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Relapse Prevention

The End of the Beginning

“This is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning.”

Sir Winston Churchill

For those who are struggling to cope with alcohol addiction, and have become deeply embedded in a cycle of alcohol dependent behaviour, the treatment focus for such individuals is, quite rightly, placed on getting the drinker to stop drinking; getting them through the process of withdrawal, and then implementing the necessary lifestyle changes to help them into early recovery.

Once this has been achieved and some sense of equilibrium has been restored to the ex-drinkers life it can be tempting to think that the job of recovery has been done.

However, as anyone who has ever suffered a major relapse can tell you, you don’t recover from alcohol addiction simply by stopping drinking; you recover by creating a new lifestyle which precludes the need for you to drink alcohol any more, and give you the emotional and psychological coping strategies to deal with any temptations which may arise to do so. As the quote from Winston Churchill so aptly puts it, making it successfully through withdrawal and into early recovery is just the end of the beginning. It is from here that the journey to full recovery really begins.

Relapse Prevention PlanningMaking such a fundamental change however takes time and a whole lot of effort, and requires conscious and deliberate action to ensure that the goal of full recovery is kept front of mind, and to be on guard against slipping back into old familiar ways and ultimately destructive habits.

It is a paradox that the time when you need to be the most disciplined in sticking to the rituals and behaviours which have kept you sober is when you least feel the need to do so. This is because it is easy to believe, as your mental and physical health improve and your self-esteem begins to increase, that you have this thing licked. That you are cured, and you don’t need to worry any more.

Therefore, in order to safeguard against all of your good work and effort being in vain, this is also the best time to consider your relapse prevention strategy.

Understanding the Relapse Process

An important point to understand about relapse is that it is not a single event, but rather a process which plays out or unfolds over a period of time. It may be the event which sticks in the memory – as the “trigger” which precipitated the actual lapse – but with hindsight and some honest analysis it can be seen that the preconditions for relapse had already been set in place.

According to established relapse and relapse prevention models (eg Graham et al.; Beck et al.; Liese & Franz), there is a chain of events between thoughts, feelings and subsequent behaviours which lead to a lapse from abstinence, or to full blown relapse (uncontrolled drinking).

The stages in the process of relapse go broadly as follows:

In the first stage of the process, the activating stimuli can and usually does appear long before we are even contemplating drinking again. Most often these stimuli occur, or to be more accurate, have an impact on us due to the fact that we have stopped taking proper care of ourselves and have stopped doing the things which we know to be essential to our recovery.

Perhaps we have stopped paying attention to proper rest, exercise and diet in our lives; maybe we have let minor problems build up instead of dealing with them as they occur, or perhaps we have allowed our stresses to escalate to dangerous levels.

Or it could be the opposite – perhaps we have become complacent. We think we don’t need to follow our maintenance rituals any more, and that we are “cured” or “normal” again. Perhaps we even think we could go back to drinking again and contemplate testing our abilities to control our drinking.

Of course, in either of these scenarios we might not actually be conscious of our thoughts and actions at the time – we simply let our thoughts and behaviours drift due to some general sense of unease rather than by conscious action.

Symptoms of such a shift in our thinking will, however, manifest themselves in our emotions. For example we may be feeling:

    • Anger
    • Resentment
    • Bitterness
    • Pessimism
    • Cynicism
    • Boredom
    • Frustration
    • Intolerance
    • Irritability
    • Defensiveness
    • Isolation

Or on the flip side:

    • Arrogance
    • Overconfidence
    • Superiority
    • Cockiness

getting stuck in recoveryLeft unchecked these feelings can cause the individual to become stuck in their recovery and cause inner turmoil. Although they may initially deny that they have become stuck, eventually these feelings boil over and they move further into the relapse process.

They may start to think that the effort to stay sober has been a waste of time and start to glamorise their memories of times when they were drinking. If they have not grown and developed sufficiently in their recovery they may be feeling lonely, isolated and bored, and think that drinking offers them a way out of these feelings.

They then start to have thoughts in which they give themselves permission to drink – facilitating beliefs – such as, “One won’t hurt”; “I can handle it”; “No-one needs to know”; “Everybody drinks”, etc.

At this point they begin fantasising about situations when they will have a drink again, and maybe even start to plan the people and situations they need in place in order to set up the relapse.

This process can stretch out over days or weeks, but equally it can happen very rapidly given the right set of circumstances and with the required preconditions in place. One recovering alcoholic reports how after being sober for 7 months he boarded a plane on route to a summer holiday with no intentions of drinking. Three hours later he got off the plane blind drunk. The trigger had been the party atmosphere amongst the other holiday makers on the plane, who were all drinking, but on reflection he admitted that during the long preparations for the holiday his thinking about his condition had changed from “I’m in recovery” to, “I’m cured”.

Avoiding Relapse

In general terms there are 3 types of relapse-inducing situations which you should be aware of and highly attuned to in order to avoid or manage them:

Emotional Factors
  • Both negative emotional states (eg anger, anxiety, etc.), and positive emotional states (eg celebrations, success, achievement, etc.)
Environmental Factors
  • For example, social pressure from friends, both verbal and non-verbal; exposure to familiar drinking haunts; attending drinking-related events (weddings, sports matches, etc).
Interpersonal Factors
  • For example, arguments with loved ones; negative feedback from the boss; conflict with neighbours, etc.

In each case it helps to have a plan in place where your response to risky stimuli offers you both a behavioural and cognitive means of control. For example:

Behavioural Response
  • Walk away; remove yourself from the high risk situation; refuse to engage; seek distraction
Cognitive Response
  • Choose your beliefs; positive self-talk; rational thinking; understand consequences of actions

This leads to a relapse prevention model as follows:

Conventional wisdom says that the earlier in the relapse process you seek or permit intervention, the greater the chances of avoiding relapse. In simple terms this means recognising the signals that indicate you have become stuck in your recovery and being willing to take action or ask for help to overcome any blockage.

It also means, as has been repeatedly stated, to stick to your recovery strategy, even if you think you no longer need it.


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