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Creating a Relapse Prevention Plan: What to Include to Stay on Track

April 18, 2022

Table of Contents

A relapse prevention plan is a written document that you can share with your support team - yourself, friends, family, and health professionals -  to minimize a return to unhealthy behaviors, including drug and/or alcohol use. 

Addiction is a chronic disease with relapse rates between 40% and 60%. To prevent relapse it can be helpful to have a plan, recognize when old patterns or triggers come up, and learn how to manage them.

A concrete relapse prevention plan can help prepare the patient for the signs and symptoms that may indicate impending relapse so that the individual can intervene before they use substances again. 

Relapse is often gradual. Recognizing dangerous behaviors before you pick substances up again can help to prevent a relapse.

What Is a Relapse Prevention Plan?

Relapse is common with substance use disorder (SUD). It does not indicate failure, as it is often a natural part of the healing process. A relapse prevention plan helps to prevent a relapse or minimize the consequences of a partial relapse. 

Relapse generally does not happen overnight. Rather, it has three distinct phases:

  1. Emotional relapse: The individual is not thinking about using, but isolation, denial, bottling up of emotions, and other negative emotional patterns begin.
  2. Mental relapse: The individual is often torn between wanting to use and not wanting to use. They begin to bargain with themselves and have difficulties recognizing high-risk situations.
  3. Physical relapse: The return to actual use of substances. 

A relapse prevention plan helps a person to identify the initial phases of a relapse - emotional and mental - before physical relapse occurs.

Steps to Creating a Relapse Prevention Plan

When creating a relapse prevention plan, it can be helpful to work with a trained professional who understands SUD. The plan often works best if it is written down. It also often works best if the clinicians know the patient well and their individual situations, triggers, and strengths. It can also be helpful for family or friends to be involved. 

Steps can include the following:

  1. Assess your personal history. It is helpful to know exactly what has caused a relapse before, and your own history with drug and alcohol abuse.

  2. Set recovery goals. Know what you are aiming for and what you want in your life. Write these specifics down. They can include career goals, family goals, educational goals, spiritual goals, hobbies or activities you want to explore, and more.

  3. Identify potential triggers. It is vital to know what could possibly lead to relapse. Make a detailed list. Be as specific as you can, outlining potential scenarios or stressors.

  4. Understand your warning signs. Since relapse often starts with the emotional and then mental aspect, it’s important  to recognize your own personal responses.

  5. Design an action plan. This is one of the most important parts of the plan. It should detail exactly what to do if you feel the signs of a relapse beginning — the people you will call, what actions will you take, and what will you do instead of returning to substance use. 
    Be as detailed and specific as possible. Include your support people in your action plan, so they know how to best encourage you when needed.

What to Include in a Relapse Prevention Plan

Each relapse prevention plan will be personal and specific to you, but there are some general things that should be included.

  1. Personal triggers: List exactly what people, places, things, behaviors, actions, emotions, dates, and more might be a trigger for relapse for you.
  2. Coping tools and strategies: Define what tools, strategies, and activities you can do to minimize cravings and prevent relapse. Hobbies, activities, support group meetings, breathing exercises, journaling, or other things you have learned in therapy or counseling sessions can help.
  3. Support: Write down where you will turn for help. Make a list of people to call, support group meetings to attend, therapy sessions you can go to, and programs you can turn to for relapse prevention help.
  4. Lifestyle strategies: Think offensively when making a relapse prevention plan. Write down possible lifestyle enhancements, such as ways to stick to a healthy diet and exercise plan, embrace educational opportunities, and try recreational activities that can offer a positive outlet.

Relapse Prevention Models

While each relapse prevention plan is unique, there are several different models that help provide a template. Examples are the Marlatt and Gordon model and the Gorski-CENAPS Model for Recovery and Relapse Prevention.

Marlatt and Gordon Relapse Prevention Model

This model explains how both things that are right in your face, which include high-risk situations, coping skills, and outcome expectancies, as well as factors that are more underlying, like cravings and lifestyle issues, can contribute to relapse. 

The model also details how both specific and global strategies can be used to reduce the risk for relapse. By identifying possible high-risk situations that are specific to an individual and designing coping strategies for managing them along with more generalized strategies that include lifestyle balance, relapse can be avoided or the effects reduced.

Gorski-CENAPS Model for Recovery and Relapse Prevention

This model uses nine basic principles for relapse prevention planning. It couples each principle with a clinical technique or procedure to use for minimizing and preventing relapse. 

  1. Self-regulation: physical, social, and psychological stabilization
  2. Integration: self-assessment
  3. Understanding: relapse prevention education
  4. Self-knowledge: identification of relapse warning signs
  5. Coping skills: warning sign management
  6. Change: review of the recovery plan
  7. Awareness: inventory training
  8. Support: involvement of significant others
  9. Maintenance: comprehensive follow-up plan

Relapse Prevention Resources

There are many worksheets, workbooks, and support group options that can aid in relapse prevention. Here is a sampling:

Your therapist, mental health professional, or SUD counselor will likely also have relapse prevention resources they can share with you. Generally, these resources are available as part of a comprehensive treatment program for SUD.

Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.

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Citations

  1. Treatment and Recovery. National Institute on Drug Abuse (NIDA). https://nida.nih.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery. July 2020. Accessed March 2022.
  2. Relapse Prevention and the Five Rules of Recovery. Yale Journal of Biology and Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4553654/. September 2015. Accessed March 2022.
  3. Relapse Prevention. An Overview of Marlatt’s Cognitive-Behavioral Model. Alcohol Research & Health. 1999. Accessed March 2022.
  4. The Cenaps Model of Relapse Prevention: Basic Principles and Procedures. Journal of Psychoactive Drugs. https://pubmed.ncbi.nlm.nih.gov/2197389/. April-June 1990. Accessed March 2022.
  5. SMART Recovery Toolbox. SMART Recovery. https://www.smartrecovery.org/smart-recovery-toolbox/. 2022. Accessed March 2022.
  6. Relapse Prevention Therapy Workbook. Gorski Publications. https://www.gorskibooks.com/products/relapse-prevention-therapy-workbook. 2022. Accessed March 2022.
  7. Alcoholics Anonymous. Alcoholics Anonymous World Services, Inc. https://www.aa.org/. 2022. Accessed March 2022.
  8. Narcotics Anonymous. NA World Services, Inc. https://na.org/. 2022. Accessed March 2022.
  9. SAMHSA’s National Helpline. Substance Abuse and Mental Health Services Administration (SAMHSA). https://www.samhsa.gov/find-help/national-helpline. Accessed March 2022.

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