Relapse Prevention

1. Relapse Process,
Prevention,
Post-Acute Withdrawal Syndrome
Syndrome (PAWS)

2. Agenda 2
CHECK- INS TIME TO PROCESS TOPIC: RELAPSE PROCESS
PREVENTION/ PAWS
TAKE AWAYS

3. Check-ins 3
 NAME
 DRUG OF CHOICE
 DAYS SOBER/DATE OF LAST USE
 (*ALL SUBSTANCE)
 CRAVINGS 0 1 2 3 4 5 6 7 8 9 10
 HOW ARE YOU FEELING AND WHY?
 WHAT ARE YOU WORKING ON?
 ONE THING SELFCARE ACTIVITY YOU
WILL DO THIS WEEKEND?

4. Process Time 4

5. The Three Stages Of Relapse.
 Contrary to popular beliefs, that relapse is a quick, almost situational occurrence, it is
actually a slow process that occurs in 3 stages: emotional, mental, and physical.
 Being aware of these three stages can help prevent relapse before it occurs.
 https://www.youtube.com/watch?v=z8npyHaUcaw
 Understanding the Relapse Process
 Relapse Prevention: Early warning signs and important coping skills
 https://www.youtube.com/watch?v=FmjjxdDwOIc
5

6. Stage 1: Emotional Relapse
During this stage, the person is not actively thinking about using drugs or
alcohol. However, their emotions and behaviors may be setting them up for a
relapse down the road.
Some of the warning signs of emotional relapse include:
 Bottling up your emotions
 Not going to recovery support group meetings
 Isolating yourself from peers and family
 Poor eating and sleeping habits
 Going to meetings but not sharing
 Focusing on other people and their problems
to avoid your own
 Not managing anxiety, anger, or other
emotional problems in a healthy way
 Intolerance
 Defensiveness
 Mood swings
 Not asking for help
 Poor self-care emotionally or physically
 Not having sober fun or taking time for oneself
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7. To prevent getting stuck in the first stage on the road to relapse, it is helpful to
ask yourself some questions to gain awareness through self-reflection.
Journaling is an excellent place to start.
Try asking yourself the following self-reflection questions:
 Are you being good to yourself?
 How are you having fun?
 Are you putting time aside for yourself, or are you getting caught up in life or drama of others?
 Which coping skills are you using?
 What can you add to your recovery program to keep you in a safe place emotionally and physically?
 Are you addressing your emotions, feelings, and thoughts? If so, how? If not, why not?
 Have you been attending and participating in recovery support meetings?
 How are you managing daily life stressors?
 Can you compare your self-care and behaviors now with the way they were when you were actively
using? What is similar, and what has changed?
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To prevent relapse, it is crucial to recognize that you are in emotional
relapse and to immediately change your behavior.
If you’re feeling anxious, begin implementing deep breathing
techniques.
Denial is very common in the emotional relapse stage.
When one has been in emotional relapse for a period of time, they
begin to feel uncomfortable or not at ease in their own skin.
This results in feeling discontent, restless, and irritable. Unfortunately,
due to fear of judgement or failure, many do not share how they are
feeling when this occurs. However, sharing how you are feeling is crucial
at this stage.
 If you don’t begin practicing self-care, you will become exhausted.
When you’re exhausted, you will want to escape. As the tension builds,
one becomes at greater risk of moving into stage 2—mental relapse.

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Stage 2: Mental Relapse
When we choose to not work on any signs or symptoms of the emotional stage, there is increased risk of
transitioning to the second stage of relapse, which is mental relapse. Once in mental relapse, which is best
described as a war going on inside one’s mind, the individual is at high risk for physical relapse. Part of them
wants to use, while the other part doesn’t. Fantasizing about using is not uncommon in this stage. As
individuals go deeper into the mental relapse stage, their cognitive resistance to relapse diminishes and their
need of escape increases. It is important to remember that occasional thoughts of using are normal in early
recovery, but the thoughts that occur during mental relapse are different as they are thoughts of considering
making an actual choice to use rather than a fleeting thought of using.
Signs of mental relapse include:
• Cravings or physical and psychological urges to use
drugs and/or alcohol
• Thinking about people, places, and things associated
with past use
• Hanging out with old friends who use alcohol or
other drugs
• Minimizing consequences of past use or glamorizing
past use
• Bargaining
• In bargaining, individuals start to think of scenarios in
which it would be acceptable to use. A common
example is when people give themselves permission
to use on holidays or visiting family.
• Another form of bargaining is when people start to
think that they can relapse periodically, perhaps in a
controlled way, for example, once or twice a year.
• Bargaining also can take the form of switching one
addictive substance for another.
• Lying
• Thinking of schemes to better control using
• Looking for relapse opportunities (hanging out with
old friends or missing meetings)
• Imagining using
• Fantasizing about using
• Planning your relapse

