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.
For more information refer to Gorski, T. T. (2003). How to Develop an RP Plan. At the Addictions Web Site of Terrence T.Gorski. See www.tgorski.com; www.cenaps.com; and, www.relapse.org.
Anthony R. Quintiliani, PhD., LADC
From the Eleanor R. Liebman Center for Secular Meditation in Monkton, Vermont
Author of Mindful Happiness
positive thoughts and emotions. When we get stuck in negative cycles of thinking, feeling and doing our right brain and limbic area dominate. A very old mindfulness belief is that you are not your thoughts, your emotions, or your behaviors; these parts of you are simply associated with your life experiences. When a client learns to defuse a though it means they have changed its linguistic structure and removed it from being cemented into their CABs, or cognition-affect-behavior cycles. In all good therapies, especially Cognitive-Behavioral Therapy and various mindfulness therapies (MBCR, DBT, MBCT, MBRP, ACT), helpers often work on truth-analysis of unhelpful, repetitive, negative thoughts patterns – especially those embedded into CABs cycles of ineffective experiences. Self-medication, isolation, and avoidance are commonly associated with these realities. Sometimes this work includes meta-cognitive analysis regarding your thoughts about your thoughts or the patterns of your thoughts. The clear logic is that the words we often tell ourselves in times of stress or fear are NOT often true. Of course, if indeed you are seriously endangered best to allow your limbic brain area to save your life. The list below will note various approaches used to defuse thoughts from our experience of being, our CABs cycles.
example: “I am so worthless” helps solidify your brain plasticity about personal meanings and images. Try this: “Sometimes I feel worthless” or “When really bad things happen, I can feel worthless” or “My unpleasant feeling can relate to feeling less worthwhile.”
we learn to care more about others and less about ourselves. The self-centered ego gives way to compassionate tolerance. Buddhist practices and meditations may improve our interpersonal relations, both intimate and distant. Today our world, nation, regions, and families are locked in bitter conflict; the entitled view of “my ideas are right” holds sway and prevents any forward movement for negotiated co-existence of different ideas and people. If we hope to save ourselves as well as our world, we MUST practice more interpersonal mindfulness. Such practices of random acts of kindness, general compassion, taking in suffering and giving out joy, tolerance, openness to differences, general gratitude and others all support more inter-personally cooperative thoughts and behaviors. Such thoughts and behaviors will improve self, dyads, relationship, family, community, race, ethnic group, religion, state, nation, and world. The need for this shift is highly urgent! We must change our being from greed, aversion, and hate to generosity, inclusivity, and love. If not our species and our world may fail.
happening right now in this present moment. What, exactly, is it that is upsetting me? What, exactly, is it that may lead to mutual satisfaction here now? Begin your changes by starting with yourself. Notice what conflictual inner self-messages continue to play and re-play themselves over and over again in your own mind. Begin by listening to your own inner conflicts, and work at listening and reflecting deeply on both sides of this dynamic. Work on a solution, even if it is not a perfect one. First practice more radical acceptance with your own inner conflicts, then gently move to outer conflicts – begin gently with significant others. Practice, practice, practice and practice more. There cannot be a winner! Once you feel the sensations and emotions of successful compromise, begin to practice beyond intimate circles and into your general world environments. It is all about sharing your love and acceptance of self with others, and being for the betterment of others. On this path also practice good self-care.
realities the issues of rampant self-referencing and entitlement seen in so many people today – “Me/Mine Mind” (my terms). As we make our way through samsara, we condition/reinforce ourselves to the desire/attachment for sense pleasures; we understand that such states are temporary, and that we cannot hold onto them. Thus we are soon back in dissatisfaction as a norm. We crave too much; we crave too often. We lack mindful abilities and skills to be content and satisfied with what we have right now. This does not imply that you not work at personal improvement; it does imply that to do so in an authentic manner, requires great mindfulness, self-understanding, and patience.
thoughts, emotions and behaviors associated with the first arrow. Second, is life purpose. Why are we here? We are here to live, to be, to learn, to experience, to cope, to love, to be spirit, and to find our deeper personal meanings. Impermanence is third. Nothing stays exactly the same; everything is in a state of change. Bad experiences do not last forever, and good experiences do not last forever – in fact because we desire them they may be more short-lived. Ultimate reality is next. All the problems we face (troubled love, the lack of it, finances, jobs, family relations, loneliness, illness, etc.) test our resolve and skills. To use the true ways of reality or the way things are (impermanence, emptiness, dependent origination, and no-self) in our service is to become more resilient to our suffering. These teachings and ways of being require much practice and understanding. It is not that you will not suffer; it is hoped that you will not react so harshly to your suffering and see it as simply one form of our temporary reality. Gratitude is the next doorway. Do your best to have gratitude and contentment with what you do have now – whatever the immediate personal experience is. We humans often take for granted many positive aspects of our lives, until we lose one of them. Have gratitude as your norm. Next to last, be in your true self. Yes, you will have negative emotions and suffering. And yes you will have joy and happiness. The highest form of happiness is to learn not to suffer so much even when you are suffering. Live in full honesty with who/what you are. Also seek to find meaningful pathways to lasting happiness, which is most often not attached to possessions. Love yourself more, and love others as well. Lastly, be and act in compassionate ways to yourself and to others. This is the most true pathway to lasting happiness. Be kind, and act to put the interests of others ahead of your own self-interests.