A Relapse Prevention Plan: Early Warning Signs and Tools of Recovery
6 Min Relapse Prevention Video
10 Most Common Triggers of Substance Abuse Relapse
- Withdrawal symptoms (anxiety, nausea, physical weakness)
- Post-acute withdrawal symptoms (anxiety, irritability, mood swings, poor sleep)
- Poor self-care (stress management, eating, sleeping)
- People (old using friends)
- Places (where you used or where you used to buy drugs)
- Things (that were part of your using, or that remind you of using)
- Uncomfortable emotions (H.A.L.T.: hungry, angry, lonely, tired)
- Relationships and sex (can be stressful if anything goes wrong)
- Isolation (gives you too much time to be with your own thoughts)
- Pride and overconfidence (thinking you don’t have a drug or alcohol problem, or that it is behind you)
The Stages of Relapse
Relapse is a process, it's not an event. In order to understand relapse prevention you have to understand the stages of relapse. Relapse starts weeks or even months before the event of physical relapse. In this page you will learn how to use specific relapse prevention techniques for each stage of relapse. There are three stages of relapse.(1)
- Emotional relapse
- Mental relapse
- Physical relapse
In emotional relapse, you're not thinking about using. But your emotions and behaviors are setting you up for a possible relapse in the future.
The signs of emotional relapse are:
- Mood swings
- Not asking for help
- Not going to meetings
- Poor eating habits
- Poor sleep habits
The signs of emotional relapse are also the symptoms of post-acute withdrawal. If you understand post-acute withdrawal it's easier to avoid relapse, because the early stage of relapse is easiest to pull back from. In the later stages the pull of relapse gets stronger and the sequence of events moves faster.
Early Relapse Prevention
Relapse prevention at this stage means recognizing that you're in emotional relapse and changing your behavior. Recognize that you're isolating and remind yourself to ask for help. Recognize that you're anxious and practice relaxation techniques. Recognize that your sleep and eating habits are slipping and practice self-care.
If you don't change your behavior at this stage and you live too long in the stage of emotional relapse you'll become exhausted, and when you're exhausted you will want to escape, which will move you into mental relapse.
Practice self-care. The most important thing you can do to prevent relapse at this stage is take better care of yourself. Think about why you use. You use drugs or alcohol to escape, relax, or reward yourself. Therefore you relapse when you don't take care of yourself and create situations that are mentally and emotionally draining that make you want to escape.
For example, if you don't take care of yourself and eat poorly or have poor sleep habits, you'll feel exhausted and want to escape. If you don't let go of your resentments and fears through some form of relaxation, they will build to the point where you'll feel uncomfortable in your own skin. If you don't ask for help, you'll feel isolated. If any of those situations continues for too long, you will begin to think about using. But if you practice self-care, you can avoid those feelings from growing and avoid relapse. (Reference: www.AddictionsAndRecovery.org)
In mental relapse there's a war going on in your mind. Part of you wants to use, but part of you doesn't. In the early phase of mental relapse you're just idly thinking about using. But in the later phase you're definitely thinking about using.
The signs of mental relapse are:
- Thinking about people, places, and things you used with
- Glamorizing your past use
- Hanging out with old using friends
- Fantasizing about using
- Thinking about relapsing
- Planning your relapse around other people's schedules
It gets harder to make the right choices as the pull of addiction gets stronger.
Techniques for Dealing with Mental Urges
Play the tape through. When you think about using, the fantasy is that you'll be able to control your use this time. You'll just have one drink. But play the tape through. One drink usually leads to more drinks. You'll wake up the next day feeling disappointed in yourself. You may not be able to stop the next day, and you'll get caught in the same vicious cycle. When you play that tape through to its logical conclusion, using doesn't seem so appealing.
A common mental urge is that you can get away with using, because no one will know if you relapse. Perhaps your spouse is away for the weekend, or you're away on a trip. That's when your addiction will try to convince you that you don't have a big problem, and that you're really doing your recovery to please your spouse or your work. Play the tape through. Remind yourself of the negative consequences you've already suffered, and the potential consequences that lie around the corner if you relapse again. If you could control your use, you would have done it by now.
Tell someone that you're having urges to use. Call a friend, a support, or someone in recovery. Share with them what you're going through. The magic of sharing is that the minute you start to talk about what you're thinking and feeling, your urges begin to disappear. They don't seem quite as big and you don't feel as alone.
Distract yourself. When you think about using, do something to occupy yourself. Call a friend. Go to a meeting. Get up and go for a walk. If you just sit there with your urge and don't do anything, you're giving your mental relapse room to grow.
