Relapse prevention is a phrase that gets tossed around a lot in the treatment industry. On the surface, the idea behind relapse prevention sounds reasonable enough: teach a recovering addict enough coping skills and tactics to make it through a wide variety of potential life situations, and you can better prepare them for potential pitfalls in recovery.
What they didn’t tell you is that the basic formula for relapse prevention is flawed.
The problem with relapse prevention
Conventional wisdom in the substance abuse community states that relapse prevention is both a cognitive and a behavioral approach. This immediately sends up some red flags in my mind, because:
1) Behavioral therapy is not enough (in my opinion), to overcome addiction, and
2) Cognitive therapy is really only achieved after “proper living” (i.e., you have to live your way into good thinking, not think your way into good living). This has proven to be true for myself, as well as others in recovery. Unfortunately, “living your way into good thinking” requires more than mere behavior modification, in my opinion.
So the formula used for relapse prevention is usually something like this:
Discover your triggers –> increase your awareness of those triggers –> figure out coping mechanisms to deal with those triggers so that you don’t go back to using drugs or alcohol.
Sounds good in theory, right? So let’s see why it breaks down in real life:
1) Relapse prevention fails to properly address emotional relapse – One of the biggest problems with relapse prevention strategies is that they do not take into account the overwhelming power of the emotional relapse. This is the point where a person gets so frustrated and fed up with things that they essentially say to themselves “screw it. I don’t care anymore.”
It’s not so much that relapse prevention strategies don’t address the concept of emotional relapse, because they can, and they do. For example, an addict might develop the strategy of “catching themselves” when they notice that they are sliding into a state of frustration and despair, and attempt to take corrective action before they actually pick up a drink or a drug.
That’s not the problem. The problem is that this type of strategy is inadequate to address the mountain of anger and frustration that a person might experience in early recovery. Sure, you can try to address the slide into emotional relapse with an “awareness –> response” strategy, but is that really going to work in a pinch? My experience from watching recovering addicts around me says “no.” It’s going to take more than a responsive strategy to conquer potential relapses (more on this in a minute).
2) Relapse prevention ignores the holistic approach to recovery – Traditional relapse prevention ignores too many aspects of a complete recovery to be truly effective. Instead of just focusing on cognitive and behavioral therapies, shouldn’t relapse prevention consider the recovering addict as a whole, thus treating addiction as a “whole person” disease (like it really is)?
For example, exercise is not generally considered a key concept in recovery programs, but it has become a huge part of my recovery, and I believe that most anyone can benefit greatly from some regular exercise. It’s more than just being healthy or boosting self-esteem….I believe you have to get your blood pumping on a regular basis in order to feel truly alive and good about yourself.
Holistic approaches can be difficult to measure, and I seriously doubt that any real studies have been done to test the effectiveness of this approach (as they have been done with cognitive-behavioral strategies). In other words, you’ll have to take it on faith that the holistic approach to recovery is worth investigating.
3) Relapse prevention ignores spirituality and some critical, related concepts such as gratitude – Even the Big Book of Alcoholics Anonymous has a very descriptive story that clearly illustrates how the true addict or alcoholic has no real mental defense against the first drink (or drug). In other words, cognitive therapies that attempt to teach us “how to react” to trigger situations are ultimately ineffective for the true addict or alcoholic. AA is saying that there will come a time in every person’s recovery when they will be faced with a situation in which no mental defense can possibly prevent taking a drink or a drug–they will have to rely on some other means to remain sober.
This is where spirituality comes in, which traditional relapse prevention ignores. The connection with a higher power, or even the simple but powerful practice of daily gratitude can be enough to pull us through these types of situations. The point is that something more is needed than mere cognitive or behavioral approaches.
4) Relapse prevention lacks focus – Imagine being a newly recovering addict and trying to juggle the advice given in traditional relapse prevention programs: “First, I’ve got to change my thinking… positive thoughts, watch the negative self talk, watch out for my irrational beliefs, and so on. Next, don’t forget to focus on behaviors, so that I don’t get caught up in any actions that might lead to unstable emotional states. Oh, and I’m also supposed to remember to use the correct coping skill when each unique situation presents itself to me….phew!”
To me, this represents a lack of focus. How can a newcomer in recovery (or anyone, for that matter) possibly manage all of these ideas as they move through their day? How powerful can this strategy really be if it is just a bunch of cheap tactics thrown together, supposedly to be used only at the appropriate times in order to be effective?
And also, In this case, it is not only a lack of focus that fails the recovering drug addict, but a lack of intensity too. When you’re trying to incorporate too many ideas like this all at once, none of them have the power to really change much for you. Instead, try using a laser-beam focus with a concept like overwhelming force, and then you’ll start seeing some powerful results in your life.
5) Relapse prevention is uninspiring – They say that there are 3 possible components that make up any relapse prevention plan: Coping skills, cognitive therapy, and lifestyle modification. In other words: “Change your thinking, change your behavior, change the way you deal with stuff, and change your life situation.” Do these things and you can prevent relapse, they say.
But this mish-mash of advice–even when followed with dedication and enthusiasm–will often lead to relapse. The usual relapse prevention advice such as “change your thoughts from negative to positive thinking” or “avoid old people, places, or things that might trigger you” turns out to be rather uninspired. It’s not that the advice is wrong….it just falls flat, because people simply aren’t driven to implement the stuff.
Who can take this kind of advice and honestly follow it with passion? No one does, really. How do I know this? Because the winners in recovery that I have talked with were actively creating a new life for themselves in order to “live their way to success.” They were not merely “changing behaviors” and “avoiding negative thought patterns.” Trying to follow boring relapse prevention strategies is….well….boring. There has to be a better way to motivate yourself in recovery.
Relapse prevention done right – what you can do
1) Adopt a creative strategy instead of a responsive one – Traditional relapse prevention strategies are largely reactive in nature. A situation comes up, and your job is to say “OK, what do I do with this now? How do I get through this without drinking or using drugs?”
This is reactive, and leaves your life and the possible outcomes in the hands of fate, more so than in the power of your own making. The solution is to start focusing on the creative life of recovery. Start living a powerful new creative existence instead of merely bouncing through life like a pinball. The creative theory of recovery can show you how to do this. This is purposeful living that drives you through life with enthusiasm. No longer are you merely struggling to stay sober or clawing your way from one day to the next.
2) Immerse yourself in a proactive solution – instead of merely reacting to risky situations with a band-aid approach. With traditional relapse prevention, everything that you do is merely a tactic; a band-aid approach to cover up the potential tricky situations and slippery places you might find yourself getting into. Instead, immerse yourself in a proactive solution, just as the creative theory of recovery would have you do. Examples of this might include heavy involvement in the AA or NA fellowship, regular and active 12 step work (helping other addicts and alcoholics), living in long-term treatment, or even passionately pursuing a holistic hobby, such as Tai Chi or meditation. The intensity and focus of your efforts is critical.
To be honest, just about any relapse prevention strategy is fine (including traditional ones), but only if you throw yourself into it with an insane amount of passion and dedication. What we have come to regard as traditional “relapse prevention” is so boring and uninspired that no one can possibly get excited about….unless they can see the empowering and creative benefits of following such a plan.