Relapse Prevention (RP) Treatment Therapy

Relapse Prevention: Why Addicts Relapse

Drug addiction and alcoholism are chronic diseases of the brain. Not only are they destructive, but they can lead to overdose and death if not addressed. Addiction has generally been characterized as a chronic relapsing condition. The craving level, the adverse impact of drug use, family history, commitment to recovery, and age are strong predictors of relapse.

A sobering fact to consider is that 40 to 60 percent of people in addiction treatment relapse in the first few months of recovery. Those rates extend to the 2-year mark; about 50% of addicts will make it two years. 

Relapse prevention can be a panacea for those that need to manage their triggers successfully. The skills learned and practiced in treatment for relapse prevention range from positive coping skills to disorder-specific therapies that can be used in everyday life and applied to inevitable struggles.

The Brain Science Of Addiction And Relapse

When drugs are abused, their effects are felt deep in the brain and affect various processes, functions, and areas of the brain. Drugs interact with naturally occurring chemicals (dopamine) in the brain.  Virtually all mind-altering substances have some impact on the brain’s reward processing center and pathway.

After passing the blood-brain barrier, drugs enter into the brain and attach to cells, or neurons, with specific kinds of receptors that bind to the substance. For example, Marijuana activates the endocannabinoid system, which causes the “high” and stimulates dopamine release in the brain’s reward centers, reinforcing the behavior. 

Addictive drugs create a shortcut to reward by sending a flood of dopamine to the nucleus accumbens. This flood of dopamine causes a burst of euphoria or the “high” associated with drug use. This flood of neurotransmitters can be highly pleasurable, and individuals are often keen to repeat the feeling with recurring drug use.

The brain gets used to the surge of dopamine and cuts back production.  When the drugs are not active in the brain, dopamine levels can drop, causing uncomfortable withdrawal symptoms, powerful cravings, and a return to drug use.

These changes in the brain do not resolve immediately.  It can take several months or longer of continuous sobriety before individuals begin to feel like themselves again.  This is due to Post Acute Withdrawal (PAW).  Post-Acute Withdrawal refers to that time after acute Withdrawal when the brain is healing from prolonged drug or alcohol use.  During this time, they are at an increased risk for drug and alcohol relapse because they lack the brain’s chemicals that make them feel good.

If drugs or alcohol are used, dependence sets in, and the individuals may feel compelled to keep taking drugs or drinking to avoid negative emotional and physical withdrawal symptoms.  Finally, there is a loss of voluntary control when taking drugs or drinking alcohol; binges become common, and physical withdrawal sets in.

What is Relapse prevention planning?

Relapse prevention planning is an addiction specific treatment method to identify and prevent high-risk activities and prevent a return to substance abuse. Causes of relapse can be physical, emotional, or mental.   Many things can cause or contribute to relapse.  Physically you are at an increased risk for relapse if you are hungry, angry, lonely, tired, or in pain.  Emotionally, you are at a higher risk of relapse if your emotions are oscillating rapidly or just feel like crap.  Increased stress can take a toll on your mentality, leading to a higher chance of relapse.

Prevention of relapse is crucial in the process of treating substance abuse disorders and addiction. Without learning the factors that cause relapse or how to manage the three types of relapse, the individual may fail in recovery.     

Factors that cause relapse

Different factors can cause a relapse. These are called triggers.  They vary from stress to a favorite place to parties to a person; they can be anything. However, many people dismiss their triggers and think that they will not relapse because they will never use drugs or alcohol again.  These people are at especially high risk for relapse.  After all, if you know you will remain sober, there’s not much reason to continue daily activities designed to prevent substance use.


Triggers are defined as internal or external indicators that cause an individual to crave and possibly use an intoxicating substance.  A trigger can be a person, place, thing, or activity.  When triggered, cravings can come on very quickly, and familiar thinking patterns take root again.

For example, triggers can form from emotions, thoughts, situations, places, people, odors, boredom, stress, and exhaustion, to name several.

For these reasons, receiving relapse prevention education and learning and practicing the skills necessary to avoid using the substance(s) again is crucial for an addict in recovery.

Relapse stages

The three relapse stages are well documented and are widely known. They’re physical, emotional, and mental.  The relapsing process can take on momentum if not addressed until the individual gives in and begins using drugs and alocohol again.


At this stage of relapse, the individual is not actively thinking about using drugs.  Instead, they might notice an increase in anxiety or depression.  Another indicator is a perversive feeling of unease or feeling irritable, restless, and discontent.

 In early recovery, emotions are often erratic and volatile.  When emotions are all over the place, relapsing is easy not to worry about. People in recovery are experiencing new and at-times anxious-ridden feelings that can overwhelm them and spur a relapse. For many people, emotions can be intense, complicated, and uncomfortable.

Cognitive-behavioral therapy is an excellent resource for targeting the emotional links between a trigger and the positive or negative association that triggered it. In recovery, monitoring and balancing your emotions is critical, because ignoring them can cause an individual to backtrack.


Mental relapse is the second stage of relapse.  At this point, thoughts of using begin to occur.  In this phase, the individual will often fantasize about using or harbor the unrealistic belief that they can successfully use drugs or alcohol again. 

At this stage, the individual transfers subliminal thoughts about using to consciousness and begins to think actively about using once again. At this stage, the brain of the person is constantly considering using the substance again. It is deliberate.  

Someone in this relapse stage is thinking about or skipping meetings or therapy sessions, and planning how the substance can be used again. Recovering from a mental relapse can be challenging. But it can be quashed if detected early on, and the person can get back on track, usually with a fuller appreciation of recovery and an increased motivation.

One of the biggest problems is that many recovering addicts just don’t see the signs they are in relapse mode because they lack objectivity.  Often, realizing that an individual is headed for a substance abuse relapse is enough to get them back on the right track.  The type of relapse doesn’t matter; heroin relapse, crack relapse, and meth relapse all share similarities that can help an individual overcome them.


The final stage of relapse is a physical relapse. After not using the substance for a long time, the individual used the substance again. That usually leads to active addiction in which the person slowly loses control over the use of drugs or alcohol.  However, this lack of control happens faster than it initially did at the beginning of substance abuse .

This process is not linear.  Someone might jump right into mental relapse in response to a difficult or traumatic experience.  It is extremely common for people to drift back and forth between the phases of relapse. 

Relapse Prevention Treatment

Relapse Prevention (RP) focuses mostly on life-style changes and the relationships that the recovering person has.  For example, identifying when a job is high risk and coming up with contingency plans or helping the client find other employment. Relapse Prevention is often combined with CBT. 

Cognitive-behavioral therapy (CBT) is one of the two essential parts of relapse prevention. This type of treatment focuses on the individual’s negative behavior and instead advances more positive newer behaviors. The brain is essentially “reprogrammed” to associate positive behaviors, rather than substance use, with happy things. CBT is useful not only in treating substance use disorder but also in preventing relapse.

Pearls of wisdom:

Despite the risk for relapse and which relapse phase or stage you may or may not be in, one thing is clear; if caught early enough, with prevention techniques and practices, a recurrence of drug use can be avoided in the future.

Relapse prevention is a valuable and beneficial resource for people who undergo addiction treatment. When individuals learn what that stages or relapse are, their triggers, and how to handle triggers when they surface, they can be overcome and relapse prevented.

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