Wait for 30 minutes. Most urges usually last for less than 15 to 30 minutes. When you're in an urge, it feels like an eternity. But if you can keep yourself busy and do the things you're supposed to do, it'll quickly be gone.
Do your recovery one day at a time. Don't think about whether you can stay abstinent forever. That's a paralyzing thought. It's overwhelming even for people who've been in recovery for a long time.
One day at a time, means you should match your goals to your emotional strength. When you feel strong and you're motivated to not use, then tell yourself that you won't use for the next week or the next month. But when you're struggling and having lots of urges, and those times will happen often, tell yourself that you won't use for today or for the next 30 minutes. Do your recovery in bite-sized chunks and don't sabotage yourself by thinking too far ahead.
Make relaxation part of your recovery. Relaxation is an important part of relapse prevention, because when you're tense you tend to do what’s familiar and wrong, instead of what's new and right. When you're tense you tend to repeat the same mistakes you made before. When you're relaxed you are more open to change. (Reference: www.AddictionsAndRecovery.org)
Once you start thinking about relapse, if you don't use some of the techniques mentioned above, it doesn't take long to go from there to physical relapse: going to get a drink; calling your dealer for example for opioids, cocaine, or marijuana.
It's hard to stop the process of relapse at that point. That's not where you should focus your efforts in recovery. That's achieving abstinence through brute force. But it is not recovery. If you recognize the early warning signs of relapse, and understand the symptoms of post-acute withdrawal, you'll be able to catch yourself before it's too late.
1) The stages of relapse were first described by Terence Gorski. Gorski, T., & Miller, M., Staying Sober: A Guide for Relapse Prevention: Independence Press, 1986.
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Last Modified:February 7, 2018
Addiction can be an ongoing struggle for many people, even after they complete an intensive treatment program; periodic relapses are not uncommon. Relapse-prevention planning is crucial, then, for maintaining long-term sobriety.
In its simplest terms, relapse occurs when you have abstained from using drugs for any period of time and then use again. This use may be a brief, one-time lapse in abstinence, which is often called a slip, or it may be a binge that involves using drugs in large amounts or repeatedly. In either situation, relapse does not mean you cannot get back on the road to recovery. However, it may indicate that underlying issues are not being managed effectively or that you could benefit from recommitting yourself to your sobriety.
The first six months of recovery is when a large percentage of relapses occur—studies demonstrate that between 66% to 80% of relapses occur in the first 6 months after treatment.1 Relapses can be motivated or influenced by changes made previously to the brain during active drug use, or by the experience of uncomfortable feelings, pain, stress, or a combination of these factors. With this in mind, creating a solid drug relapse-prevention plan before you leave inpatient treatment is a great proactive step to protect your sobriety.
Contributing Factors to Relapse
Any number of factors may play a contributing role in a relapse, so part of a successful drug relapse-prevention plan is knowing and recognizing the signs of specific high-risk situations and applying effective relapse-prevention skills to maintain sobriety. Common contributing factors to relapse may include:2
Successful RecoveryIf you are aware of the signs of relapse and how you can protect yourself from falling back into a cycle of addiction, you are in a better position to protect yourself against relapse in the future.
- Emotional or mental health issues: Negative emotional states such as depression, anger, anxiety—or even boredom—often create high-risk situations associated with relapse. You may use drugs to avoid experiencing these uncomfortable emotions. An unmanaged mental health issue can be one of the highest risk factors for relapse.
- Conflict: Situations involving conflict with other people can leave you feeling anxious and upset, which could eventually lead to relapse.
- Social pressure: Social pressure includes both verbal and nonverbal pressure from friends or people in your social circles. This pressure may seem harmless, such as being around people who are using drugs, or it may be direct, such as a friend teasing you about not using. Any social situation where drugs are being used makes it easy for you to relapse—avoid them at all costs.
- Celebrations or other positive events: Weddings, sporting events, graduations, and other special events— generally viewed as positive activities, yet ones that are often associated with alcohol or other substance use and may therefore play a large role in relapse. You may have used drugs to celebrate or to enhance positive feelings, so be aware of this as another risk factor in relapse.
In many cases, the path to relapse occurs long before you actually use drugs, so a vital component of relapse prevention is to learn how to detect the early warning signs of potential problems that might steer you toward relapse. By identifying these factors, you can take positive steps to remain on your path to recovery. And the better you are at spotting the signs of possible relapse, the earlier you can take action to ensure long-term sobriety.
