Relapse prevention is a key component of high-quality mental health with substance use treatment.
By definition, addiction is a chronic, relapsing disorder. And many clinicians believe that relapse prevention is the primary reason people seek treatment. “By the time most individuals seek help, they have already tried to quit on their own and are looking for a better solution.”
Yet for many behavioral health providers—it can be challenging to know how relapse prevention fits into an overall treatment plan.
Common areas of uncertainty are:
- Should relapse prevention be addressed in every session?
- Is it best to wait until stability or abstinence is achieved before focusing on relapse?
- Which particular high-risk situations should providers be aware of?
The exact answer to each of these questions depends on each client’s individual circumstances.
But there is one factor that is common across all people in mental health with substance use treatment: During times of high stress, an individual’s risk of relapse dramatically increases.
Stress and Substance Misuse
Drug and alcohol researchers have long highlighted the important role stress plays in developing and maintaining. The presence of both chronic and acute stress increases a person’s risk of developing a substance use disorder, then experiencing the cycles of relapse characteristic of addiction.
In terms of relapse specifically, a fascinating study from 2016 conducted by the University of Michigan’s Center for the Study of Drugs, Alcohol, Smoking, and Health, examined associations between stressful life events and drug use in over 900 adults.
In short, researchers found that the more stressful life events a person experiences after achieving sobriety, the greater their risk of relapse. They also observed a strong correlation between the number and severity of stressful events and the propensity for relapse.
Not surprisingly, results from the study led to a recommendation that, “Treatment for drug use disorders and relapse prevention programs should include assessment of stressful life events.”
Now, that recommendation certainly seems like solid advice. But it still leaves some questions about how on a practical level, mental health with substance use recovery providers can help clients avoid relapse during times of high stress.
To unpack that a little further, let’s take a look at some stressful life events that may increase the risk of relapse. Then, we’ll cover some examples of specific strategies providers can use to support their clients.
What is Stress?
There is no universally agreed-upon definition of stress. But most scholars describe stress as a process in which the environmental demands placed on a person exceed their perceived ability to cope.
In clinical practice, it’s essential to keep the client’s perception of the event front and center when assessing a potentially stressful event. This is because how an individual views an event is arguably just as important as the event itself.
For example, the ending of a relationship or loss of a job might be devastating for one person and mark the beginning of a time of high stress. While for others, the event might be a relief, signaling the end of a stressful and challenging aspect of their life.
Nevertheless, there are several life events that are usually experienced as highly stressful for the majority of clients in mental health with substance use recovery treatment.
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Assessing High-Stress Situations
If your client experiences any of the following events, please consider conducting a risk assessment to determine if additional actions are required to reduce the risk of relapse:
- Relationship strain (marital, family, or friends)
- Financial crisis
- Death of a relative or close friend
- Difficulties with boss or coworker
- Serious illness or injury
- Sober anniversary or milestone
- Loss of a job
- Legal problems
- Reminders of drug or alcohol use (ie. seeing old acquaintances, alcohol-related social events)
- Being the victim of a crime
- A big change in life circumstances (moving house, changing jobs, new relationship)
Our Procentive EHR solution for behavioral health practices includes dynamic forms and clinical templates that you can use to guide client assessments during times of high stress.
Whether you use a formal or informal assessment process, it’s essential to ascertain:
- What is your client’s perceived level of stress (or distress) around the current situation?
- How is this impacting their thoughts, actions, and behaviors around substance use?
- Is their mental health being impacted? (i.e., worsening of mood, increase in anxiety, thoughts of self-harm or suicide)
Once you have some clarity around these areas, it’s time to work with your client on a plan to avoid relapse (or if they have resumed using, to minimize the damage).
Responding to Identified Risks
There is no “one-size-fits-all” approach to helping clients avoid relapse during times of high stress. But in many cases, one or a combination of the following strategies can assist in safely navigating a challenging time.
Planning Ahead
Encourage your client to identify and plan ahead for potential high-stress events, like sober anniversaries, changing jobs, kids moving out of home, and the birthdays of deceased loved ones.
All too often, people take a “wait and see” approach with events like these, meaning that help might not be readily available right when they need it most.
You may even want to include relapse prevention in your client’s current treatment plan. We’ve partnered with Wiley, the leader in practice planning, to make this process as seamless as possible with our EHR solution for behavioral health providers.
