|Relapse should be viewed as a normal part of
change and an opportunity for new learning. Rather than relying on client will-power,
relapse prevention training emphasises skill-power.
This site outlines prevention
and management strategies to allow client and counsellor to maximise the possibility of
maintaining successful change. Change can refer to reducing or stopping drug use,
reducing harms associated with drug use or improvements to general well-being.
This site is also available as a PowerPoint presentation at Relapse Prevention pp.
- Enhance resolution to change
- Maximise the possibility of change
- Manage high risk situations
- Manage cravings and develop impulse
- Other skills
- Refusal Skills
- Dealing with a lapse or relapse
Seven Relapse management steps
1. Enhance resolution to change
Relapse prevention begins at the beginning of intervention with a meaningful assessment
process and clear goal setting. Goal setting can be enhanced by:
Writing down goals and putting them in a prominent place
Having both short-term and longer-term goals
Making the commitment public - telling drug using and
other friends & family
Knowing the rewards of change and the costs of not
2. Maximise the possibility of
Provide the best chance for change by:
Identifying the helps and hinders of change
Work with client to enhance helps and reduce hinders
Maximise external supports
Focus on those behaviours which replace and compete with
problematic drug use (eg if drugs are used to manage relationship problems, provide
relationship enhancement skills - provide positive alternatives such as recreation,
Support environmental change (eg accommodation, employment & recreation
3. Manage high risk
Just the process of identifying situations which can undermine resolution to change may
reduce their effect. Subsequent strategies to either avoid or manage these situations will
It's useful to think of high risk triggers/situations using the Drug, Individual,
Environment - DIE model:
Drug - Availability, advertising, drug talk, use
of a drug, etc.
Individual - negative emotional states,
celebrating, negative thinking, drug thoughts, etc.
Environment - drug using friends,
relationship/family problems, money (too much or too little) etc.
Steps in managing high risk situations
Ask client to think of a times when they have either
been very tempted to use or have used.
Draw a scale of 1 to 10 and ask to categorise with 1
being least risky and 10 being most risky. (possibly prompt for situations from the DIE
model if not many)
Ask about situations which have been described where
client successfully resisted temptation. List these as helps.
Ask what was different when client did succumb to
temptation and list as hinders.
Identify the risky situations which were most likely to
happen and problem solve solutions based on the helps and hinders already developed - the
best solutions tend to be those which have already proven to be successful.
Develop an action plan and if possible rehearse responses
and actions where indicated.
Ask the client how he/she manages cravings and impulses.
Do more of what works.
Cravings and urges are normal and
should be seen as a helpful warning sign. Explain that they are like a wave. Choices
include being swept along by the wave out of control (giving in); going under the wave and
letting it pass over; or riding the wave out (urge surfing). Skills required for dealing
with cravings are relaxation, diversionary and escape techniques while the wave passes.
Cue exposure (controlled exposure to triggers) can also be used by those with knowledge of
Impulses have been
described as "A sudden tendency to act
without reflection." It is not an impulse if:
4. Manage cravings and develop
Time - it is not sudden. Ask the client if the
consequences of a relapse are important and if they will give at least 20 minutes before
Act - explain that there is a big difference
between having impulsive thoughts (which are common) and acting on impulses (which can be
controlled). Get them to give examples where they have had thoughts but not acted on them.
Reflection - thinking about the short and longer
term consequences may help. To assist, it can be helpful if the client carries around a
reminder with them of what they have to lose (e.g. a photograph of their partner/child
and/or a small decisional balance sheet with what they have to lose if they use and what
they have to gain if they do not - see motivatinal interviewing).
Teach the 4 Ds:
Deep breathing and drinking water both assist to reduce anxiety and stress associated with
cravings. As they also help to delay and distract, they are simple but powerful
5. Other skills
Provide further skills training to deal with negative symptoms:
Social pressure (assertiveness training)
Anxiety (anxiety and stress management)
Depression and Anger (depression and anger management
Relationship pressures (couples counselling)
General problems (problem solving & goal setting
Develop positive life skills
6. Refusal Skills
Refusal skills are a specific set of skills related to dealing with social pressure.
Once again, it is useful to find out from the client how they manage this. The following
additional tips are only used if required so as not to undermine client self-efficacy:
Strong body language and confident tone of voice
Say 'no' first
Request the other to stop asking
Change the subject
The client should practice with the counsellor being both a 'refuser' and a 'pusher'.
If required, linking this training with assertion training will provide additional
(Refusal skills based on work by Monti, Abrams, Kadden, Cooney (1989) Treating
Alcohol Dependence: A Coping Skills Training Guide (pp. 61-63). Guilford Press, New
7. Dealing with a Lapse or Relapse
Explain the difference between Lapse & Relapse:
Lapse = a brief slip or lapse in resolution
Relapse = reinstatement of former behaviour or collapse in resolution
Prepare the client for the possibility of a lapse or relapse. Using the analogy
of a fire drill, (preparation, even though it may not happen) may help reassure the client
of your faith in him/her. However, explain that trying new things may involve occasional
mistakes which can be useful to learn from. Some key points to discuss:
One drink does not necessarily mean one drunk - or one
'hit' an addict (NB: caution if the client is following an AA or NA 12 step treatment
Include in the 'fire emergency plan' someone to telephone
or speak to as soon as possible.
Express your interest in discussing any lapses or
relapses as part of mutual learning. Emphasise your availability in the event of a
Explain the consequences of a lapse or relapse in the
context of statutory issues and their willingness to continue working on issues. If there
are limits on degree and number of relapses regarding statutory issues, these should be