Fifth Slice of Cheese: Relapse Plan

Memo to Self: “Plan for relapse"

Dr. Bill Haning talks about one of the impediments that stands in the way of a simple intervention like “stop using drugs and alcohol” from being effective: namely, failing to recognize that sobriety requires a commitment to long- term recovery management. There is evidence that, of people who successfully complete treatment for a substance use disorder, as many as half will have at least one relapse in their first year after discharge. This makes sense: addiction is a chronic, relapsing disorder. But with adequate planning and safety measures in place, relapse is not inevitable. Many people, once they have a foothold in sobriety, remain sober and enter long-term remission of their substance use disorder. As William White says in his very important commentary, relapse does not have to be part of recovery.

 

What we did at Le Mont for Relapse Planning:

 

We required each resident to have a relapse plan in place from the time of admission. This is different from a relapse prevention plan since relapse has already occurred. This relapse plan is designed to catch the relapse early and stop it definitively. All logistical details are worked out ahead of time: who will the resident call, what will they do next, where will they sleep that night, what will take place the next day? If relapse occurs, the plan goes into effect automatically. It is a step-buy-step checklist designed to abort any further progression of drug use.

My brain tells me that my conscious decision not to relapse is all I need to stay sober. Neuroscience tells us different. A good deal of my relapse process occurs outside of my awareness, and relapse can be underway long before I realize it. For instance, I am likely to underestimate the power of cues to cause me to relapse.

 

A strategy to cope with my failure to recognize my relapse process is to rely on the consciousness of others. One way of doing this is called Network Therapy, developed by Dr. Mark Galanter. As Dr. Haning, describes, as a recovering person I create an observational network of people around me whom I trust and have given permission to call me on my behaviors when they begin to indicate a relapse process is underway.

Dr. Haning describes the rationale behind relapse prevention - what the typical risk factors at work in relapse are and strategies to counter them?

Dr. Kitty Harris discusses strategies to help a person whose relapse process has become more conscious in the form of craving

I asked Dr. Thomas Kimball how a Collegiate Recovery Community might handle relapse in one of its’ participants.

The following are excellent books to read about relapse by one of the leading experts in Relapse Prevention, Terry Gorski.

 

Staying Sober: A Guide for Relapse Prevention (1986)

Terrence Gorski and Merlene Miller

 

Relapse Prevention Therapy Workbook: Identifying Early Warning Signs (2010)

Terrence Gorski and Stephen Grinstead

 

I read his book Staying Sober in treatment, and I am grateful for what it taught me.