Relapse Prevention Planning

Nine Steps to Building a Relapse Prevention Plan

Overview

A relapse prevention plan can be viewed as more of a process than a document, although it is highly useful for the client to write down the triggers, thoughts, feelings, and behaviors that lead to relapse and the strategies they develop with the counselor's help to cope in high-risk situations in order to prevent relapse. Terence Gorski outlined a process which may be useful in developing a relapse prevention plan, which I have adapted below. For more information visit http://www.tgorski.com/gorski_articles/developing_a_relapse_prevention_plan.htm

Step 1: Stabilization

• Relapse prevention planning probably won't work unless the relapser is sober and in control of themselves. Detoxification and a few good days of sobriety are needed in order to make relapse prevention planning work. Remember that many patients who relapse are toxic. Even though sober they have difficulty thinking clearly, remembering things and managing their feelings and emotions. These symptoms get worse when the person is under high stress or is isolated from people to talk to about the problems of staying sober. To surface intense therapy issues with someone who has a toxic brain can increase rather than decrease the risk of relapse. In early abstinence go slow and focus on basics. The key question is "What do you need to do to not drink today?"

Step 2: Assessment

• The assessment process is designed to identify the recurrent pattern of problems that caused past relapses and resolve the pain associated with those problems. This is accomplished by reconstructing the presenting problems, the life history, the alcohol and drug use history and the recovery relapse history. By reconstructing the presenting problems the here and now issues that pose an immediate threat to sobriety can be identified and crisis plans developed to resolve those issues.
• The life history explores each developmental life period including childhood, grammar school, high school, college, military, adult work history, adult friendship history, and adult intimate relationship history. Reviewing the life history can surface painful unresolved memories. It's important to go slow and talk about the feelings that accompany these memories.
• Once the life history is reviewed, a detailed alcohol and drug use history is reconstructed. This is be done by reviewing each life period and asking four questions:
  1. How much alcohol or drugs did you use?
  2. How often did you use it?
  3. What did you want alcohol and drug use to accomplish?
  4. What were the real consequences, positive and negative, of your use?In other words, did the booze and drugs do for you what you wanted it to do during each period of your life?
• Finally, the recovery and relapse history is reconstructed. Starting with the first serious attempt at sobriety each period of abstinence and chemical use is carefully explored. The major goal is to find out what happened during each period of abstinence that set the stage for relapse. This is often difficult because most relapsers are preoccupied with their drinking and drugging and resist thinking or talking about what happened during periods of abstinence. Comprehensive assessments have shown that most relapsers get sober, encounter the same recurring pattern of problems, and use those problems to justify the next relapse. As one person put it 'It is not one thing after the other, it is the same thing over and over again!'

Step 3: Relapse Education

Relapse education needs to reinforce four major messages: First, relapse is a normal and natural part of recovery from chemical dependence. There is nothing to be ashamed or embarrassed about. Second, people are not suddenly taken drunk. There a progressive patterns of warning signs that set them up to use again. These warning signs can be identified and recognized while sober. Third, once identified recovering people can learn to manage the relapse warning signs while sober. And Fourth, there is hope. Relapse prevention therapy can teach recovering people how to recognize and manage warning signs so a return to chemical use becomes unnecessary.

Step 4: Warning Sign Identification

Relapsers need to identify the problems that lead them to relapse. The goal is to write a list of personal warning signs; usually there are a series of warning signs build one on the other to create relapse. It's the cumulative affect that wears the alcoholic down. The final warning sign is simply the straw that breaks the camel's back. Unfortunately many of relapsers think it's the last warning sign that did it, and as a result they don't look for the earlier and more subtle warning signs that set the stage for the final disaster. A good place to start reviewing and discussing the warning signs of relapse is using this document - Phases and Warning Signs of Relapse. This warning sign list describes the typical sequence of problems that lead from stable recovery to alcohol and drug use. The client should select five or so warning signs that they can identify with, and tell about a time when they experienced that warning sign in the past while sober. The goal is to look for any additional hidden warning signs that are reflected in the story and prepare for the next step of managing them.

Step 5: Warning Sign Management

Warning sign management involves helping the client develop and learn non-chemical problem solving strategies that identify high risk situations and coping strategies for those situations and triggers. The client should identify irrational thoughts, unmanageable feelings, and self-defeating behaviors related to each warning sign and propose corresponding rational thoughts and constructive behaviors to help cope with these warning signs.

Step 6: Recovery Planning

A recovery plan is a schedule of activities that puts relapsers into regular contact with people who will help them to avoid alcohol and drug use. Attending twelve step programs and/or attending relapse prevention support groups that teach them to recognize and manage relapse warning signs is highly recommended.

Step 7: Inventory Training

Most relapsers find it helpful to get in the habit of doing a morning and evening inventory. The goal of the morning inventory is to prepare to recognize and manage warning signs. The goal of the evening inventory is to review progress and problems. This allows relapsers to stay anticipate high risk situations and monitor for relapse warning signs. Relapsers need to take inventory work seriously because most warning signs are deeply entrenched habits that are hard to change and tend to automatically come back whenever certain problems or stresses occur. If the client is not alert, they may not notice them until it's too late.

Step 8: Family Involvement

A supportive family can make the difference between recovery and relapse. Encouraging family members of alcoholics to get support through Al-Anon or other methods is highly important, to ensure the well-being of the family member and enable them to effectively support their alcoholic loved one. We need to encourage our family members to get involved in Alanon so they can recover from codependency.

Step 9: Follow Up

Warning signs will change as we progress in recovery, and the alcoholic's ability to deal with the warning signs of one stage doesn't guarantee that they will recognize or know how to manage the warning signs of the next stage. Relapse prevention plans needs to be updated regularly; it is recommended that they are reviewed monthly for the first three months, quarterly for the first two years, and annually thereafter.

Relapse Prevention Plan Examples

For specific examples of prevention plans please see the links below:

http://lifering.org/wp-content/uploads/WorkbookRelapseCh11.pdf

For teens: http//www.hazelden.org/web/public/document/sample relapse prevention.pdf

For an example of using the steps above, please watch this video: