Relapse Prevention
Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC
Executive Director AllCEUs
Objectives
~ Define relapse in terms of addiction as well as mental health
~ Examine relapse prevention techniques
~ Explore needs of the person: Psychosocial and Maslovian
What is Relapse
~ Relapse is the return to addictive behaviors or the recurrence of mood symptoms
~ Relapse often starts long before the person uses again
~ Get caught up in day-in-day-out
~ Start acting “mindlessly”
~ Stop going to meetings/counseling/church/lifeline
~ Begins running out of energy to do new behaviors
~ Frustration, irritability and exhaustion set in
~ Caveat…an extreme stressor can prompt “immediate relapse”
Relapse Definition
~ Relapse is the return to something that has been previously stopped
~ Relapse is multidimensional
~ Emotional
~ Mental
~ Physical
~ Social
~ A relapse is when you start returning to any of these people, places, things, behaviors or feeling states.
Extreme Stressors
~ Those things that overwhelm an individuals ability to cope
~ Thrust them into the fight or flight
~ New coping skills and support resources may not even be considered, or only half-heartedly
~ Have clients identify or practice dealing with these types of situations in group
~ Divorce
~ Death
~ Job Loss
~ Diagnosis of a terminal or chronic illness (Cancer, ALS, HIV)
Beginner Tools for Extreme Stress
~ Get support… You are outnumbered!
~ Self-soothing/De-Escalation
~ Systematic Desensitization
~ Cognitive Behavioral Therapy
~ CPT Note Card
~ I feel… because ……
~ What am I upset about
~ What are the FACTS for and against this belief
~ Am I using all or nothing thinking or jumping to conclusions
~ I need to call _______ to get an objective perspective or what would _____ do

The 4 Ds
~ Delay – Most urges, feelings and cravings rise and fall like waves in about 20 minutes if you do not “feed” them
~ Distract – Craving time passes more quickly when engaged in a distracting activity for a few minutes.
~ Use Distress Tolerance Skills to IMPROVE the moment and ACCEPT reality. DBT Video
~ De-Stress – By reducing your stress and distress, you are allowing your body to maintain higher levels of calming and “happy” chemicals.
~ For more tips, listen to the Happiness Isn’t Brain Surgery Podcast on preventing vulnerabilities.
~ De-Catasrophize – Challenge your thoughts and when necessary, reframe them into more accurate notions, like, “This is really uncomfortable, but I can manage.“
~ Video on thinking errors
Relapse Prevention Card
~ Fold a paper into four squares:
~ On the first square, write: “Delay, Distract, De-Stress, De-Catastrophize
~ On the second square, write out 5 personally relevant distraction ideas
~ On the third square, write out 3 of your most significant reasons for wanting to recover
~ On the fourth square, write out some negative expectations – accurate predictions for what will happen if you slip (over eat, smoke, drink, say “yes” when you need to say “no”)
Creating a Relapse Prevention Plan
~ Triggers and Vulnerabilities are multidimensional
~ Emotional
~ Mental
~ Physical
~ Social
~ Environmental
~ Cravings: Compile a list of who you can call, what you can do to distract yourself from a craving and how you could stop a craving altogether. (gambling, smoking, sex, over eating)
~ Healthy tools: Think about what new and old behaviors/tools you can use to keep you on the right track. Some examples include writing a list of consequences should you relapse, attending a support meeting, exercising, journaling, or writing a gratitude list.
Emotional Relapse
~ In emotional relapse, your emotions and behaviors become negative and unpleasant.
~ You start finding it difficult to experience pleasure
~ What triggers your negative emotions (Anger/resentment/jealousy/guilt; depression; anxiety/fear/stress)
~ Things/Media
~ People
~ Places
~ Events
Emotional Relapse
~ Negative emotions make us uncomfortable
~ Identify the emotion, explore why you are feeling that way and take steps to fix the problem
~ You can become stuck in the emotion, sometimes
~ Nurturing and blowing it out of proportion
~ Compounding it with other emotions like anger and guilt
~ Personalizing it
~ Trying to escape from it
~ Remember that emotions are just cues like a stoplight.
~ You feel how you feel in the moment
~ You can choose to change or improve the next moment
Preventing Emotional Relapse
~ Practice mindfulness
~ Increase positive experiences (real and guided imagery)
~ Keep a gratitude journal
~ Avoid personalizing something that may not be about you
~ Remember that…
~ Negative emotions are the mind’s way of telling us to get off our butts and do something—Like our car’s idiot light or hunger pangs
~ Dwelling on, nurturing, avoiding or hiding from negative emotions never makes anything better
~ You can *choose* to feel and fix, or relapse and repeat

Activity
~ List 10 things that you chose to get anxious or angry about over the last week
~ Why did you get upset? (What was your mind telling you needed to be fixed)
~ Did holding on to the upsetness do any good?
~ What was your initial reaction, and was it helpful?
~ What could you do differently next time to either
~ Change/fix the situation (Improve the next moment)
~ Change how you feel about the situation (Walk the middle path)
~ Let it go (Radical Acceptance)
Mental Relapse
~ In mental relapse there's a war going on in your mind.
~ Part of you wants to stay positive, but part of you is struggling with tolerating the distress.
~ The signs of mental relapse are:
~ Focusing on the negative
~ Having a pessimistic/helpless/hopeless attitude
~ If you had an addiction (food, nicotine, drugs, relationship), you may also be:
~ Thinking about people, places, and things you used with
~ Glamorizing your past use
~ Lying to yourself and others
~ Justifying your behaviors
~ Minimizing the impact of one (drink/hit/bet etc.)
~ “Screw It” attitude