Many people identify the following warning signs as issues that will challenge their sobriety:3,4
- Frequenting old using grounds or hanging around drug-using friends
- Keeping drugs in your home for any reason
- Isolating yourself from friends or support groups
- Constantly thinking about using drugs
- Quitting therapy, skipping scheduled appointments, or veering away from your addiction treatment program
- Overconfidence or feeling as though you no longer need support
- Relationship conflicts
- Being too hard on yourself or setting impossible goals
- Abrupt or sudden changes in eating or sleeping habits, personal hygiene, or energy levels
- Feelings of confusion, depression, uselessness, anxiety, stress, or being overwhelmed
- Boredom or irritability, usually stemming from a lack of structure
- Refusing to deal with personal problems related to daily life events
- Replacing drugs with other obsessive behaviors such as gambling
- Major life changes that cause intense emotion such as grief, trauma, or extreme elation
- Thinking that “just one time” won’t hurt
- Physical illness or pain
It is not uncommon for you to relapse at least once during recovery. It may happen when thoughts of using drugs resurface in the early stages of recovery. Changes in your attitude, behavior, thoughts, feelings, or disruption to routine can be early warning signs of an impending relapse.3 Developing and following an effective relapse-prevention plan can help stay ahead of a relapse.
Tips for Successful Relapse Prevention
While in early recovery, you may experience warning signs of relapse. However, relapse is not inevitable. There are many effective ways to prevent relapse, such as:
- Since drug use can alter brain pathways and impair your ability to regulate emotions and deal with stressful situations, to prevent relapse, it is important to learn how to deal with all of your emotions, both positive and negative.3,4 Ignoring day-to-day problems can create a buildup of stress, which can increase the likelihood of relapse.
- Because stress is a huge relapse trigger, it is important to learn how to maintain a balance in your life. An essential component of drug-relapse prevention, then, is to find ways to balance work and relaxation. This can include incorporating hobbies, exercise, socialization, or other enjoyable activities that can help you lower your stress levels and discover that life in recovery can be fun.2
- Learn how to manage high-risk situations.2 Weddings, holidays, or even spending time with family and friends can be triggering. Avoiding high-risk situations isn’t always possible, so it is important to plan ahead for how you will deal with them.
- Urges will occur, so part of a relapse-prevention plan is learning how to ride out the urge until it passes.2 Urge-surfing focuses the mind on experiencing the feelings of the urge, both physical and mental, and allowing you to distract yourself from thoughts of using.
- Building a sober support group is vital to your recovery. Friends, family, addiction professionals, and sober peers can all become part of your support group to help you maintain sobriety.
As we discussed before, identifying high-risk situations and mapping out a plan to deal with them is an essential component to your relapse-prevention plan. This is a great task to work on with your therapist as you work through all the potential landmines on your road to long-term recovery.
Begin by asking yourself several key questions to identify your personal high-risk situations:
- Are there specific days you used drugs, such as holidays or weekends, or were you a daily user?
- Are there specific times of day when you experience cravings most often?
- What specific locations are associated with your drug use?
- Who have you used drugs with in the past?
- Have you ever used because of your emotions? Which ones?
- What positive effects have you experienced from using drugs?
- What negative consequences have you experienced from using drugs?
The best relapse-prevention strategy is to identify these situations in your life, then make sure to have a specific plan in place to deal with each one. Ask a supportive friend or family member to role-play ways to refuse or avoid drugs, so that it feels comfortable and natural. Many recovering individuals find that bringing a member of their sober support group to what they know will be a challenging situation can make it easier to stay abstinent. Having an escape plan from one of your identified triggering situations (parties, a specific person’s house, a neighborhood restaurant) is also helpful so that you can leave if others start using or you start to feel a strong urge to use. Offering to be a designated driver can also help you stay sober and maintain control of the situation.
Relapse can be discouraging, but it doesn’t mean an end to sobriety. Please call our confidential helpline at 1-888-287-0471 Who Answers? to speak with a treatment support specialist. They can help connect you to drug addiction treatment resources today.
