Why You Should Have a Relapse Prevention Plan
So you've done a great job abstaining from alcohol? Congrats! It's time to get started with an alcohol relapse prevention plan.
Lapse versus Relapse versus Prelapse
Not all alcohol behavior is created equal. The trick is to notice the difference among those behaviors and to tailor your response accordingly.
Lapse: A temporary return to previous behavior that one is trying to control or quit – a one-time occurrence. This is sometimes also referred to as a Slip.
Example: Jenny was committed to abstaining from cocaine. She went to a party, where someone offered her a line of cocaine. She accepted the offer. Even though she immediately regretted doing the drug, she stopped herself from doing what she would have done in the past – text message her dealer to deliver her own supply so that she could use for the rest of the night.
Relapse: A full-blown return to behavior that one is trying to moderate or quit.
Example: Harry was an ex-smoker. He hadn’t touched cigarettes in 10 years. When he learned that his adult son was diagnosed with cancer, Harry became so overwhelmed that he went to the convenience store and bought a pack. He smoked half of the pack that same night. The next morning, he felt sick. His wife was furious. Harry told her that it was his way of coping with the horrible news. He drove to Indiana and bought a carton. He would take the dog on long walks and only smoke them then, when he was away from his family. He told himself that he would quit again once the situation was resolved.
Prelapse: When your brain enters into a mindset associated with relapsing.
Example: It was another rough day for Scott at work. He loved his job and his team. He was well-respected for his intelligence, ethical viewpoint, and commitment to bettering the world. However, his work involved dealing with numerous community associations that often saw him as the lightning rod for their anger. They directed things at him in very public forums that were simply out of his control, and he was tasked with being a spokesman who responded to their concerns. Scott’s co-workers were headed to the bar to “unwind” after a particularly heated community meeting. Scott was avoiding this kind of drinking, because it made his wife upset when he came home and appeared glassy-eyed or buzzed. Scott declined his co-worker’s invitation, remembering his commitment to his wife. As he got in his cab home, he noticed his thoughts continue down the path: “You’ve had a terrible day. You deserve to relax – your family doesn’t understand how hard it is. And look – you’ve said no to your co-workers! That’s progress. What if you just had some of the vodka out of that big handle under the bar when you get home and put it in a juice glass? You won’t be hurting anyone, and you deserve to relax.” This thought bothered Scott, and he began to debate the pros and cons of sneaking liquor at home.
Climbing out of the Well
It’s clear that the ideal time to intervene is when you notice the onset of an alcohol Prelapse – a shift in your mindset that indicates you are working towards a regression back to old habits. However, most people who are starting the process of behavior change are simply trying to prevent a full-blown alcohol relapse.
The problem is that most people go into this process with an all-or-nothing, black-and-white mindset (no thanks to AA): “I’m either good (not relapsing) or bad (relapsing).” Is it any surprise that this in turn leads to the abstinence-violation effect?
Abstinence Violation Effect (AVE)
This term goes back to Marlatt and Gordon’s model of relapse prevention, way back in 1985. It remains relevant today. It refers to the idea that if we slip or engage in an undesirable behavior, like alcohol abuse, we will use false internal attribution to explain why we did what we did.
For example, when Jenny used the line of cocaine, she could have run with the feelings of shame and guilt and tried to attribute her behavior to something about her. She could have thought to herself, “I used because I am a bad person and a failure. I used because I don’t have enough willpower.”
False internal attribution leads to spiraling shame and guilt, which in turn leads most people back to bad habits: “Why bother trying to change? I’ve already thrown away my progress. And I am obviously a bad, weak person.” If Jenny had gone down that path, she most definitely would have called her drug dealer.
Or, as most people say at that low point, “F*** it.”
Mindfulness as an Empowering Shift
Your use of mindfulness when you notice Prelapse or experience a Lapse can prevent you from spiraling into a full-blown relapse.
Most of my clients appear visibly distressed when I introduce the idea of developing a relapse prevention plan. My guess is that they hear the words “relapse” and “plan,” and that the word “prevention” barely resonates. This is understandable. No one wants to relapse. (“Why are we planning on a relapse? I should just never do it again!”)
Consider the number of times you have been a passenger on an airplane. Regardless of the carrier, the destination, or the class of service you receive, you will hear the same thing before the plane takes off: the safety plan.
No pilot or crew planes on a hazardous landing or crash. No passenger wants to think about crashing. And yet, the message is delivered again and again, to the point where even the occasional traveler zones it out as the flight attendants model the oxygen delivery device. Why? They know the plan by heart. They can see the emergency exit doors. They could probably deliver the safety plan to the passengers themselves.
Mindlessness (in this case, zoning out while flipping through an inflight magazine or listening to music on headphones) is a luxury afforded to those who have already developed a deep and lasting awareness.
Have you ever shared a flight with a seatmate who is on the first flight of their life? In general, they are terrified. They nervously stare ahead, focusing on the seat in front of them. Their seatbelt is maximally tightened. They can’t even hear the safety plan announcement because they are envisioning the worst case scenario – a horrific crash. Or they hit the bar hard prior to boarding, and proceed to take a heavy dose of Xanax that their doctor was happy to prescribe them when they identified “fear of flying” as a concern. If that is the case, they are asleep before the plane even takes off. Unfortunately, neither of these processes are mindful.
Planning ahead is something that we do in the event that something deviates from our desired plan. Planning is different from worrying (people who worry, on some level, engage in magical thinking by believing that their worry will prevent the feared outcome). Planning is smart. And that is why you have a relapse prevention plan.
A good alcohol relapse prevention plan also includes a contingency for reaching out to others when we need help. Those people who think they know the plane safety protocol by heart may not realize that they are the kinds of people who freeze up in paralysis during moments of crisis. If they freeze, then they need the help of someone else to get them out safely.
This is also why you will have a support network of people you can reach out to if you are in over your head. There is nothing wrong with asking for help – it takes courage. And that is a plan for success. SS