Relapse Prevention Techniques for Alcohol Use

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines alcohol use disorder (AUD) as a chronic, relapsing brain disease, in which a person develops a physical dependence on alcohol and compulsively consumes the substance even when they want to stop or moderate their drinking. People who struggle with alcohol use disorder experience withdrawal symptoms, which can be life-threatening, when they try to quit. NIAAA reports that an estimated 16 million people in the US have diagnosable alcohol use disorder, formerly called alcoholism. About 15 million of those people are adults, ages 18 and older; about 623,000 adolescents, ages 12-17, have reported AUD.

The combination of safely detoxing with medical supervision and participating in an evidence-based rehabilitation program for at least 90 days (three months) is the process that has helped the most people end their physical dependence on alcohol and change their behaviors around alcohol and other intoxicating substances. Staying sober requires ongoing social support from friends and family, and may require ongoing therapy and attendance at support groups. During rehabilitation, people working to end their addiction to alcohol will be taught techniques to prevent relapse.

Relapse Prevention Strategies for Alcohol and Drug Abuse

The Substance Abuse and Mental Health Services Administration (SAMHSA) defines relapse prevention as a process of teaching people overcoming substance abuse, like AUD, to recognize the symptoms that could lead to relapse and change their behaviors to prevent falling back into addiction. There are several potential warning signs that a person might relapse, including mood changes, stress, instability in work or relationships, or being around substances. SAMHSA notes that people who successfully complete their evidence-based rehabilitation program and manage to maintain sobriety begin to reverse the process and relapse into AUD if they:

• Have a mistaken belief that leads to irrational thoughts
• Experience painful feelings that cause them to return to addictive thinking patterns
• Find self-defeating ways to avoid experiencing painful feelings
• End up in, or seek out, situations in which people abuse drugs or alcohol
• Begin to behave irresponsibly when confronted with mentally or emotionally stressful situations
• Begin to feel that drugs and alcohol are the logical response to this pain or stress

There are certain steps in most forms of relapse prevention designed to help a person overcoming AUD or another addiction understand their behaviors and recognize potentially negative signs in the future.

What Steps Need to Be Taken after Treatment to Guard against Relapse?

The counselor-based model of relapse prevention therapy has nine steps that counselors use to guide their clients through behavioral learning and understanding to prevent relapse to alcohol or drug abuse.

1. Self-regulation: This begins with stabilizing the person, not just physically with an appropriate detox program, but also mentally and emotionally. Inpatient rehabilitation programs help their clients develop a daily regimen, which includes therapy, exercise, healthy and regular meals, and socializing. Irrational thoughts, behaviors, anxieties, and mood swings that come up during this sober transitional period should be addressed during therapy sessions.
2. Integration: As therapy continues, the counselor should guide their client through understanding problematic behaviors and reactions to past stress or emotions, and how those two tie together. The counselor can then guide their client through the process of developing better behavioral reactions to stressful situations or emotional pain; the client works to integrate these into their daily life.
3. Understanding: As the counselor and client work together to change the person’s behaviors, there must be an understanding of the risk of relapse and how recurring negative emotions in daily life may put the individual at risk of relapse. Understanding how parts of life that are out of the individual’s control may cause certain reactions helps the person recognize these negative reactions and behaviors enough to control the outcome and avoid relapse.
4. Self-knowledge: As the person integrates their understanding of emotional reactions and behavioral responses, their new self-knowledge will help to reduce the potential for relapse.
5. Coping skills: Much of what triggers relapse is stress or painful emotions. The counselor should work with their client to develop stress management techniques; these may include deep breathing, mindfulness, exercise, or other methods.
6. Change: As the individual develops self-knowledge and begins practicing coping skills, they will affect behavioral and mental changes, which further reduce the risk of relapse. However, maintaining this process for several months – potentially after the rehabilitation program is complete – will more fully integrate these behavioral changes into permanent change.
7. Awareness: The daily inventory technique teaches the individual to take time and think about what they are experiencing or how they are being affected by their daily life. They scan for relapse risks, including stress. This helps them understand that they need to be aware of the potential for relapse.
8. Significant others: Social support is one of the most important pillars of recovering from alcohol and drug abuse. Friends and family must support the individual’s efforts to make positive behavioral changes. Therapists, doctors, and support group leaders are also important people in a person’s ongoing recovery from AUD.
9. Maintenance: The therapist and client will work together to develop a relapse prevention plan, using all the techniques listed. This plan should be reviewed and updated as needed on a monthly basis for the first three months; quarterly for the rest of the year; and every six months for the first two years after treatment has been completed. Going back to the plan reminds the individual of the steps they need to take to stay healthy and sober, and helps them see if any are not working well.

Medications to Reduce Relapse for Alcohol Use Disorder

Sometimes, a person who is at risk of relapse for any reason may receive a prescription for a drug to prevent cravings for alcohol. These drugs are acamprosate or naltrexone. The World Health Organization (WHO) recommends these two drugs and disulfiram; however, due to negative reactions and less relapse prevention success with disulfiram, it is not often prescribed in the US.

• Acamprosate:This drug stops cravings for alcohol, so it should be taken consistently, as prescribed. Sometimes, a person may turn to drinking again as a reaction to stress, but acamprosate reduces cravings for alcohol and reduces the effectiveness of alcohol to release neurotransmitters like dopamine and serotonin. Without the pleasurable experience normally derived from alcohol, a person overcoming AUD should learn that they cannot relax or feel less emotional pain by consuming alcohol.
• Naltrexone: This medication is an opioid receptor antagonist, and it is largely prescribed to reduce cravings for opioid drugs. However, it appears to work well for people who struggle with AUD, too. Nausea is the most common side effect from this medication, but it is not designed to be an avoidant, like disulfiram, which triggers nausea if a person drinks; instead, naltrexone stops certain chemicals from binding to receptors, like the opioid receptors, and releasing neurotransmitters. This process in the brain prevents a person from feeling pleasure if they consume either alcohol or opiates.

The combination of medications and therapy can help many people, especially those who have relapsed back into alcohol abuse after going through AUD rehabilitation in the past. Medication may be an effective way to help people who have struggled with long-term drinking, who are in environments which involve drinking, or who have relapsed more than once.

The primary focus, however, is therapy. Working with a counselor to understand addiction and change behaviors is the most effective process for preventing relapse because the individual understands what relapse means and the signals leading up to a potential relapse.

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