Alcohol Awareness Month: What is a Relapse Prevention Plan? Part One

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Recovery, like life, is filled with ups and downs, highs and lows, successes and setbacks – which is why anyone who enters recovery needs to accept the fact that relapse is real, relapse happens, and the best way to both prevent and recover from relapse is to have a solid relapse prevention plan.

To clarify, relapse is when a person in recovery from alcohol and/or drug use returns to using alcohol or drugs after a period of abstinence. Relapse is not exclusive to the disease of addiction, which we now refer to as the disordered use of substances. We diagnose people with alcohol use disorder (AUD), opioid use disorder (OUD), and cannabis use disorder (CUD), for instance.

For general use, we say substance use disorder (SUD) and person with a SUD, or person with AUD. We use person-first language and foreground the disease model of addiction with this new terminology, which reduces stigma and allows us to understand AUD/SUD the way we understand other medical conditions that also require evidence-based support and have a real risk of relapse, such as diabetes and hypertension.

We should also clarify what we mean by recovery. There are various accurate and helpful definitions of recovery, each of which focuses on different aspects of the process. This definition, proposed in a paper published in 2019, works very well and aligns with our current understanding of the complexity of the recovery process:

“Recovery is an individualized, intentional, dynamic, and relational process involving sustained efforts to improve wellness.”

The concept of relapse prevention is not exclusive to the disordered use of alcohol or substances, either. Consider these five rules of recovery, published in the peer-reviewed journal article “Relapse Prevention and the Five Rules of Recovery.”

The Five Rules of Recovery

Recovery involves:

  1. Behavioral change
  2. Total honesty
  3. Asking for help
  4. Practicing self-care
  5. Sticking to your plan

A team of therapists and psychiatrists created those rules for people in recovery from alcohol or drug use, but they could well have been created by a team of cardiologists for a person with heart disease, or a specialist creating rules for a person with diabetes.

Alcohol Awareness Month: Relapse Prevention

Every year during the month of April in the U.S., we recognize Alcohol Awareness Month in order to raise awareness about the dangers of alcohol consumption, alcohol use disorder (AUD), increase knowledge about evidence-based treatment for AUD, and reduce stigma about AUD and the treatment and recovery process. To learn more about Alcohol Awareness Month, please navigate to the blog section of our website and read this article:

Alcohol Awareness Month 2024

To learn more about how we define recovery, please read these articles by our Chief Medical Officer Dr. Chris Johnston on the website Medium:

What is Recovery? Abstinence, Sobriety, or Something Completely Different?

Recovery, Recovered, Recovering: New Definitions Acknowledge the Process of Recover

To increase your knowledge about the role of relapse prevention in the big picture, please read this article on our blog:

Relapse Prevention: The Aftercare Plan

The title of that article is the perfect entry to discussing relapse. Aftercare is everything related to health, recovery, and wellness that happens after a formal treatment program is finished. An aftercare plan includes items like first doctor’s appointments, community support meeting times, self-care activities, connections to vocational, housing, education, and food support, and – the topic of this article – a relapse prevention plan.

What is Relapse? An Expanded View

As we mention above, in this context relapse means a return to alcohol or drug use after a period of abstinence. That’s a good, basic understanding of relapse, which we’ll elaborate on now. The authors of the study cite above – Relapse Prevention and the Five Rules of Recovery – identify three distinct stages of relapse: emotional, mental, and physical. Here’s what they mean by that.

Emotional Relapse

One way to think about this stage of relapse is like an iceberg. Emotional relapse is everything going on under the surface before a relapse. It’s not a perfect analogy, because the precursors to relapse are felt by the person and may be seen by their peers. Signs of emotional relapse include:

  • Denying, ignoring, or not talking about emotions
  • Self-isolation/withdrawal
  • Reduction in frequency of attending community support meeting
  • Stopping going to meetings
  • Attending meetings without participating
  • Getting distracted trying to solve other people’s problems
  • Unhealthy eating habits
  • Poor sleep hygiene

The thread that connects the elements of emotional relapse is an overall decline in self-care, which means the person in recovery neglects their physical, emotional, and psychological health.

Mental Relapse

During this stage, the person in recovery recognizes that they want to return to alcohol or drug use. If the person in recovery does not intentionally interrupt this stage and analyze the preceding emotional stage, likelihood of relapse increases. Signs of mental relapse include:

  • Increased frequency of cravings for alcohol/drugs
  • Increased intensity of cravings for alcohol/drugs
  • Thinking often about past use
  • Glamorizing/mythologizing past use
  • Denying negative consequences of past use
  • Lying and bargaining in relation to past use
  • Spending time planning ways to use alcohol/drugs
  • Looking for opportunities to use alcohol/drugs
  • Proactively planning relapse

Physical Relapse

This stage is actual relapse to alcohol or drug use. Some addiction professionals distinguish between a one-off, short relapse – a slip or a lapse – and a full relapse, which means a longer return to alcohol or drug. In either case, researchers indicate:

  • Most physical relapses are relapses of opportunity
    • A person in recovery thinks they can return to use without accountability to themselves or others
  • Physical relapses lead to uncontrolled mental and emotional relapse
    • Increases likelihood of repeated physical relapse, i.e., prolonged return to use

Researchers and clinicians recognize that effective coping skills along the continuum of relapse can reduce risk of relapse, and the absence of the ability to interrupt the stages of relapse at any point – emotional, mental, or physical – increases risk of relapse.

That’s why a relapse prevention plan is an essential component of any aftercare plan or long-term recovery plan.

What is a Relapse Prevention Plan?

A relapse prevention plan is something a person in recovery designs – with the help of their therapists, counselors, and recovery peers – to reduce the risk of relapse. A robust relapse prevention plan includes practical, actionable tools to help a person in recovery increase emotional/psychological self-awareness, recognize the emotional and psychological factors that increase risk of relapse, called triggers, actionable tools to use in order to manage triggers, and finally, a plan for steps to take if relapse happens.

We adapted the template we share below from a program developed and published by the Hazelden Betty Ford Foundation called “Living in Balance (LIB),” with supporting research published by the National Institute on Drug Abuse (NIDA) in the report “Approaches to Drug Abuse Counseling.”

Marlett and Gordon, the therapists/researchers who developed the cognitive-behavioral approach to relapse prevention that serves as the theoretical basis for the LIB relapse prevention template, describe the chain of events that most often precede a relapse to alcohol or drug use, sometimes called a slip:

“A person headed toward a slip makes numerous small decisions at the time which, although seemingly small and irrelevant at the time they are made, actually bring the individual closer to the brink of the slip. A chain of small decisions can lead, over time, to relapse.”

A person in recovery and their counselor/therapist acknowledge this phenomenon when they create a relapse prevention plan. In essence, they recognize the stages of relapse, the necessity of identifying them, and the benefit of intervening in them.

The LIB template can help people in recovery:

  • Identify triggers
  • Understand how triggers lead to relapse
  • Interrupt the stages of relapse at any point
  • Manage triggers
  • Return to recovery if relapse happens

To see an example of a template based on the LIB model, read the next article in this two-part series: Alcohol Awareness Month: What is a Relapse Prevention Plan? Part Two.

The materials provided on the Pinnacle Blog are for information and educational purposes only. No behavioral health or any other professional services are provided through the Blog and the information obtained through the Blog is not a substitute for consultation with a qualified health professional. If you are in need of medical or behavioral health treatment, please contact a qualified health professional directly, and if you are in need of emergency help, please go to your nearest emergency room or dial 911.