical and biological changes occur in the body and brain during active addiction that allow addiction to progress from early experimental use to a later, more compulsive type of use. Changes in the body and brain lead to changes in thinking, emotions, behavior and lifestyle. These changes, in turn, lead to countless problems with the legal system, relationships with family and friends, health and impairment problems, job losses, financial problems, accidents, child custody problems, problems with mood and temper regulation, profound losses and intense feelings of guilt, shame and inadequacy, and distortions in thinking and perceiving reality. The thought distortions prevent a person with addiction from seeing the very logical connection between the substance use and the consequences. These changes work together to allow a person to continue in addiction, often at the horror and amazement of loved ones; sometimes with the unintended help of loved ones who can get caught in the process themselves.
Relapse prevention skills are those skills that help an addict anticipate and cope effectively with the very real potential for relapse. Coping skills can be cognitive or behavioral. Cognitive skills have to do with the way a person thinks that can help or hinder efforts to stay sober. Behavioral coping strategies are things a person can do that will enhance the person’s ability to cope and ultimately to stay sober. Learning to apply specific coping skills to preventing relapse or maintaining sobriety is relapse prevention. Developing a plan based on an individual’s increased awareness of his or her own specific strengths and vulnerabilities is a relapse prevention plan.
Relapse is a Process
One of the first tasks in relapse prevention is to understand that relapse is a process, not an event, and it begins with a thought that ultimately leads to picking up to drink or use again.
A person attempting to stay sober will likely report that the relapse “just happened” or happened unexpectedly. In reality, the relapse may have begun days ago with a single thought, such as “There’s no reason I can’t hang out with my drinking buddies. Just because I’m sober doesn’t mean they have to be.” Or, “I’m strong enough now. I can handle being around my buddies again, without picking up. Anyway, they’re my friends.”
Following the thought(s) are some actions that eventually lead to the relapse. The person may initiate contact with their friend, just talking on the phone at first, then eventually meeting each other for a sober activity, then before he knows it someone has passed a drink or a joint, then he picks it up automatically without even thinking about it except that one hit can’t hurt or wtf, then while they’re a little buzzed and their inhibitions are low, they’re very easily persuaded to snort a line, hit a joint or drink a shot, and before they know it they’re on a 3 day binge until they crash, then wake up thinking, “Oh shit!”
Then comes the shame and guilt, and attempts to cover up the slip, which leads to feeling lousy about himself and irritable with friends and family, who are mad at him for blowing them off again and breaking yet another promise, and then he calls his friend once more but with a real case of the fuckitz this time, and off they go again, then a few days later he wakes up in jail and doesn’t remember how he got there or where his car is, but if the cops weren’t harassing him, his wife nagging, the kids demanding, and the boss expecting so much he wouldn’t be there.
If he’s fortunate, he will be court ordered to treatment where he will learn that familiar people, places and things are “triggers” to a conditioned neurobehavioral response that is experienced as an overwhelming, irresistible, uncontrollable craving or urge. While the “trigger” can be avoided and the user can learn ways to cope with “triggers,” once the cravings start and begin to build momentum, relapse is inevitable. A person, who knowingly exposes himself to a trigger, has already decided to use.
Coping with High-Risk Situations
Another relapse prevention task is to identify and learn to cope with high risk situations such as intense or unstable emotional states, interpersonal conflict and social pressure. While there are some situations that are generally high risk for anyone in recovery, it is important to also recognize situations that are a particular challenge to this particular addicted person. For example, the acronym HALT is used as a way to remember that being Hungry, Angry, Lonely or Tired is a risk for most people in recovery. A person may have a particular problem or stressor that is high risk for them, but not everyone. If a person has a history of trauma or a traumatic loss, a particular sight, sound, smell or sensation can be high risk for that person that wouldn’t affect another person at all.
Since many people who become addicted have a pattern of avoiding feelings and using substances to numb feelings, or as a misguided way to cope with feelings, a significant aspect of relapse prevention is learning to cope with feelings. One person may struggle with anger and domestic violence, while another struggles with depression and anxiety, and others with trauma and loss. In fact, studies have shown that 60% of women in treatment for substance use disorders and 40% of men in treatment have co-occurring trauma related symptoms. Sometimes the trauma occurred before the substance use, sometimes during active substance use, and often before and during. A significant loss can often be related to the onset of substance use and with an increase in use. Mood and anxiety disorders and other mental health conditions often co-occur with substance use, and need to be treated and stabilized to prevent relapse.
