Addiction treatment can help you to stop using and start your recovery, but the real challenge of staying sober begins once you return to your daily routine. While relapse is a pretty common part of the addiction cycle, you can avoid it by recognising and sidestepping physical and emotional triggers.
Are you currently in recovery? Then you probably know all too well that leaving the safe setting of a treatment center and transitioning back home may well mean living with temptation. Once out of treatment, your life suddenly seems full of triggers that may cause you to stumble. However, there are many ways to recognise and avoid those “red flags” before they can get hold of you.
Is Relapse Always a Part of the Journey to Recovery?
Resisting and avoiding temptations takes continuous motivation and awareness – and a solid relapse prevention plan, as we will explain later. It is normal to fear the possibility of relapse, and once more, being drawn back into the addiction cycle, you are not alone. Please be aware that relapse does not mean that you have failed. According to the US National Institute on Drug Abuse (NIDA), 40 to 60 % of those treated for substance use disorders (SUD) will relapse at some point. This fairly high rate suggests that relapse is not an individual failure but a relatively common part of recovery.
Remember that relapse is not a sign that the addiction treatment has failed. SUDs are disorders that affect and alter the way your brain works. Addiction as such cannot be cured, but it can be treated. Therefore, it is helpful to interpret relapse as a red flag and a sign to consult with your counsellor, therapist, or doctor to either modify your continuing care plan or resume treatment.
Lastly, don’t be disheartened if you have the feeling that you struggle more than others to stay on the path to sobriety. Many popular treatment programs and mutual-aid groups such as Alcoholics Anonymous (AA) support the belief that you are in recovery “for life”. A shocking idea? It may come as a surprise, but this notion often helps rather than discourages people from achieving long-term recovery. It causes them to be more careful and aware of possible triggers and to commit to changing their former harmful behavioural and thought patterns. However, adapting to a new sober lifestyle takes time and involves whole living environments, and relapse may, but doesn’t have to occur along the way. Because every relapse is very risky and can lead to returning to active addiction, it is best to avoid them altogether.
Preparing a Relapse Prevention Plan
An essential part of a structured treatment plan should be dedicated to the planning of continuing- or aftercare. Your treatment counsellors will help you develop a solid post-discharge strategy to manage your daily life, which involves identifying the triggers that have contributed to and led you to addiction. A trigger can be anything that may cause you to use drugs following a period of sobriety. Such a relapse prevention plan is key to obtaining coping skills and navigating obstacles that threaten to sabotage your sobriety.
A comprehensive plan should include the following:
- Whenever possible, it recruits the help of a supportive family member or friend who will prepare and accompany you through the transition. They can, for example, ensure that triggers have been removed from the home.
- A list of possible triggers.
- A schedule for regular counselling sessions at your treatment centre’s alumni program or mutual-aid group meetings such as AA or similar 12-step-support groups.
- Steps to change unhealthy habits include committing to a healthy diet, a fitness routine, and a regular sleep schedule.
- If you have been treated in an inpatient program, it may be advisable to continue in an outpatient program for the first 3 to 6 months post-discharge to benefit from a continuity of certain treatment elements.
- A reminder of the H.A.L.T. rule: the risk of relapse is highest when you are Hungry, Angry, Lonely, or Tired, so it is vital to have a plan in place for coping with those emotions.
- A list of all the negative and harmful things and consequences of using and a complementary list of all the benefits of staying sober. Keep these lists always at hand to remind yourself, if needed, why working hard for this new life is worth the effort.
Internal and External Triggers
Internal triggers are positive or negative thoughts or emotions that make you crave drugs. Do you feel belittled or criticised? Using again could numb the anger and shame that you are experiencing. Or are you and your friends celebrating your birthday? You may feel confident and think you deserve this one glass of Champagne.
External triggers are environmental events and situations that provoke your need to use drugs. They can be manifold and range from certain activities, social situations, locations, objects, people, and even a word uttered in a harmless context. Unlike internal triggers, external triggers can be purposefully avoided. Read on to learn how you can control them.
The most common relapse triggers are …
… H.A.L.T.
