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According to most clinicians and the book Relapse Prevention: Maintenance and Strategies in the Treatment of Addictive Behaviors, there is a definitive dividing line between a person experiencing a lapse and a relapse. A lapse refers to a short return to one’s previous behavior and then a self-correction, whereas a relapse refers to a return back to a pattern of behavior following a period of abstinence.
Many individuals in recovery often confuse lapses with relapses. While lapses should be considered signs that one needs to adjust their recovery program, relapses are obviously a more serious issue. Individuals in recovery from substance use disorders should attempt to develop a program that avoids both lapses and relapses. Any attempt to develop such a program should be focused on understanding the major issue that results in individuals experiencing lapses and/or relapses.
The major obstacle associated with unsuccessful recovery from substance use disorders is the tendency for an individual to give in to cravings for drugs or alcohol. Cravings represent programmed response patterns in individuals that occur as a result of conditions in the environment or alterations in mood or emotional state, and result in an urge to return to previous behaviors. Often, cravings appear to come out of nowhere, but they are most likely triggered by some condition in the environment or by some feeling. Environmental conditions that can trigger cravings can consist of factors that were formally associated with drug or alcohol abuse, the experience of stress, or even the experience of success. Emotional states that can trigger cravings can include negative emotions, such as issues with depression or anxiety, or even positive emotions, such as happiness or the feeling of success.
Cravings often represent very vivid and emotionally driven memories that are associated with the pleasant effects that a person once achieved from the drug of choice. These vivid memories are powerful reinforcers that contribute to the continued use of the drug.
Most individuals in recovery will find that even after years of abstinence, they will occasionally experience cravings; however, for most individuals, cravings are strongest in the initial stages of recovery, and their intensity wanes significantly over time.
The types of situations that are responsible for inducing cravings are often referred to as cues or triggers because these situations result in the experience of certain memories, emotions, or physical sensations that were associated with one’s past drug use. Often, these memories are visceral in nature, such that one actually has the subjective experience of feeling how the drug once made them feel as opposed to rationally trying to convince oneself to use the drug. This makes cravings extremely powerful and often results in what is subjectively experienced as a compulsion to use one’s drug of choice as opposed to some rational, logical, internal debate. The internal debate often occurs after the craving has been experienced and one decides whether or not one should act on it. Often, individuals who give in to cravings feel as if they were under compulsion to return to their formal behavior and had lost control.
Triggers that stimulate cravings for drugs or alcohol come in numerous forms. They can be quite personalized and specific to one’s personal experience (e.g., being with certain people or in certain places where one habitually used one’s drug of choice), or they can be very general in nature and affect a great number of individuals in recovery (e.g., the experience of psychological stress).
Triggers are associated with neurochemical events in one’s brain that are subjectively experienced as powerful urges to begin using one’s drug of choice. There are numerous mental and physiological associations that occur when one is exposed to an environmental or emotional trigger.
Many physiological changes have been documented to occur when one experiences a trigger that leads to a craving, such as increased blood pressure, increased heart rate, and an increase in sweat gland activity. Physiological changes lead to changes in one’s mental state that can include excitement, stimulation, anticipation of reinforcement, and recalling past pleasant associations with the use of the drug that often include actual feelings and visual images.
Triggers may consistently cue cravings or may be very inconsistent in their ability to induce cravings. In addition, because cues can occur over a variety of different situations and are often inconsistent and unpredictable, many individuals who relapse have the perception that the trigger just “came out of nowhere” and upon reflection are very surprised and confused following a lapse or relapse. Attempting to identify and control triggers or drug-related cues is a major part of relapse prevention; however, since everyone in recovery will experience a craving at one time or another, it is important to address any particular triggers that one may experience and also develop a strategy to deal with cravings.
Relapse prevention therapy can rely on two approaches to addressing cravings. These strategies consist of the use of medications or behavioral interventions.
Medications cannot address triggers; they can only reduce the cravings associated with these cues. Behavioral interventions can address both triggers and cravings.
Behavioral approaches to relapse prevention offer numerous techniques to help a person develop self-confidence and coping skills, and deal with cravings. When combined with family and peer support and with social support group programs like 12-Step groups, these approaches can support one another and become powerful tools to avoid relapse.
Individuals can also benefit from the use of medications and behavioral interventions as part of their relapse prevention therapy program. Using both available medications and behavioral interventions can increase the effectiveness of one’s relapse prevention program as well as reduce the risk that one will suffer lapses that can evolve into full-blown relapses.
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When people in recovery experience cravings, they are time-limited events. They typically peak rather rapidly, and within several minutes, they have weakened considerably.
Several strategies taught in relapse prevention therapy can help a person ride out cravings.
Some other approaches to deal with cravings and triggers include:
It is important to be aware of the general signs that an individual may be headed for relapse. Some of these signs include:
Relapse prevention therapy can consist of the use of medications, behavioral interventions, or combination of both. Medications can directly deal with the physical aspects of cravings, whereas behavioral interventions can deal with cravings, prepare one to deal with triggers that can induce cravings, and offer a plan to deal with the common triggers and stressors that occur during recovery.
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