Problems with interpersonal relationships and social pressures also need to be addressed in order to prevent relapse. Many people began using in adolescence which is developmentally the time many social and relationship skills are learned. Often these skills are not developed resulting in some emotional, social and interpersonal immaturity. In the case of multi-generational alcoholism and addiction, the person may not have had role models available to teach the skills. A lack of skills in communication, anger management, assertiveness, setting boundaries and limits, conflict resolution, problem solving, parenting, etc. can result in a host of relationship, marital and family problems that could be significant “triggers” for relapse and contribute to a poor recovery environment.
Other Aspects of Relapse Prevention
Learning to cope with urges and cravings and building confidence in one’s ability to cope with them are key components to preventing relapse. Learning ways to minimize damage and reduce the impact of negative consequences can help. In the example above where the addict continued to use and make a bad situation worse, the addict and their family can learn to think and respond more effectively to a lapse that will prevent additional damage. Staying engaged in treatment and recovery even after a relapse occurs is paramount. It’s easy to get discouraged and quit, and can be a real challenge to examine what led to a relapse and what can be done next time to prevent it. It’s helpful to know that when a person has a lapse they don’t have to fall all the way to the bottom again. They can get back up and realize that even though they’ve slipped some, they’ve still come a long way from where they were. Lastly, a recovering person needs to create a more balanced lifestyle. It is common for people in recovery to substitute addictions. Instead of staying out drinking all night to avoid dealing with some problems at home, the addict might pick up extra hours at work or take up a hobby that is used as an escape to avoid problems in much the same way as substances were used. On the other hand, and this is often a problem for family members, the person in recovery does need to spend time engaging in recovery activities such as attending meetings, going to group, or meeting with a sponsor. The family often expects the recovering person to spend more time at home and with them, and gets frustrated when the person spends so much time doing the things he needs to do to stay sober.
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Kim Harris (author) on December 20, 2011:
Wow, molometer! 3 brain surgeries! I'd love to hear more about that. She is in the late stage of the disease. So sad to see someone progress from functioning to mentally impaired due to alcohol. Thanks for sharing that. I think most people are surprised to learn that alcohol can cause that much harm. Happy Holidays again:)
Kim Harris (author) on December 20, 2011:
Hi justateacher. I hope he remembers the skills he learned and has kept in touch with AA. Holidays are tough for people in recovery. I did a separate holiday edition hub for that:) A good intervention would be to acknowledge the risk of relapse during the holidays in a way that doesn't sound accusatory. If he gets defensive there's a good chance he has relapsed or is about to. If not, he might find some relief in talking about it. Now I want to get back to your hub on Trusting in America to read the latest comments. I'm interested in how other people would have responded. Thanks for reading and commenting, justateacher....and Happy Holidays!
Micheal from United Kingdom on December 20, 2011:
Very useful information, bookmarked and voted up.
Sadly I had a sister-in-law, she was a lovely woman who finally succumbed to alcoholism.
She went through rehab more times than I can remember, 3 brain surgeries and god knows how many complications associated with a body, that is being destroyed by alcohol.
This hub, may help someone see the early warning signs. Giving them a chance to intervene in this dread disease.
Thanks for sharing.
LaDena Campbell from Somewhere Over The Rainbow - Near Oz... on December 19, 2011:
Kim - my husband went through rehab a year and a half ago, and has stayed clean for most of that time. I fear that right now, he may be starting to relapse. I am seeing some of the signs and signals and am hoping against hope that I am wrong...informative hub...
Kim Harris (author) on September 05, 2011:
thanks jenubouka. this is one of my most read hubs, even though very few people post a comment. I appreciate that you took the time to read and comment. Thanks for the follow too. Feel free to re-post what was most helpful in the hub when you get a chance.
jenubouka on September 05, 2011:
All I can say is thank you, I will keep this article close to my finger tips.
Kim Harris (author) on July 27, 2011:
Thanks for reading and commenting Dr Bill Tollefson. One of my group members "came clean" last night about a relapse after a positive urine screen. She had a year clean. I was as concerned about the thinking that led to her relapse as I was about the thinking following her relapse; maybe more. She was thinking more clearly by the end of group, and has a more realistic picture of relapse and recovery now. Thankfully she was able to learn from her relapse experience.