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It is important to remember that it gets harder to make the right choices as the pull of addiction gets stronger.
Techniques for dealing with mental relapse include:
Play the tape through.
When you think about using, it is easy to believe that you are able to control your use this time. Imagine the consequences of
what will happen, whether physical, psychological, or other, and decide if it is really worth it. You may not be able to stop the
next day, and you’ll get caught in the same vicious cycle.
Talk to a trusted peer.
A helpful tool is expressing your thoughts and feelings with a trusted friend, family member, or member of a support group.
As you begin to share your thoughts and feelings, your urges begin to dissipate. They won’t feel so overwhelming, and you
will feel less alone.
Wait for 30 minutes.
Most urges usually last approximately 15 to 30 minutes max. It may feel like an eternity, but if you keep yourself busy or
distract yourself, it’ll quickly diminish. Taking a 30-minute walk is also very helpful.
Take it one day at a time.
Try not to focus on whether you can stay abstinent forever. For now, take it one day at a time. This is a great time to become
productive and/or take time to focus on yourself.
Use relaxation techniques.
Relaxation is an important tool in relapse prevention. This is because when you’re tense, Relaxation techniques help reduce
tension, irritability, cravings, anger, and anxiety. When you’re relaxed, you will be more open to change. Deep breathing and
meditation are excellent forms of relaxation techniques.

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Stage 3: Physical Relapse
When a person doesn’t take the time to acknowledge and address the
symptoms from emotional and mental relapse, it doesn’t take long to lead
down the path to physical relapse. This includes the act of drinking alcohol
or using other drugs. The key is to reach out for help if you find yourself in
physical relapse immediately in order to stop the vicious cycle of addiction
before it is too late.

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Post-Acute Withdrawal Syndrome (PAWS)
https://www.youtube.com/watch?v=so-BZyj21ZA
Understanding PAWS and Relapse
PAWS symptoms most commonly manifest after a withdrawal period from alcohol,
benzodiazepines and opioids, but have been known to occur with (cessation of) use of
other psychoactive substances. It is estimated that 90 percent of recovering opioid
users experience the syndrome to some degree as do 75 percent of recovering alcohol
and psychotropic abusers. The precise mechanisms behind PAWS are still being
investigated, but scientists believe the physical changes to the brain that occur during
substance abuse and are responsible for increased tolerance to the substance are
responsible for the recurring symptoms.

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Signs And Symptoms
Symptoms of PAWS tend to fluctuate in severity, and may disappear altogether only to
reappear at a later time. Some of the most common symptoms of PAWS include:
Difficulty with cognitive tasks, such as learning, problem solving, or memory recall
Irritability
Feelings of anxiety or panic
Depressed mood
Other symptoms may include:
Obsessive-compulsive behaviors
Difficulty maintaining social relationships
Craving originally abused substances
Apathy or pessimism
Disturbances in sleep patterns
Increased sensitivity to stress
These symptoms tend to increase in severity when triggered by stressful situations, but
might flare up even without any clear stimulus.

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Causes And Risk Factors
It is thought that PAWS is the result of physiologic changes that occur in the brain as a result of substance
abuse. During drug abuse the brain makes adaptations to accommodate for the changes in available
neurotransmitters, and these changes can result in excitability when levels of these neurotransmitters change
during abstinence. Scientists hypothesize that that the brain’s capacity to deal with stress is reduced with
prolonged substance abuse and the related withdrawal experiences. Infants born to mothers who have
repeatedly abused substances are also at risk of developing PAWS.
PAWS can manifest after withdrawal from almost any abusive substance, but those abusing benzodiazepines
seem to be the most at risk. There have been reports of benzodiazepine abusers experiencing symptoms of
PAWS for years after final cessation of the abuse.
Treatments
Treatment is generally administered over an extended period of time because the symptoms of PAWS can
continue for months or years. Acamprosate, a drug commonly used to help recovering alcoholics, has been
found to be somewhat effective in managing some PAWS symptoms. Other drugs may also be used. Most
patients undergo psychotherapy as well, in the form of behavioral therapy, group therapy, or both to learn to
cope with the symptoms.
PAWS can be challenging to deal with, especially after going through detox and then working to resist relapse.
The unpredictable fluctuations of symptoms can be stressful, but a combination of drugs and therapy can help
make those symptoms more manageable.

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Takeaway

16. Thank You
HAVER A WONDERFUL WEEKEND!