Lapses and relapses are an integral part of recovery of substance use. This article discusses ways to avoid them and how to deal with it when it happens. Important for the person going through substance use problem and their family to understand. This is part of the series on substance use shared by the Addictions Research Group at Sangath India.
Part 1 of the series described about What is Substance Use Disorder
Part 2 talked of How to overcome a Substance Use Disorder
Part 3 talked of How to support Substance Use Recovery of a Loved One
Recovery from substance use problems can be a difficult journey. People on the path of recovery might often return to the old and familiar patterns of problematic substance use. When a person has been unable to stick to their plan of controlling or stopping their substance use on one occasion, it is called a lapse. Lapse is a temporary departure from a person’s substance use reduction goals, followed by a return to their original goals. If there is a sustained departure from the substance use reduction goals, the person is said to be experiencing a relapse.
Recovery involves more than not using substances. It includes creating conditions that make it easier for the person to manage their use and adapt to this change in their life. Developing coping skills can help prevent a lapse and also prevent a lapse from turning into a relapse. Understanding the triggers that may lead to lapse or relapse equips the person to avoid them or manage them better if they occur.
Why do people experience relapse?
Certain triggers may lead to thoughts and emotions which can make one vulnerable to relapse. Triggers can be circumstances, events, or places that may lead to challenging emotions like despair, anger, panic or anxiety. Triggers often remind the person of their familiar behavioural patterns of problematic substance use. Some examples include:
- External triggers: People, places, or things that were previously associated with problematic substance use. For example: Meeting friends with whom one previously used the substance, finding old drug paraphernalia or returning to locations associated with previous substance use can act as triggers.
- Internal triggers: Challenging emotions like frustration, anger, anxiety, and sadness can act as triggers if not managed well. Celebratory feelings, sexual arousal, excitement and other overwhelming positive emotions can also act as triggers.
- Social or interpersonal stressors: Marital conflict, family dysfunction, loss of one’s job, financial problems, societal stigma or lack of strong social support can act as triggers. Situations that involve triggers and are associated with a person’s previous problematic substance use patterns are high-risk situations. Places, people, and situations that are likely to hinder the use of substances or have never been associated with problematic substance use for the person, are low-risk situations. A person willing to recover must make efforts to decrease the time spent in high-risk situations and increase time spent in low-risk situations.
Marlatt and Gordon’s Relapse Prevention Model(1985)
How to prevent relapse?
Avoiding Triggers
- It is necessary to actively avoid situations that carry potential triggers. These include going to places closely associated with past substance use or with availability of the substance, having substance in one’s close proximity etc.
- Developing a structured plan for the day: Planning one’s day in advance helps in reducing time spent in high-risk situations and helps avoid triggers that might be intricately associated with one’s daily activities. It also reduces chances of deviation from a routine, reinforces substance-free activities and makes self-care easier.
Dealing with triggers and associated challenges
- Seek help for withdrawals: Withdrawals are the most challenging part of early recovery. They can be physically painful and can lead to anxiety, irritability, mood swings, lack of enthusiasm/concentration etc. The physical distress as well as the emotions related to withdrawals can act as major triggers for relapse. In case a person is going through withdrawals, it is necessary for them to seek support. It might help to talk to a doctor or a counsellor in such a situation to help them prepare better for withdrawals.
- Learn to say “no”: Refusing substance when offered, or resisting the desire to accept it, is a task that requires planning and practice. Some ways of handling such a situation can be:
- Practice a standard response beforehand (e.g. No thanks! I’m driving back home/I’m not drinking tonight/My doctor has advised me to stop drinking).
- Respond rapidly instead of hesitating or considering the offer
- Maintain eye contact and respond with a clear and firm “no” that does not leave any room for negotiation, persuasion, or future offers
- Say no and change the topic - keep the conversation brief
- Leave the situation
- Create a network of support: Triggers can be difficult to manage without social support. Hence, it is important to communicate with one’s loved ones about things they are experiencing and ways that they would like to be helped. It is also a good idea to spend special occasions and celebrations like birthdays or New Year’s with this support system rather than alone to cut down on situations that might enable substance use beyond one’s set goals. If possible, participation in support groups where one may find companions with similar lived experiences can be useful (e.g. Alcoholics Anonymous) .
- Deal with cravings: People may get an intense or urgent desire to use substances beyond their set goals after refraining from doing this for a long period of time. These urges, called ‘cravings’, are subjective and time-limited in nature. For some, the experience might manifest in physical symptoms, like a pacing heartbeat. Others might experience the symptoms mentally, like intrusive thoughts or mental imagery of using the substances. These cravings may put one at risk of relapsing but can be dealt with by finding effective ways of managing both internal and external triggers. This may include incorporating other pleasurable activities or hobbies like gardening, reading, cycling, etc into one’s daily routine. The most important thing to remember about cravings is that they pass on their own if you wait it out. Find something to distract yourself and avoid the pressure to act on the thought to satiate your craving. Speaking to a counsellor can help in charting out a plan for managing cravings strategically.
Preventing a lapse from turning into relapse
One needs to prepare in advance so that if they experience lapse, it does not turn into a relapse. Writing a set of ‘reminder cards’ to oneself can help prepare for this. “Reminder Cards” can be sealed and only opened after a slip has occurred. These cards contain certain things that one needs to tell/remind themselves while experiencing a lapse. See the picture below for an example of a reminder card. Seeing a counsellor can help in identifying the factors that led to a lapse or reconsidering what can be done differently to deal with the lapse better.
What should I do if I experience a relapse?
Relapse should be accepted as a normal part of recovery and viewed as an opportunity to reflect on the experience. Associating relapse with failure promotes shame, guilt, and demotivation. This might lead to people giving up on the process of recovery. If you are a person experiencing relapse, the following can help you deal with them better.
- Resolve to begin working on your substance use goal again. Use strategies that have helped you in the past to get back on track.
- Think of the triggers, events, or emotions that led you to experience relapse in the past and create a plan to avoid or deal with them. Learning to identify a high-risk situation from a low-risk situation can better prepare you to navigate different circumstances.
- Take part in activities you enjoy and surround yourself with supportive people. Try to find make new friends or join new social circles where problematic substance use is not involved.
- Remember that relapse does not signify a lack of determination, willpower, or character but it might be an indicator of the efficacy of coping skills. Effective coping skills and better planning as discussed in the previous section, can help overcome it.
- Trusting the treatment: Medications and cognitive behavioural therapy/motivational interviewing can provide tremendous help in one’s recovery. So, do not feel ashamed or guilty that you have relapsed; but seek out your counsellor and work with them to get back on the path to recovery.
- Reframe the negative thoughts you experience owing to the situation. Instead of thinking “I did not stick to my plan last night”, think “I have stuck to my plan for 30 out of 31 days”. This will help you measure your overall progress and avoid dwelling on the few instances of deviation from the plan. Instead of thinking “once a user, always a user” or labelling yourself as “hopeless,” remember that relapses are a part of the journey and possible to overcome.
If you are struggling with relapse prevention or need professional help to manage a relapse, here are some helplines you can seek support from.
This article is produced by the Addictions Research Team at Sangath India. The content production and editorial team involved Bijayalaxmi Biswal, Dr Abhijit Nadkarni, Miriam Sequeira, Kedar Mirchandani, and Shubhangi Kashyap.
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