Relapse Prevention Worksheets
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Looking for a relapse prevention plan worksheet to share with therapy clients? This article includes helpful tips and strategies for relapse prevention, plus free downloadable relapse prevention worksheets.
Overcoming substance use disorder can be a lifelong process. Just like other chronic illnesses, addiction may also involve returning to use or relapse, making it a challenging disorder to overcome.
This article provides an overview of relapse, how relapse prevention worksheets can assist clients, and tips to prevent returning to use. It also includes a free relapse prevention plan worksheet to save to your electronic health record (EHR) and use in your practice.
What factors increase the risk of relapse?
Substance use disorder is a chronic, relapsing disorder characterized by compulsive drug use despite harmful consequences, and can cause changes in the brain, according to the National Institute on Drug Abuse (NIDA).
Substance use disorder is a complex brain disorder and mental health condition, and some people experience relapse. Like other chronic medical conditions, such as hypertension and asthma, addiction has similar relapse rates of 40% to 60%.
Other research shows that as many as 85% of individuals may relapse after one year of addiction treatment.
There are several factors that may increase the risk of relapse:
Leaving treatment
Inpatient treatment provides a place away from the stressors of home life and the support of doctors and behavioral therapists. Returning home, however, may increase stressors, like caring for young children, a stressful job, and conflict in relationships.
Needing healthy relationships
Life in recovery is very different to a life of using substances. There are many triggers that present a risk of relapse, like socializing with friends you used to use with or a partner from a toxic relationship. Inadequate support is a risk factor for relapse.
Learning new coping skills
While coping skills may be learned in therapy or treatment, practicing them in the real world takes time.
Emergent situations and crises
Losing a job, ending a relationship, or losing a loved one can cause distress and may increase the desire to use.
Cravings or prolonged withdrawal
These experiences are a strong risk factor for returning to use.
Negative thoughts about recovery
A person may withdraw from the recovery practices that helped them initially as their life gets busier, or they may start to have negative thoughts about sobriety.
Understanding these risks of relapse can be the key to a solid recovery plan. This should involve creating a relapse prevention strategy with a therapist or drug and alcohol counselor.
What is relapse prevention?
Researchers posit that relapse happens gradually, taking sometimes weeks or even months before a person returns to use. However, there are known warning signs, and the goal of relapse prevention is to learn to identify those signs and develop adequate coping skills.
The stages of relapse can be condensed into three core phases:
Emotional relapse
Emotional relapse relates to the thoughts and behaviors that may make a client vulnerable to relapse. This includes avoidance or “bottling up emotions,” being in either chronic or acute stress, lack of sleep, or social withdrawal.
Mental relapse
This is when the thoughts of using substances occur. People may feel really conflicted: part of them wants to use, but the other part is determined to stay in recovery.
It’s a mental tug of war situation that could drag a person down to eventual relapse.
Physical relapse
Physical relapse is the action of returning to using substances.
Relapse prevention was developed in the 1980s by G. Alan Marlatt, who was a professor of Psychology and the Director of the Addictive Behaviors Research Center at the University of Washington.
The philosophy of relapse prevention is to use a skill-based and cognitive behavioral approach to identify internal and external experiences that may cause relapse and develop strategies to address those risks.
Clinicians might use a relapse prevention plan template that identifies potential situations, lifestyle factors, social pressures, or emotional states that may lead to the craving or compulsion to use substances. The free downloadable relapse prevention worksheets include space for clients to list their triggers and cognitive and behavioral strategies to address them.
Over time, a person who practices those strategies can develop confidence to handle difficult situations.
Relapse prevention has strong empirical evidence supporting its effectiveness, according to the Recovery Research Institute.
A more modern approach includes Mindfulness-Based Relapse Prevention (MBRP), which is similar to older relapse prevention strategies, with the addition of using mindfulness techniques to overcome stressful situations and triggering thoughts and feelings.
Researchers believe that adding mindfulness to relapse prevention will improve awareness and create detachment from negative thoughts and feelings, and strengthen distress tolerance capacity.
List of relapse prevention strategies
Inspired by the Recovery Research Institute, some effective relapse prevention strategies include:
Increasing awareness about the consequences of relapse
Playing through what may happen because of relapse, like losing a relationship or job, or experiencing legal ramifications, may be a sufficient deterrent to return to use.
Identify triggers
These might be emotional or thought-based triggers, such as feeling angry, sad, or depressed, believing those thoughts, or feeling overwhelmed by external cues, like a stressful job. Triggers may lead to social isolation, less engagement in recovery activities, and increased cravings.
Plan for emergencies
Develop a strategy for high risk situations in which you might not be able to think so clearly. Speak to your sponsor, therapist, or counselor to develop a plan for high risk situations, such as the loss of a loved one, an accident, or illness. Situations like these can cause overwhelming emotions. Some potential solutions might involve attending a meeting, speaking to your counselor or therapist, calling your treatment center, calling a trusted friend, or removing yourself from the situation and distracting yourself.
Strengthen regular coping strategies
These should address everyday activities that help to keep stress at bay and enhance well-being, such as regular exercise, attending regular recovery meetings, eating nutritious food, mindfulness meditation, and getting enough sleep.
Develop a strong recovery community
Recovering together enhances the likelihood of staying in recovery. Your community may be close friends and family that know about your recovery, perhaps a recovery mentor or trusted friend, counselor, therapist, pastor, or anyone else in the community that can support your journey.
Maintaining health
Addressing mental and physical health problems quickly can reduce the risk of relapse. One strategy for this relapse plan may be to register with a provider and book regular visits.
What does a relapse prevention plan include?
If you’re using free relapse prevention worksheets, such as our template at the top of this article, the key to developing a solid relapse prevention plan is to do so collaboratively.
A relapse prevention plan may include:
- The clients own words
- Relapse triggers
- An action plan to combat triggers
- Activities that will prevent relapse and increase motivation to sustain recovery
- Actions to develop a recovery-oriented system of care, which may include obtaining medical and dental insurance, establishing care with a primary care provider and mental health provider, and attending regular therapy sessions. Your client may also choose to attend mutual aid groups, like SMART Recovery, LifeRing, or Alcoholics Anonymous.
- The client’s own benchmarks for health and well-being, that support their physical and mental health and promote recovery
- Ways to find joy. Recovery can be very serious initially, especially if it involves formal treatment and attending a 12-step program. While a program of recovery can be helpful to sustain recovery, so too is establishing a lifestyle that is fulfilling. Explore opportunities with your client that may bring enjoyment, pleasure, and relaxation.
How to use relapse prevention worksheets with clients
The relapse prevention plan worksheet can be used in several ways:
- As a visual prompt in session.
- To provide structure when outlining the core components of a strong relapse prevention plan.
- To enhance self-awareness by prompting clients to identify internal and external triggers.
- As a handout on relapse prevention tips, a copy of the client’s relapse prevention plan, or as homework to bring to the next session.
Sources
- Grant, S., Hempel, S., Colaiaco, B., Motala, A., Shanman, R. M., Booth, M., Sorbero, M. E. (2015). Mindfulness-Based Relapse Prevention for substance use disorders: A systematic review. RAND National Defense Research Institute Report.
- Guenzel N, McChargue D. Addiction Relapse Prevention. [2023]. StatPearls Publishing;
- Melemis S. M. (2015). Relapse Prevention and the Five Rules of Recovery. The Yale journal of biology and medicine.
- NIDA. 2023, September 25. Treatment and Recovery.
- Recovery Research Institute. (n.d.). Relapse prevention (RP) (MBRP).
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