Mental Relapse
~ What types of things trigger negative thoughts?
~ Things/Media
~ People
~ Places
~ Events
~ What thoughts do you have that make you feel
~ Angry/irritated/resentful
~ Guilty
~ Envious
~ Scared/Anxious/Worried/Stressed

Connecting Unpleasant Thoughts & Feelings
Preventing Mental Relapse
~ KISS: Keep It Simple Stupid
~ Trying to change too many things at once can lead to failure
~ Often some of simplest things can have the greatest impact
~ Prevent and address vulnerabilities that can make you focus on negative or have a strong, negative emotional reaction
~ Good Orderly Direction
~ Your life is a road map
~ The destination is recovery and happiness
~ Before you act, think whether that keeps you on the right road, or is an unplanned detour
~ Maintain Head-Heart-Gut Honesty (Rational, Emotional, Wise Mind)

Social Relapse
~ Symptoms
~ You have returned to the old people and places who co-sign on your b.s.
~ You have withdrawn from your social supports
~ You have become self-centered
~ You have withdrawn
~ What triggers your social relapse
~ People
~ Places
~ Things
~ Events
Preventing Social Relapse
~ Contact your social support(s) on a daily basis for the first 3 months
~ Keep a business card in your wallet with the names and numbers of 3 social supports
~ Change your phone number (if possible) and destroy contact information for people who might trigger a relapse
~ Find at least one prosocial activity to do each week —volunteer, church, go to the gym
Physical Relapse
~ Physical relapse is characterized by:
~ Fatigue
~ Increased anxiety
~ Difficulty sleeping
~ Neglecting physical health (sleep, exercise, nutrition, medication)
~ If there was also addiction…
~ Cravings
~ Dreams about the drug

Preventing Physical Relapse
~ HALT
~ Hungry
~ Nourish your body with proper nutrition
~ Nourish your mind with activities and things that increase “happy chemicals”
~ Angry/Anxious
~ Reduce chronic stress
~ Lonely
~ Nurture social supports to buffer stress
~ Be willing to ask for help
~ Tired
~ Get sufficient quality sleep
~ Address issues such as sickness and pain that prevent quality sleep
Relapse Prevention Planning
~ Review Strengths
~ What is life like when you are happy?
~ What is different?
~ What is the same?
~ List three ways you cope with stress.
~ What activities do you like to do?
~ What are your positive qualities and strengths?
~ How can you use this information to prevent relapse.
Relapse Prevention Planning
~ Review Prior Relapses (and recoveries)
~ What was happening before the relapse/recovery?
~ What triggered the relapse?
~ Change occurs when old behaviors are more rewarding or stronger than new ones.
~ Relapse: What became more rewarding than your recovery program?
~ Recovery: What made doing the hard work of recovery so rewarding?

Relapse Prevention Planning
~ Review Prior Relapses (and recoveries)
~ Before you relapse, what changes in
~ Your emotions
~ Your thoughts
~ Your behaviors
~ Your interactions with others?
~ As you recover, what changes in
~ Your emotions
~ Your thoughts
~ Your behaviors
~ Your interactions with others?
~ What have you learned?
Creating a Relapse Prevention Plan
~ Relapse Warning Signs
~ Warning Sign: Feeling unable to cope
~ General Coping Strategy: I will learn how to say no to taking on extra projects, limit my work to 45 hours per week, and learn how to use relaxation exercises and meditation to unwind.
~ Warning sign: Irrational thoughts
~ Irrational Thought: I need to try harder in order to get things under control or else I will be a failure.
~ Rational Thought: I am burned out because I am trying to hard. I need to time to rest or I will start making more mistakes.
Relapse Warning Signs
~ Warning Sign: Unmanageable Feelings (Humiliation, embarrassment, Failure)
~ Feeling Management Strategy: Talk about my feelings with others. Remind myself that there is no reason to embarrassed. I am a fallible human being.
~ Warning Sign: Self-defeating Behavior: Driving myself to keep working even thought I know I need to rest.
~ Constructive Behavior: Take a break and relax. Ask someone to review the project and see if they can help me to solve the problem.
Relapse Prevention Planning
~ Creating the Plan
~ Why do you want to change?
~ What are the most common pitfalls for your relapse?
~ What you can do to prevent that from happening again?
~ What has worked in the past?
~ Create a schedule including
~ Recovery activities
~ Work
~ Reflection time
~ Positive health behaviors including nutrition, exercise, sleep
~ Nurturing positive relationships
Self-Esteem
~ A sense of pride in who they are
~ Acceptance of strengths and weaknesses
~ Lack of self-esteem can lead to a need for external validation
~ Self-Esteem workbooks abound to develop positive self esteem
~ Eradicating harsh, self-critical self-talk is the second part (Taming the Critical Inner Voice)
~ Be aware of the imposter phenomenon.

Mindfulness
~ Relapse often begins when mindfulness ends
~ Mindfulness is being aware of
~ Who you are
~ How you feel (emotionally, mentally, physically)
~ What you want (and what you actually need)
~ Are you eating because you are hungry or stressed
~ Are you sleeping because it is time or because you haven’t been sleeping well?
~ What not getting wants met mean to you
~ Activities
~ Morning and evening journals
~ Behavior Interruption esp. regarding substitute addictions

Mindfulness ACT Matrix

Summary
~ Relapse prevention begins with remaining aware of your wants, and needs
~ Relapse begins when the old behaviors start to surface
~ Avoidance
~ Minimization
~ Rationalization
~ Denial
~ Numbing
~ Anger/resentment/regret
~ People need to learn how to self-govern as a part of recovery