Bill Tollefson from Southwest Florida on July 26, 2011:
Very Good Hub!!! I really identify with your statement "relapse is a process, not an event, and it begins with a thought". No only does relapse begin with a "thought", every addiction begins with a thought even a thought addiction. I wish more people in addiction recovery would read this article. It could really keep them out of the "pink cloud". Thanks
Kim Harris (author) on March 15, 2011:
It's amazing how many lives substance use has taken, or at least harmed. I've never heard that expression, "put the plug on the mug!" I like that. I hope you don't have copy rights on that 'cause if i can think of it in a pinch, i might want to use that phrase! Thanks so much for stopping in for a read and leaving a comment sligobay.
sligobay from east of the equator on March 15, 2011:
Thanks for the follow Kim. This is a great and informative Hub. My first hand experience in the process let's me confirm the information that you have provided. It's been ten years since I last put the plug in the jug and life couldn't be better. I'm following. Congrats on your year at Hubpages.
Kim Harris (author) on March 14, 2011:
especially if you're not the addicted one!!! Thanks Gypsy Willow. I appreciate your stopping to leave a comment.
Gypsy Willow from Lake Tahoe Nevada USA , Wales UK and Taupo New Zealand on March 14, 2011:
Excellent non blaming advice. Addiction is hard and so is coping with it even if you are not the addicte one. Thanks
Kim Harris (author) on January 06, 2011:
great feedback! Thanks rileon. this hub gets a lot of traffic, but not many comments. I was surprised to see that there was a comment here. Thanks for the emphasis on STAYING sober.
rlleon42 from United States on January 06, 2011:
Great article....getting sober is hard, staying sober...extremely hard. you give a lot of good tips to make lifestyle changes to support a happy, healthy sober life. Nice read.
Kim Harris (author) on May 09, 2010:
I am so glad you stopped by to read and comment, Valerie, and thanks for being a fan...... and a soulmate! (My profile is still under construction - as am I!)
valeriebelew from Metro Atlanta, GA, USA on May 09, 2010:
Very informative hub, and well written. I'm about to check your profile to see if you are also an addiction counselor, as I am. If so, with your love of dogs, and the same profession as mine, we are definitely soul mates. (: v
Kim Harris (author) on May 02, 2010:
Thank you Daniel. I'm honored.
Daniel Carter from Salt Lake City, Utah on May 02, 2010:
Great article, kim. Looking forward to more great reads, as well!
Kim Harris (author) on April 30, 2010:
Thanks for stopping by to post a comment frankiesgirl. It's good to "see" you again. Keep on feeling!
FrankiesGirl6Yr from South Carolina on April 29, 2010:
Relapse Prevention is a need to know coping mech. It seems like everyone can voice their opinion on how to quit, but staying clean seems to be over looked. One you have completed recovery there is a huge void that feels like it needs to be filled. You just dropped something that took up 100% of your time,effort, and reason to go on. Now that it is gone What are you suspose to do. That is something I struggled with for a long time and I continued to relapse until I figured out I HAVE to feel this time.
Again Great Job
Kim Harris (author) on April 29, 2010:
thanks for sharing your experience and making my hub richer, wordscribe.....which is a really fitting pen name for you, btw.
wordscribe41 on April 28, 2010:
At first getting sober was a full time job for me. I remember people getting frustrated I was always off doing recovery-oriented work. I like how you mention this, because it's not something family member think about when their loved ones get sober. This is a wonderful hub, filled with a very honest appraisal of the recovery process. No doubt it is a process, thankfully one that gets easier with time. Thanks for linking my hub to yours. Cheers!
Kim Harris (author) on April 28, 2010:
Thanks Micky. Appreciate your taking time to check it out.
Micky Dee on April 28, 2010:
Great hub Kim. It's good to replace that bad habit with a better habit sometimes. Thanks for another great hub!
Kim Harris (author) on April 17, 2010:
I think those messages still abound. I'm glad to know you didn't pick up on any shaming messages in my article. They do so much more harm than good. Thanks for taking time out to read.
Vernon Bradley from Yucaipa, California on April 17, 2010:
Excellent easy to read "stuff," without any hint of "come on, suck it up, it's hard, but you can do it, what's wrong with you if you can't?" I don't know if anyone still says that kind of thing, they probably do, but those are the shame voices I have had to evict from my brain to support my on going recoovery from "Oh gosh, what is it for today? The brain workings around adiction are fascinating and sometimes very helpful to me in making a decision to avoid the halt stuff. Anywho, thanks for another great hub! And I don't know how that works, but I like the idea of coauthoring a hub! cogluingcomments into a hub!
Kim Harris (author) on April 17, 2010:
ADAT! That's awesome....music to my ears:)
selrach on April 17, 2010:
Very good hub.I have had to learn a lot about what my triggers are.Living sober is hard but I am getting there.
Kim Harris (author) on April 17, 2010:
Thanks billy. Come back though. I just added a cartoon I think you'll enjoy!
billyaustindillon on April 17, 2010:
Excellent advice for a very challenging period for people trying to recover.