Addiction recovery is a lifelong struggle. Some people won’t tell you that, but it’s absolutely true. Those of us who have underestimated the strength of our addiction in the past would give just about anything to turn back the clock in time to learn this all-important lesson.
Some of us have stayed sober for years before finding ourselves back at the bar. Others among us have only lasted days. But regardless of how long it took for us to relapse, we always found ourselves wondering how it had happened. Some of us had been going to meetings, meeting with our sponsors, and possibly even becoming sponsors ourselves. If this was not enough to ensure relapse prevention, then we were at a loss.
Relapse prevention can be a tricky subject. We will make an upfront admission that the same methods will not work with equal success for each and every individual who struggles with alcoholism or addiction.
Still, there are some basic tools that are worth remembering for those who fear either their own relapse or the relapse of an individual for whom they care deeply. Below, we will discuss relapse prevention tools not only for the recovering addict, but also for the addict’s friends and family. First, however, we will discuss a few facts and statistics which underscore the importance of relapse prevention in a world of temptation.
This article is part of our series on substance abuse.
Why We Need Relapse Prevention
The need for addiction treatment is something we have previously talked about in our discussion of addiction statistics and demographics. We noted that relapse rates for substance abuse disorders are similar to the relapse rates for other disorders. At a rate of 40% to 60% for those who have been treated, relapse rates for drug addiction are only slightly higher than relapse rates for diabetes (30% to 50%) and lower than relapse rates for asthma or hypertension (50% to 70%). This relapse rate is commonly accepted by most treatment centers, having been calculated by the National Institute on Drug Abuse.
These basic relapse rates do not paint a full picture, as it is now believed that relapse rates may be directly related to the amount of time the addict or alcoholic has spent in treatment. One NIDA study showed that patients who were in treatment for less than 90 days had similar relapse rates to patients who were only in treatment for one or two days. Another NIDA study, focusing solely on cocaine addicts, showed a relapse rate of 35% for those who were in treatment for less than 90 days, but a relapse rate of only 17% for patients who were in treatment for 90 days or more.
Relapse rates for those who have not entered treatment can be even scarier. We have noted in previous articles that the key to staging a successful intervention is to ensure that the addict or alcoholic agrees to enter treatment. But not every intervention is successful. For those who receive an intervention but do not enter treatment, relapse rates may be as high as 90%. When the range of relapse rates under various circumstances can be anywhere from 17% to 90%, relapse prevention becomes a clear necessity. Without proper relapse prevention tools, we are essentially playing a deadly game of roulette in which the prize is a possible overdose.
These numbers may be discomforting, but they only amount to half of the need for relapse prevention. The other half stems from the mere fact that relapse itself is often misunderstood. When most people think of relapse, they think of physical relapse (the actual act of drinking or using drugs). But physical relapse is often preceded by at least one of two things: mental relapse and/or emotional relapse.
Emotional relapse is common in early recovery, although addicts who do not practice relapse prevention strategies may be prone to emotional relapse later on. Recovery is stressful, and most of us are accustomed to substance abuse as a means of handling stress. Emotional relapse may also be common among those who are having a rough time during the detoxification process. It is common to experience depression as the toxins leave your system, especially when experiencing post-acute withdrawal syndrome, or PAWS. Even extreme happiness may lead to an emotional disturbance and result in relapse, as it becomes easy under such conditions to drop our defenses.
Mental relapse may be steeped in denial and cognitive dissonance, as we know the dangers of our addiction but will begin to reason that we can continue using again without consequence. While emotional relapse is often caused by failure to adopt relapse prevention strategies, mental relapse often occurs when the addict begins actively planning their next fix. Not only will our denial convince us that there is no harm in using again, but we will convince ourselves that the benefits of our old way of life outweighed the massive consequences. Relapse prevention is necessary if we are to stave off this deadly manner of thinking. Otherwise, it will not be long before we find ourselves using again.
Relapse Prevention for the Addict
There are several ways in which addicts and alcoholics may practice relapse prevention, although each person may have to experiment with a few different methods before figuring out what works best for them. The most common tips are to attend meetings daily for the first 90 days (and to continue going as frequently as possible after that), make daily sponsor contacts, read recovery-related literature every day, and find some method of performing service work. Those who graduate treatment programs and move on to inhabit sober living facilities will find these tips easy to incorporate into their daily lifestyle, as they will be surrounded by people who are doing the same things.
This brings us to the next important tip, which is to build and maintain a strong and sober support network. Again, inhabiting a sober living environment is the easiest way to do this. Others may accomplish this task by going to 12-step meetings and asking fellow addicts or alcoholics for their contact information. While it is important to have a sponsor, it is also important for us to have at least a few other trusted friends and family members we can call when our sponsor is unavailable. We never know when those contacts may come in handy, and possibly even save our lives.
Note that these contacts should not just be used as shoulders to cry on when we are going through a mental or emotional relapse. We can also use these contacts to hold ourselves accountable. If we are to be put in a situation in the near future that we fear may result in temptation, we can confide in our support network. For instance, let’s say that we are going to board an airplane for the first time since we entered recovery, and we have a long history of drinking on planes. Telling others about this fear will not technically prohibit us from drinking, but the sense of accountability we have to our support network will aid in our relapse prevention. We will not want to drink, because we will feel as if we are letting people down.
