Once you have made a change, how do you maintain it? What is the difference between a lapse and a relapse? How can you recognize when a relapse is likely?
A lifestyle change is not easy to make or maintain. Lapses (a one-time return to addictive behavior) and relapses (a return to an addictive lifestyle) do occur. Some people relapse several times before new behavior becomes a regular part of their lives. Thus, it is important to learn about and use relapse prevention techniques. Before discussing prevention, it is useful to understand the nature of relapse.
Stanley J. Gross, Ed.D. is a licensed psychologist in private practice in West Roxbury, MA and Professor Emeritus of Counseling Psychology at Indiana State University, Terre Haute. His doctorate is from Columbia University. He did post-doctoral work at the University of Illinois Medical School and at the Center for Addictions Study at Harvard Medical School. He trained in systems work with family therapy pioneer Virginia Satir and at the Boston Family Institute. He is listed in the National Register of Health Service Providers in psychology and is a Certified Addictions Specialist by the American Academy of Health Service Providers in the Addictive Disorders.
Editor: Nadeem Noor
The relapse process occurs in a series of steps and in the direction of a return to addictive or other self-destructive behavior. Along the way, there are opportunities to use new ways of thinking and acting to reverse the process. To understand relapse process and prevention in the following example, imagine you are making one of these lifestyle changes: stopping smoking, attending 12-step group meetings, or beginning an exercise program.
At some point after making a change, the demands of maintaining it seem to outweigh the benefits of the change. We don’t remember that this is normal. Change involves resistance. Reaching out to a supportive person can help clarify our thinking.
We feel disappointed. We forget—disappointment is a normal part of living.
We feel deprived, victimized, resentful, and blame ourselves.
These are “red flags” for a lapse. Talk with a supportive person to clarify the situation.
It occurs to us that our old behavior (smoking, isolation, inactivity) would help us to feel better.
If we would consider why we made the change in the first place, we would remember how the old behavior made us feel worse. Talking to a supportive person, distraction, or relaxation can help relieve the pressure.
Cravings for the old behavior begin, undermining our desire to continue to care for ourselves in the new way. Cravings are a “red flag” for relapse. We need a plan to divert our attention.
A cigarette ad attracts us, or someone in a group puts us down, or we strain ourselves by overdoing exercise. More “red flags!” Acknowledge that it is difficult to make a change. Talk to a supportive person or distract yourself.
We say, “I told you so. This new stuff will never work.” The cravings increase. This shows our immediate need to develop a diversion plan to deal with cravings. We then take a risky action. We go to a smoke-filled bar, or hang out with support group cynics, or phone a friend who berates anyone who exercises. These are “dangerous situations” that put us on a slippery slope toward relapse. Put a diversion plan into effect.
We ignore our “slippery slope,” focused as we are on the old behavior. Now is the time to put our plan into action or we increase the risk of a lapse.
The cravings keep increasing. “Red flags” are waving. With our limited coping skills, failure to employ an alternative plan, and unwillingness to talk to anyone, we increase the risk of going back to our old behavior.
When we begin to think the old behavior will reduce the cravings, a lapse in maintaining the new behavior is likely to occur. We smoke a cigarette, avoid support group meeting, or miss our regular exercise appointment.
If we understand that the lapse is a natural result of our resistance to change and using the plan, we will be able to go back to our new behavior with minimal guilt. It is also helpful to talk to a supportive person to clarify the situation. We also understand that there is no magic. The cravings will not go away until we find ways of coping with them while maintaining the new behavior. To help contain and reduce cravings, start: (1) a program of new activities, ways of thinking, and acting; (2) self-help groups and psychotherapy; and (3) diet and exercise.
If our guilt is intense, in the absence of a plan, we likely will relapse until our next effort to change.
Preventing relapse requires that we develop a plan tailored to maintaining new behavior. The plan involves integrating into our behavior diversion activities, coping skills, and emotional support. Our decision to cope with cravings is aided by knowing: (1) there is a difference between a lapse and a relapse; and (2) continued coping with the craving while maintaining the new behavior will eventually reduce the craving. These coping skills can make the difference when cravings are intense:
- Ask for help from an experienced peer and use relaxation skills to reduce the intensity of the anxiety associated with cravings.
- Develop alternative activities, recognize “red flags,” avoid situations of known danger to maintaining new behavior, find alternative ways of dealing with negative emotional states, rehearse responses to predictably difficult events, and use stress management techniques to create options when the pressure is intense.
- Reward yourself in a way that does not undermine your self-caring efforts.
- Pay attention to diet and exercise to improve mood, reduce mood swings, and provide added strength to deal with stressful circumstances and secondary stress symptoms, including loss of sleep, eating or elimination problems, sexual difficulties, and breathing irregularities.