Relapse Prevention

A lapse refers to an initial episode of substance use following a period of abstinence. A lapse may or may not lead to more substance use. Clients always run the risk that a lapse will turn into a relapse, in which they continue to use alcohol or other drugs. A lapse or relapse is the last link in a chain of decisions, and how one responds to an initial lapse has a big impact on whether or not one has a full-blown relapse. The goals of this chapter are to understand the difference between lapse and relapse, to learn about relapse prevention strategies, and to learn to identify and manage relapse warning signs and high-risk factors.

Mutual Support Programs and Recovery Clubs

Numerous mutual support programs exist to help clients cope with substance use problem. The most common of these programs are Alcoholics Anonymous (AA), Narcotics Anonymous (NA), and other 12-step programs. All mutual support programs involve people with alcohol or drug problems helping each other. Some people maintain lifelong involvement in mutual support programs, and others use them for a limited period of time. Although programs vary in philosophies and approaches, most involve fellowship, recovery meetings, program steps or guidelines, recovery literature, social events, and internet resources. Some areas have recovery clubs or clubhouses for people in recovery. These provide an alcohol- and drug-free environment in which one can attend recovery meetings or other social events. The goals of this chapter are to learn about the different types of mutual support programs available and to determine which type of program may work for the client.

Dealing with Family and Interpersonal Problems

Problems and conflicts in family and interpersonal relationships are common in recovery and can contribute to relapse if clients don’t have a plan to deal with them. Conflict, tension, and disagreements are normal parts of human relationships. Not addressing these head-on sets us up to feel angry, frustrated, and unhappy. Sometimes interpersonal problems are obvious, and other times they can be subtle, covert, or hidden. The goals of this chapter are for clients to identify and address conflicts in their families and interpersonal relationships, to examine their usual style of relating to others, and to begin to formulate and use strategies for resolving conflicts.

Managing Cravings and Urges to Use Substances

Cravings can be overt, so that we are aware of them, or they can be covert and show up in indirect ways such as irritability. Cravings tend to be more frequent and stronger in the early phases of recovery. Cravings for substances are triggered by something external (people, places, events, experiences, or objects) or internal (feelings, thoughts, or memories). Cravings vary in intensity from low to severe, and also in how they show in thoughts or how they make one feel physically. The goals of this chapter are to learn strategies that will help clients prevent or manage their cravings, to begin tracking cravings daily over the next few months, and to identify the things that trigger client cravings in order to plan coping strategies.

Overview of Goal Planning

Recovery is a process of change in which clients improve their health and wellness. They set goals to work toward stopping substance use and learn skills to change themselves and their lifestyles so they can live substance-free. There are different paths to recovery, including individual, group, and/or family therapy; engaging in a treatment program such as a residential or nonresidential rehabilitation program; taking medications for addiction to alcohol, opioids, or nicotine; engaging in mutual support programs; participating in chat room discussions or online recovery meetings; using support from other people; and participating in community or self-growth activities that help clients sustain recovery. The goals of this chapter are for clients to begin to set and prioritize their recovery goals and to learn about the different paths and components of recovery.

Recognizing Consequences of Your Substance Use

Substance use can contribute directly and indirectly to problems in any area of life. Substance use disorders raise the risk of medical, spiritual, psychological, psychiatric, family, and economic problems. Problems may range in severity from mild to life-threatening. Sometimes the effects are subtle or hidden. The goals of this chapter are for the client to understand the consequences of their substance use and its effect on the people closest to them and to identify problems caused by the client’s substance use disorder.

Recognizing Your Substance Use Problem

The American Psychiatric Association classifies substance-related disorders into several categories. These include intoxication, withdrawal, substance use disorder, and substance-induced disorder. The goals of this chapter are to understand the different categories and symptoms of substance use disorders and to rate the overall severity of the client’s substance use problem.

Medications for Substance Use Disorders

Medications can help clients safely and comfortably withdraw from substances such as alcohol, opiates, or sedatives if they have a physical addiction. The medicines used will depend on the drug or drugs on which they are dependent. Medication-assisted treatment is the use of medications approved by the US Food and Drug Administration, in combination with counseling and behavioral therapies, to provide a whole-client approach to the treatment of opioid, alcohol, or tobacco use disorders. The goals of this chapter are to learn about types of medication that aid recovery from a substance use disorder, to understand the reasons why some people may have problems with medication, to learn about withdrawal symptoms and medications that help, to understand the effects of drug and alcohol use on psychiatric medications, and to determine whether or not a client needs medication to help with his or her substance disorder.

Managing a Co-occurring Psychiatric Disorder

The term “co-occurring disorders” refers to the presence of a psychiatric disorder and a substance use disorder. A psychiatric disorder increases the risk of a substance use disorder and vice versa. Treating one disorder improves the outcomes in treating the other. Psychiatric medications can be both effective and appropriate in treating the psychiatric disorder in people with co-occurring disorders. Medication-assisted treatment (MAT) can treat effectively the substance use disorder in people with co-occurring disorders. The goals of this chapter are to learn about the different types of psychiatric disorders, to learn about the causes of psychiatric disorders, and to assess the client’s psychiatric symptoms, if applicable.

Measuring Your Progress

Clients can measure their progress by comparing their current status to the goals they set at the beginning of their change program. These goals may relate to their substance use; to other areas of their lives such as physical, mental, or spiritual well-being, or relationships with family or friends; or to any other problem or issue that clients are working on changing. Progress is improvement or positive movement toward identified goals. Sometimes progress is significant and happens quickly. Other times progress is less significant and happens slowly. The goals of this chapter are to learn to define and measure the progress the client has made this far and to recognize that progress shows in many aspects of one’s life, just not substance use.