Negative Feelings and Cravings
Post-drug TreatmentRecovery from drug addiction is a long process. For many, successful long-term recovery requires work that extends beyond the initial treatment period. Read More
People in early recovery are often taught that they are more likely to relapse when they are hungry, angry, lonely, or tired—otherwise known as the acronym, HALT. Stress and other negative emotions can also increase your cravings to use.3 Experiencing uncomfortable feelings, such as fear, boredom, anxiety, stress, anger, frustration, or sadness are especially difficult when you are in early recovery, making it appealing to turn to your drug of choice to manage these feelings.1
So learning how to regulate your emotions appropriately is another essential feature of an effective relapse-prevention plan. A few ways to help you regulate your emotions is speaking to a support group, exercising, or practicing other distraction techniques, such as reading, watching television, or listening to music while the feelings pass. Following a healthy daily routine can also help you reduce stress, so focus on managing your small daily stressors, eating a healthy diet, and getting adequate amounts of rest.2
Specific Actions to Cope with Cravings
After identifying situations where problematic cravings may arise, list the specific steps you will take to manage them, including:2
- Listing the names and phone numbers of supportive friends or familywho you can speak to about your cravings. Ideally, choose people who won’t judge you for experiencing a craving but can be encouraging and supportive. Speaking to others in recovery can help you gain insight into how others successfully manage cravings.
- Reaching out to a member of your support group. They can help change your perspective and talk you through the craving, or just keep you company until is passes.
- Preparing to distract yourself so that you aren’t focused on the craving. Healthy distractions may include cleaning, exercising, meditation, or anything else that will take your mind off the craving. While it feels interminable, cravings will eventually pass.
- Keeping a record of the successful ways you’ve coped with past cravings, and referring to this often.
- Switching your focus from the craving and thinking about all the positive experiences or growth you have made. List all the things you are grateful for.
- Writing down a list of all of the negative consequences you have experienced due to your drug use, and if you have an urge, referring to this list to help remind you why you no longer use.
Specific Thoughts to Cope with Cravings
Training your mind to think positive thoughts is an important step in managing cravings and drug relapse prevention. A few ways to do this include:2
- Remembering how bleak things seemed when you were using drugs.
- Thinking about the reasons you stopped using drugs and referring to the list of negative consequences that your drug use has caused.
- Reminding yourself that your cravings are a normal part of recovery and that you do not have to give into them.
- Visualizing the cravings as waves that you have to ride out. Urge-surfing is a technique that focuses your mind on the physical and mental experience of the craving, rather than giving in to the urge to use.
- Being positive. Encourage yourself by remembering your successes each time your cravings become intense.
Planning out each step you need to take to reach these goals is worth the time you invest in doing it because reaching these goals means actively building up safeguards for your recovery, rather than just hoping that challenges won’t arise. Celebrate your small milestones too. Self-help meetings are great at helping you do this and providing incentives to stay clean, such as coins or key tags earned for increments of sobriety. Surround yourself with people who celebrate with you.
Coping with Relapse
While having a relapse prevention plan in place is important, it does not guarantee sobriety. In fact, relapse is often considered a natural part of recovery. Even though you may know this, when you do relapse, you may be overwhelmed by feelings of guilt, shame, frustration, anger, or fear. If these emotions are not dealt with properly, the relapse can become a full-blown reversal into regular drug use.
Instead, try to view a relapse as a signal that you could use additional treatment to support your recovery efforts. You may also discover that an underlying mental health issue is affecting your sobriety and can work toward treating it. Either way, don’t try to manage alone. Reach out and ask for the help you need.
With your therapist, sponsor, and support group, recommit to your sobriety, talk through your struggles, and if needed, seek a treatment program. Managing the aftermath of a relapse is difficult, but support is available to help you normalize your experience and encourage you to get and stay sober.
It helps to remind yourself that no matter how stressful things get, or how bad your life may seem, the benefits of abstaining from using drugs outweigh the short-term relief you might gain from using again. Recovery is a long-term process, and the cravings, risk of relapse, and uncertainty will fade with time. Relapse-prevention planning means finding new ways to deal with life and all that it brings.
For more information on drug addiction treatment, please call our confidential helpline at 1-888-287-0471 Who Answers? . Treatment placement specialists can help you understand your options.
- Ramo, D.E. & Brown, S.A. (2008). Classes of substance abuse relapse situations: A comparison of adolescents and adults. Psychology of Addictive Behaviors: Journal of the Society of Psychologists in Addictive Behaviors, 22(3), 372–379.
- Larimer, M.E., Palmer, R.S. & Marlatt, G.A. (1999). Relapse prevention: An overview of Marlatt’s Cognitive-Behavioral model.Alcohol Research & Health, 23(2), 151–160.
- Shafiel, E., Hoseini, A.F., Bibak, A. & Azmal, M. (2014). High risk situations predicting relapse in self-referred addicts to Bushehr province substance abuse treatment centers.International Journal of High Risk Behaviors & Addiction, 3(2).
- Sinha, R. (2011). New findings on biological factors predicting addiction relapse vulnerability.Current Psychiatry Reports, 12(5), 398–405.