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.”
more impulsively to escape from the painful feeling tone or to quickly improve it. We tell ourselves stories about “how bad it is” as we immediately work to reduce the psychic suffering. This is where so many common human problems are born; this is where we may begin habitual behaviors around eating, consuming, angering, isolating, acting out, acting in, using mind-altering substances, and greediness, etc. There are ways to reduce this kind of mindbody stuckness and misery.
increase personal freedom with the skill of pausing between stimulus and reaction. Become more liberated by practicing your PAUSE, then label in a neutral manner – just wait it out. No need to avoid or to self-medicate the unpleasant feeling. This is our best HOPE to master choiceless awareness, especially when it leads to unpleasant feeling tones. Simply pause and label: “I am feeling unpleasantness in my body.” This too will pass. Try NOT to be more specific, since doing so may lead to stories and avoidance behaviors (negative reinforcement). Negative reinforcement by way of quick relief from suffering WILL cause unhealthy habits to form. The more you avoid or self-medicate painful feelings, the stronger the habit will become. This is a path to powerlessness NOT liberation. Just pause and label “I am feeling unpleasantness.” WAIT! Get stronger is your tolerance. Become a more satisfied and happier person. Just keep labeling without actions.
will guide you through a longer meditation dealing with your perceptions and experiences with impermanence. It is hoped that by being more direct in the guided practice, you may benefit prematurely. Although there is no substitute for regular daily meditation practice, especially when vipassana is concerned. Let’s begin. Do your best to remain on focus and deep.