This acronym of four trigger emotions or sensations (Hungry, Angry, Lonely, Tired) also stands for the simple but effective tool which you can use to avoid them: remind yourself each day “to HALT”, i. e. to pay close attention to your emotions and to focus on body-awareness. Your self-care will improve, and your physical and emotional condition will strengthen over time. So, take a moment every day to check your body and mind: “Am I hungry? Angry? Lonely? Tired?”
> H-unger: Whether as a physical or emotional need, hunger tells us that our body calls for nourishment to thrive and function well. Carry healthy snacks around with you, and be mindful about preparing and eating regular meals to avoid feeling hungry.
> A-nger: This emotion is a response to a situation that affects you in a confrontational way. The key is not to react to the situation and instead remove yourself from it by calming down, either physically or mentally. If there is no way around addressing the situation directly, do it assertively, with a calm and rational mind.
> L-oneliness: Social isolation is quietly dangerous. Together with boredom, it is a common reason for relapse. With no healthy and motivating outside stimulation, your mind may easily drift towards “Just this once …”-thoughts. Remind yourself to actively stay in touch with the world. Take a walk, call a friend, go to a meeting, join a fitness club … Your support network is there for you. Reach out and connect.
> T-ired: Staying aware of possible triggers, changing your lifestyle and following all advice on how to stay sober will take up a lot of your energy. Your body and mind work hard in the early stages of recovery, so be especially aware of feeling exhausted and tired. Your brain is not on good terms with fatigue, leading to impaired judgment, depression, or high blood pressure. Take time to rest and sleep enough to charge your battery.
… Stress
Neglecting “to HALT” on a regular basis often leads to stress, commonly referred to as the #1 relapse trigger. Stress affects certain areas of the brain that are associated with impulse and cognitive control as well as stress regulation. As a result, you may have a more challenging time managing triggers responsibly and may be tempted to cope with the pressure by using again. Avoid this risk by including stress-management routines in your daily life, such as regular exercise, breathing exercises, or practising mindfulness.
… Exposure to Drugs
It is vital that your relapse prevention plan includes a list of social situations and places where drugs are available. Establish new routines in healthier environments, be it another park for your stroll, a supermarket in a different neighbourhood, or another route to avoid the smell of a pub. Changing into a new setting also often means making new friends and surrounding yourself with positive influences.
… Difficult Relationships
You may not want to hear this, given that falling in love is one of the most beautiful experiences in the world, but there is a sound reason for the common advice to “wait to date”, at least for the first year of recovery. In this early stage of recovery, you are still learning how to cope and regulate certain emotions without the help of drugs. You will need to focus all your attention on getting better. Don’t let anyone or anything get in the way of recovery. And as unromantic and heartless as it may sound, falling in love and beginning a new romantic relationship will demand lots of time and a great deal of attention. A difficult relationship or a break-up with a new partner causes stress – in other words: it leads you right to one of the most powerful relapse triggers of all.
… Times of Celebration or Special Social Gatherings
Any happy occasion, such as birthdays, job promotions, graduations, or national holidays, deserves to be celebrated. However, if “celebrating” means clinking glasses or enjoying a cold one, relapse is likely just around the corner. While you probably cannot avoid all social events that will inevitably expose you to temptations, it will help to be accompanied by a trusted friend or partner who can remind you of all that you have gained through sobriety and encourage you to resist.
… Mental or Physical Illness
Co-occurring disorders such as depression, anxiety, or physical conditions and pain are common with SUD and may lead you to consider self-medication for relief. As prescription drugs for the treatment of those illnesses might be mind-altering and become relapse triggers, you must tell the attending doctor that you are in recovery, so he can provide non-addictive alternatives, or better yet, ask your doctor for a referral to a mental health practitioner.
Seeking Help in Recovery
No matter the best-laid relapse prevention plan – preventing and avoiding triggers is like running an endless obstacle course. There is always the risk that you might bump into a hurdle, get caught off guard, or slip and fall. Remember that this may be humbling, but it does not mean that your recovery failed. It is a sign for you to consider attending additional – and perhaps modified – treatment. Pick yourself up and go after sobriety with even more intensity, focus and willpower. If you are interested in NEOVIVA’s various treatment options focusing on relapse and prevention planning, don’t hesitate to contact us for more information.
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