One of the most important relapse prevention tools, however, is the simple act of planning ahead. Yes, we should live our lives one day at a time. But that does not mean that we should be wholly unprepared for situations that may challenge our recovery. If we do not know how we will react to a given situation, then there is a frightening chance that we will react in the wrong way. And some situations are more difficult to plan for than we would imagine.
For instance, what will you do if a friend offers you drugs or alcohol? Will you simply say “no” and walk away? Will you tell them that you are in recovery? What if you wish to retain your anonymity, but they continue to badger you about the issue? You must anticipate such situations, or else you run the risk of giving in and succumbing to peer pressure.
Not only must you plan for such instances, but you must also know your triggers. Relapse triggers may be largely emotional, such as anger, anxiety, or depression. There are, however, many physical triggers. Seeing certain people or certain locations may cause us to remember our using days, and it can become difficult to think of anything else. While there is no such thing as a geographical cure, it might be advisable to avoid locations in which we have frequently used our drug of choice.
All of the above tips are important, but we would also suggest for those who are serious about relapse prevention to seek out some form of cognitive behavioral therapy. There is a specific form of therapy called mindfulness-based cognitive therapy, which has proven just as effective in relapse prevention as most antidepressants. In truth, any form of therapy may be at least somewhat beneficial, as it gives us another outlet through which we may discuss our triggers—whether emotional or otherwise—and formulate a plan to deal with them in the future.
Since mindfulness therapy (and cognitive behavioral therapy in general, for that matter) is based largely on understanding one’s own thoughts and behavior, it would be prudent to practice other activities meant to build mindfulness. Zen sitting meditation and walking meditation may both be used to this end. There is also something to be said for maintaining proper nutrition, as it can promote better mental health. There are a number of tools and tips for relapse prevention that may be of use to you, but the ultimate goal is to keep yourself happy and healthy. The better you feel about yourself, the less likely you are to attempt an escape through substance abuse.
Relapse Prevention for the Family
We will not spend as much time on this section, as relapse prevention is not the family’s responsibility. That said, those who are truly supportive of the addict or alcoholic in their lives will also be supportive of their relapse prevention plan. Chapter 9 of Alcoholics Anonymous warns that the family must let the alcoholic in their lives do what is necessary to stay sober. It can be frustrating to work around someone’s meeting schedule, but the results of skipping those meetings could be absolutely devastating.
There may be other times at which living with a recovering addict or alcoholic can be frustrating as well. Some of us have become rather pompous once we began to feel as if the majority of our character defects were behind us. This is not what recovery is all about, and this startling lack of humility usually caught up with us. The most the family can do under such circumstances is to avoid exacerbating the situation. When the family receives criticisms on their character from someone who has hurt them time and time again, it can be tempting to lash out and remind them that they were not always so dignified. But those who lack humility to this degree are often overcompensating for their guilt. As long as they keep going to meetings and contacting their sponsor, someone will correct them eventually. Attacking them on a personal level will run the risk of shattering their illusion too suddenly, and they may return to their substance abuse if they are unable to handle the emotional fallout.
When there has been a history of codependency (or even sometimes when there has not), the best thing to do may be to establish some firm boundaries. If you possess the financial means to have them tested for drugs, then this can be extremely helpful. It may sound harsh, but it will help them to hold themselves accountable. Even if you cannot test them, you should lay out the consequences that they will face if they relapse. These consequences should not be mild—make it clear that they are fighting for their life. The hardest part, of course, will be following through on these consequences if they do relapse. It can be hard, but the pain suffered by the addict or alcoholic who feels as if they have lost their family can often be enough to ward off future relapses.
For at least a while, the family should probably refrain from drinking around the addict or alcoholic in question. Later in recovery, this will no longer be quite as important to their relapse prevention. But early on, seeing the family nursing an alcoholic beverage can act as a major trigger. The family should learn about some of the other triggers that the addict has identified while devising their own relapse prevention strategies, so as to help ensure they do not encounter these triggers too often. Again, relapse prevention is not the sole responsibility of the family. Still, the avoidance of triggers may require all hands on deck for a while.
More importantly than anything else, the family and friends of the alcoholic should look after themselves. You should try to learn a bit more about the nature of addiction, and you should seek out some channels of support if you are having trouble coping with your loved one’s disease. But aside from that, the most important thing for you to do is look after yourself. Just as the addict must practice relapse prevention in order to avoid reverting to substance abuse, you must practice your own form of relapse prevention so that you do not revert back to codependent behaviors such as enabling.
Relapse prevention may require the assistance of the entire family unit at first, but you should all eventually grow stronger in your recovery. Just remember that, much as the addict must keep their defenses up regardless of how long they have been sober, you must continue to defend against the tendency toward enabling. The family unit might never feel quite like it did prior to recovery, but a big part of relapse prevention is accepting that these are good changes. We shouldn’t give them up for anything in the world. For the memory of what life was like in active addiction, whether from the point of view of the addict or of the family, is one of the strongest relapse prevention tools of all.
I agree with what you said about how the family of a recovering alcoholic needs to remain supportive even though it may be difficult. My brother decided to quit drinking cold turkey and I think he needs more help. I’ll be sure to do my best to stay supportive as we look for some help for him.