Increasing Services
One of the simplest and most effective ways to support a client during a time of high stress is to temporarily increase services. This might look like attending weekly individual or group therapy sessions instead of fortnightly, adding in some extra telehealth appointments, or booking into an intensive outpatient program.
Two barriers to be aware of with this approach, especially for elderly clients, are transport to appointments and familiarity with telehealth.
Be sure to check if any of these are an issue for your client and assist them if needed. Regarding telehealth, it’s best practice to use an EHR solution like Procentive, with an integrated HIPPA-certified system.
Reviewing Medications
Many people in mental health with substance use recovery utilize medication-assisted therapy as part of a comprehensive treatment plan.
Whether prescribing is done through a psychiatrist, addictions specialist, or primary care physician, reviewing medications during a time of high stress can be a great relapse prevention strategy.
In many cases, adjusting existing medications, or considering new options, can help reduce the risk that a client will resort to harmful substances as a coping mechanism to get through a stressful time.
Engaging Outside Supports
Don’t be afraid to get creative with your client and think about some new options for managing a high-stress time.
Attending a 12-step or substance use support group, engaging a mentor, or even joining a sports team or community interest group can be a great source of additional support.
Also, especially for men, encourage your clients to reach out to friends or family for support. Many people with addictions tend to bottle up emotions and not ask for help when they are stressed, meaning that even those they are close to may not know they are struggling.
Specialized Therapy
Some high-stress situations your clients encounter will fall outside your area of expertise. Relationship problems, trauma following an assault or serious illness, or the loss of a job are common examples.
In each of these scenarios, it’s important to be compassionate and understanding. But be clear with your client that they might benefit from specialized therapy, in addition to continuing mental health with substance use treatment.
You might want to encourage your client to speak with their insurer, a social worker/care coordinator, or primary care physician to find a suitable specialist for their particular challenge.
Stress Can Be an Opportunity for Growth
Promoting the idea that when handled constructively, stress can be an opportunity for growth, is one of the most beneficial things mental health with substance use recovery providers can do to support their clients.
For many people, substance use and addiction began as a coping mechanism to deal with life stressors. And in the absence of other skills, a pattern of resorting to drugs and alcohol in high-stress times is what maintains their destructive habit.
By supporting clients to see that there are more effective ways to manage times of high stress, behavioral health providers can start laying the foundations for true healing and recovery.
If you struggle to incorporate relapse prevention into your practice due to the competing demands of working as a mental health with substance use provider—take a look at our full-featured, simple EHR solution for behavioral health practices—Procentive.
It includes everything you need to power your practice, all in one place. Including an easy-to-use interface, a full library of dynamic forms and clinical templates, 24/7 web access, and an optional integrated HIPPA-certified telehealth feature.
Procentive takes the hassle out of running a mental health with substance use recovery practice. Allowing you to spend less time on administration—and more time caring. Interested in learning more? Get a free demo of Procentive today!
References
- National Institute on Drug Abuse (NIDA). ‘What is Drug Addiction’. Retrieved 17th Nov 2022. https://nida.nih.gov/publications/drugs-brains-behavior-science-addiction/drug-misuse-addiction
- Melemis S. M. (2015). Relapse Prevention and the Five Rules of Recovery. The Yale journal of biology and medicine, 88(3), 325–332. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4553654/
- Sinha R. (2008). Chronic stress, drug use, and vulnerability to addiction. Annals of the New York Academy of Sciences, 1141, 105–130. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2732004/
- Sinha, Rajita. (2002). Sinha R. How does stress increase risk of drug abuse and relapse? Psychopharmacology (Berl) 158: 343-359. Psychopharmacology. 158. 343-59. 10.1007/s002130100917
- McCabe, S. E., Cranford, J. A., & Boyd, C. J. (2016). Stressful Events and Other Predictors of Remission from Drug Dependence in the United States: Longitudinal Results from a National Survey. Journal of substance abuse treatment, 71, 41–47. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5096384/
- Cohen S, Kessler RC, Gordon LU. Strategies for measuring stress in studies of psychiatric and physical disorders. In: Cohen S, Kessler RC, Gordon LU, editors. Measuring Stress: A Guide for Health and Social Scientists. Oxford University Press; New York: 1995. pp. 3–26. [Google Scholar]
