Relapse Prevention
Name one common trigger for substance use
Stress, people, places, emotions, Conflict, cravings, etc.
What does SUD stand for?
Substance Use Disorder
What does "dual diagnosis" generally refer to?
Having a substance use disorder and a co-occuring mental health disorder
"Having a craving means you're going to relapse"
MYTH
A craving is an urge, not an inevitable behavior
Name one healthy coping skill
Deep breathing, walking, journaling talking to friends, music, meditation, exercise, etc.
What is the difference between a trigger and a craving?
A trigger is something that prompts thoughts/urges to use.
A craving is the desire or urge to use.
Which is a central nervous system depressant?
Alcohol
Name one mental heath condition that can co-occur with SUD
Depression, anxiety, PTSD, bipolar disorder, etc.
"Relapse means all of your recovery progress is gone"
MYTH
Recovery skills, insight, relationships, and progress aren't erased
Someone is experiencing a strong craving but can't reach their sponsor/support person.
Name 3 immediate strategies
Name 3 things someone can do when experiencing a craving
Distract themselves, contact support, leave the situation, use coping skills, exercise, attend a meeting, delay acting on the urge, etc.
What is the difference between tolerance and dependence?
Tolerance means needing more of a substance to achieve the same effect.
Dependence means the body has adapted and withdrawal may occur when use stops.
Give an example of how substance use and mental health symptoms can create a cycle
Anxiety --> substance use to cope --> temporary relief --> increased anxiety/withdrawal --> more substance use
"People can experience cravings even when they genuinely want to stay sober"
FACT
Wanting recovery doesn't necessarily eliminate cravings
What is the difference between an internal coping skill and an external coping skill?
Internal coping works with your thoughts, emotions, or physical responses.
External coping involves changing your environment, activity, or social support.
*DOUBLE JEOPARDY!*
What does HALT stand for, and why can these states increase relapse risk
Hungry, Angry, Lonely, Tired
These states can increase emotional vulnerability and make cravings/impulsive decisions harder to manage.
Why is combining opioids with other depressants particularly dangerous?
Both can suppress breathing and consciousness, significantly increasing the risk of respiratory depression, overdose, and death
A person feels anxious, uses a substance, and temporarily feels better. Why might this make them more likely to use again the next time they're anxious?
What is this process called?
The substance provided temporary relief, which can reinforce the behavior. This is an example of negative reinforcement.
Negative reinforcement = “I did this, and something uncomfortable went away, so I'm more likely to do it again.”
"Avoiding every uncomfortable emotion is an effective long-term relapse prevention strategy"
MYTH
Recovery involves learning to tolerate and manage uncomfortable emotions
Someone is overwhelmed by a problem they cannot solve today. What is the difference between coping with the emotion and solving the problem?
Problem-solving addresses the situation itself.
Emotion-focused coping helps the person tolerate/manage the feelings when the problem can't immediately be changed.
Someone says, "I already messed up today, so I might as well keep using."
What thinking pattern is this, and how could you challenge It?
All-or-nothing thinking / abstinence violation effect
Challenge It by recognizing that one lapse doesn't require continued use and that they can stop and return to recovery immediately.
*DOUBLE JEOPARDY!*
Why can substances become strongly associated with specific people, places, smells, music, or routines?
Through conditioning and learned associations.
Conditioning is when the brain learns to connect a specific situation, place, person, feeling, smell, sound, or routine with substance use.
Learned associations are connections your brain makes between two things because they have repeatedly happened together.
The brain learns to associate environmental cues with the effects/reward of substance use, which can later trigger cravings.
Put these steps of urge surfing in the correct order:
A. Notice where you feel the urge in your body
B. Recognize that the urge is temporary
C. Observe the craving without acting on it
D. Notice the urge rise and eventually decrease
C → A → D, while B is an ongoing reminder throughout the process.
C. Observe the craving without acting on it
A. Notice where you feel the urge in your body
D. Notice the urge rise and eventually decrease
B. Recognize that the urge is temporary
"After years of sobriety, someone no longer needs relapse-prevention strategies"
MYTH
Risk can change over time, and major stressors or unexpected triggers can still occur
*DOUBLE JEOPARDY!*
A client says, “I know all the coping skills. I just don't use them when I need them.” What is the actual problem—and what could be done about it?
The issue may be skill implementation rather than skill knowledge.
Skill Knowledge = “I know what to do.”
Skill Implementation = “I actually use what I know when I need it.”
EX. Skill knowledge is knowing how to swim. Skill implementation is actually getting in the water and swimming when you need to.