Relapse prevention means spotting a relapse early and acting before you use again. Willpower alone isn't enough. What counts is noticing your warning signs before things get serious.
Very few relapses come out of nowhere. Researchers describe how a relapse often starts weeks, sometimes months, before the first drink. If you know what to look for, you have time.
Relapse is common. A widely cited review puts the share of people who return to substance use within a year of treatment at 40 to 60 percent. So a relapse tells you little about whether your treatment "worked". It shows that addiction is a chronic condition and needs ongoing attention.
Lapse or relapse?
The best-known relapse prevention model separates two things. A lapse is the first use after a period of sticking to your goal. A relapse is a return to the old pattern, meaning uncontrolled use.
A lapse doesn't have to become a relapse. A lot depends on what you tell yourself afterwards. If you see the lapse as proof that you'll never manage, you're more likely to give up on your goal. Researchers call this the abstinence violation effect. If you see it instead as a sign of a situation you didn't have a plan for yet, you can learn from it.
If your goal is to cut down and not to stop completely, the same applies. A lapse is then going past the limit you set yourself.
A relapse unfolds in three stages
Broadly, a relapse can be split into three stages. The earlier you step in, the easier it gets.
Emotional relapse. You aren't thinking about drinking or using at all. But you sleep badly, eat at odd times, cancel plans and keep your feelings to yourself. Underneath it, you're usually taking less care of yourself.
Mental relapse. You think more about old places and people, remember mostly the good nights and start bargaining. "Only on holiday." "Just one glass, at the weekend." Occasional thoughts about using are normal. Pay attention when they come more often and are hard to push away.
Physical relapse. You use. This often happens in moments when you think nobody will notice.
Your body sends signals in the first two stages too. You find it harder to fall asleep or wake more often at night. You feel tense, get irritated more quickly or struggle to wind down in the evening. These signs are easy to dismiss as "just stress". That's exactly why they're worth paying attention to.
High-risk situations: where things tip over most often
When does it tip over most often? More than half of all relapses start with distressing feelings or an argument with other people. That means anger, anxiety, sadness, frustration or simply boredom. In more than one in five cases, pressure from outside plays the main role, meaning people who push you to drink along with them.
In everyday life this can look quite different. The phone argument with your sister. Friday night after a week where everything went wrong. The wedding where someone hands you a glass of champagne without asking. Good moments count too, like a promotion you want to "celebrate", or the thought "Let's see if I can handle one drink now".
There's good news too. Every situation you get through without using makes you more confident that you'll manage the next one. Psychologists call this self-efficacy.
What goes into your relapse prevention plan
A plan works best when it's specific and you wrote it while you were doing well. In the moment, very few people can think clearly. These five parts belong in it:
Your personal warning signs. In your own words and as precise as you can make them. "I skip training for the second week in a row" works better than "I withdraw".
Your most common high-risk situations. And a way out for each one. When do you leave? What do you say when someone offers you a drink? A sentence you've prepared beats any good intention.
What you do when cravings hit. Cravings come in waves. They build, peak and ease off, usually within about 20 minutes. With a mild craving it often helps to question the thought. With a moderate one, try movement, slow breathing or distraction. A strong craving can sometimes be interrupted by a sharp physical sensation, like cold water on your face.
People you can call. With names and phone numbers. Talk to them beforehand so they know your call is meant seriously. Your therapist and your counselling service belong on this list too.
What you do after a lapse. Your first steps for the next 24 hours, so you don't have to think in that moment.
A sixth point is easy to miss, and that's balance. If your days are all obligations, the pull towards a quick reward grows. So write down what does you good and when you'll do it next.
If you can, write your plan together with your therapist. Keep it somewhere you'll find it when things get hard, and look at it again once a month.
If it happens anyway
A lapse has happened. What matters now is what you do next. These steps help:
Leave the situation as soon as you can.
Call someone from your plan on the same day.
Watch out for the thought "It doesn't matter now anyway". That's the thought that turns a lapse into a relapse.
Look calmly at what happened. Which situation was it? Which warning signs did you miss? Add them to your plan.
Tell your therapist. The sooner, the better.
If you want to stop after a longer period of heavy drinking, speak to a doctor first. Alcohol withdrawal can be physically dangerous. If you're in a very dark place right now and you're in Germany, the Telefonseelsorge is free and open around the clock on 0800 111 0 111.
You can start today. Take five minutes this evening and write down three things that tell you you're not doing so well. Maybe you sleep badly, cancel plans or think more often about old nights out. That's the start of your plan.
