Relapse Prevention Plans – The Basics
T. T. Gorski, Anthony R. Quintiliani, Ph.D., LADC
The following information about how to develop effective relapse prevention plans has been paraphrased from the Work of Terrence T. Gorski. It is highly practical and a concrete way to develop your skills in relapse prevention interventions. Intermediate (Marlatt and Gordon) and advanced relapse prevention (MBSR, ACT) strategies will follow in future posts. The core steps are noted below.
- Stabilization: After detox and a few days without using substances, the core issue is WHAT do you need to do so you will not use substances today? This is very early abstinence, so best to be highly respectful, gentle, concrete, and proceed slowly with your client.
- Assessment of Realities: A primary rationale for assessment is to discover the client’s patterns of problems and related behaviors that most often lead to relapse. Key areas to examine are patterns of use, recovery effort history, sources of emotional dysregulation, and details about repeated self-medication to reduce experienced suffering. You will most likely discover areas involving childhood trauma, various forms of person abuse, unhelpful familial patterns, serious losses, peer group problems, and insults to the integrity of the self.
- Education: Key areas of client education include that relapse is a normal part of recovery process; extremes of guilt and shame need to be combatted; identification and counteracting the progressive warning signs; and, instilling a strong sense of hope.
- The Warning Signs: It is important to individualize the plan for each client. Although common core categories of unpleasant life experiences leading to self-medication exist, each person’s response to them differs in the details. Your best bet for success is to include both self-help and clinical applications regarding the warning signs of relapse. Help the client take a personal inventory about their known warning signs. Some signs may not be in awareness.
- Dealing with Warning Signs: It is important to teach the client skills for managing their warning signs. It is not enough to simply talk about the skills (generic talk therapy); it is important that clients practice the skills – a bit more Behavior Therapy. Behavioral approaches help to concretize ways of being and doing that counteract automatic unhelpful sequences forming from warning signs. Often poor responses come after unhelpful thinking patterns. So it may be helpful to use some Cognitive Therapy to help client understand and counter unhelpful, automatic negative thinking. Rational Emotive Behavior Therapy may be helpful in helping clients modify self-defeating behaviors, and Mindfulness-Based Stress Reduction may be helpful in improving mind-body emotional dysregulation and behavioral urges. If you know how to do Dialectical Behavior Therapy, it can be highly effective here. Last but not least, use whatever might be helpful from AA’s 12 steps. Do not expect that one shoe fits all; do not expect that your favorite approach is the correct approach. A varied and skilled application of various approaches tends to work best.
- Recovery Plans: Clients will obtain the best outcomes by participating in both self-help and clinical applications of recovery and relapse planning. A concrete relapse prevention plans, founded on good personal information and scientific interventions, tend to be most successful.
- Personal Inventory: It is often helpful for clients to learn how to do morning and evening inventory work. This is similar but not the same as Psychosynthesis, in which people use preview to prepare to deal with expected challenges and joys of the day, and review in the evening to see what worked and what did not. If clients become anxious after evening review, they will be helped by MBSR’s body scanning technique. It may help people enter sleep and remain in sleep.
- Family Role: Supportive family involvement is strongly encouraged, but only if it is supportive in nature. Don’t try to force family roles if systemic support is lacking.
- Follow-Up: We need to check in with clients to see what is working and what is not working. This should help us to monitor progress and revise relapse prevention plans as needed. A periodic urine screen may be helpful to work with both self-report and evidence of progress.
Anthony R. Quintiliani, PhD., LADC
Author of Mindful Happiness