Relapse Prevention Workbook

Relapse prevention is why most people seek treatment. By the time most
individuals seek help, they have already tried to quit on their own and they
are looking for a better solution. This workbook offers a practical
approach to relapse prevention.

There are four main ideas in relapse prevention.

1. First, relapse is a gradual process with distinct stages. The goal of

treatment is to help you recognize the early stages, in which the
chances of success are greatest
2. Second, recovery is a process of personal growth with
developmental milestones. Each stage of recovery has its own risks
of relapse.
3. Third, the main tools of relapse prevention are a willingness to
participate in your own recovery and awareness of yourself and how
you think, which change negative thinking and develop healthy
coping skills.
4. Fourth, most relapses can be explained in terms of a few basic rules.
Education in these few rules can help you focus on what is
important.

The Stages of Relapse

The key to relapse prevention is to understand that relapse happens

gradually. It begins weeks and sometimes months before an individual
picks up a drink or drug. The goal of relapse prevention is to help you
recognize the early warning signs of relapse and to develop coping skills
to prevent relapse early in the process, when the chances of success are
greatest.

1. Relapse happens after a period of recovery has occurred. Have you

experienced this? What happened? Why do you think this
happened?

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Emotional Relapse

Relapse is broken down into terms of three stages of relapse: emotional,

mental, and physical.

During emotional relapse, we are not thinking about using. We remember

our last relapse and don't want to repeat it. But our emotions and
behaviors are setting us up for relapse down the road. Because we are not
consciously thinking about using during this stage, denial is a big part of
emotional relapse.

These are some of the signs of emotional relapse:

● bottling up emotions
● Isolating
● not going to meetings
● going to meetings but not sharing
● focusing on others (focusing on other people’s problems or focusing
on how other people affect them); and
● poor eating and sleeping habits.

The common denominator of emotional relapse is poor self-care, in which

self-care is broadly defined to include emotional, psychological, and
physical care.

2. Referring back to your last relapse, which of these emotional signs

did you feel or experience? What other emotional factors can you
identify in retrospect?

3. What does self-care look like for you? Can you identify areas of
poor self care in your last relapse?

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Understanding what self-care means and why it is important is crucial to

your recovery. The need for self-care varies from person to person. A
simple reminder of poor self-care is the acronym HALT:
● Hungry
● Angry
● lonely, and
● tired

For some individuals, self-care is as basic as physical self-care, such as

sleep, hygiene, and a healthy diet. For most individuals, self-care is about
emotional self-care. An important aspect of recovery is understanding
and making time for yourself, to be kind to yourself, and to give yourself
permission to have fun.

Many times, when we look back at our past, we find that in many ways we
were selfish, and it feels ‘selfish’ now to make time for ourselves. This could
not be further from the truth. When we were actively drinking or using, ​we
were sick.​ We were not able to concretely focus because our brains were
not working properly. Even if we were not high or drunk all of the time,
our subconscious addicted brain was focused on attaining more of the
substance, sometimes just to function. This is the nature of addiction,
and another reason why it is considered a disease of the brain as much as
the body.

4. Leading up to your last relapse, can you identify where you were
Hungry, Angry, Lonely or Tired? Think about your eating patterns
and habits, your sleeping patterns, your emotional state, your
‘alone-ness’ in your addiction. How did these factor in?

Ask yourself these questions every day:

● “Am I starting to feel exhausted again?
● Do I feel that I’m being good myself?
● Am I allowing myself time to have fun?
● Am I putting time aside for myself or am I getting caught up in life?”

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Compare your current behavior to behavior during past relapses and see
if your self-care is worsening or improving.
5. How can you tell if you are exhausted? Can you recognize this or
does that observation come from someone else?

6. How do you treat yourself well? What does positive self talk look like
to you? What positive affirmation could you tell yourself every
morning and every night?

7. What types of things can you identify that are ‘fun’ for you, or that
bring your peace or make you smile? How can you make more time
for that?

8. How do you notice if you are getting too caught up in other things
and neglect yourself? How do you take quiet time just for yourself?
Do you set aside extra time early in the morning to journal or read
just for yourself? Take a quiet walk and notice nature? What things
can you do to make that happen for yourself?

The transition between emotional and mental relapse is not arbitrary, but
the natural consequence of prolonged, poor self-care. When we practice
poor self-care and live in emotional relapse long enough, eventually we
start to feel uncomfortable in our own skin. We begin to feel restless,
irritable, and discontent. As our tension builds, we start to think about
using just to escape.

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Mental Relapse
In mental relapse, there is a war going on inside our minds. A Part of us
wants to use or drink, while another part of us doesn’t. If we slide deeper
into mental relapse, our cognitive resistance to relapse diminishes and
our need for escape increases.

These are some of the signs of mental relapse:

● craving for drugs or alcohol
● thinking about people, places, and things associated with past use
● minimizing consequences of past use or glamorizing past use
● Bargaining
● Lying
● thinking of schemes to better control using
● looking for relapse opportunities; and
● planning a relapse.

9. After reading these signs, can you identify any of these that were
present during your last relapse? If you recognize them now, did you
recognize them at the time? Why or why not?
a. Cravings

b. Thinking about people, places & things (some people call this
‘romanticizing’

c. Minimizing the Consequences (It wasn’t that bad)

d. Bargaining (Thinking about future times when you will be able

to use ‘safely’; occasionally)

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e. Lying (About how much, how often, type of drug, where you
have been)

f. Thinking of ways to use occasionally (like bargaining, but

specifically about being able to control use)

g. Looking for opportunities to use (purposely attending events

or places where use is expected)

h. Planning a relapse (You might not call it relapse, just returning

to use responsibly)

When we are struggling with emotional and mental relapse, we also are
placing ourselves in high risk situations, such as social gatherings, places
where we used to drink or use, circumstances where others are drinking or
using. Most of us have a hard time identifying our high-risk situations
and believing that they are high-risk. Sometimes we think that avoiding
high-risk situations is a sign of weakness., telling ourselves that our will
power is stronger than the situation.

10. Looking back, can you identify any high risk places you were places
in preceding your relapse? (High risk situations also include
emotionally damaging situations, such as difficult family encounters,
where in the past, using or drinking was a coping skill you used to
get through it.)

In bargaining, individuals start to think of scenarios in which it would be

acceptable to use. A common example is when people give themselves
permission to use on holidays or on a trip. It is a common experience that
airports and all-inclusive resorts are high-risk environments in early
recovery. Another form of bargaining is when people start to think that
they can relapse periodically, perhaps in a controlled way, for example,
once or twice a year. Bargaining also can take the form of switching one
addictive substance for another.

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11. After reading about Bargaining, do you recognize that as one of

your mental relapse signs? Why or why not?

Occasional, brief thoughts of using are normal in early recovery and are
different from mental relapse. When people enter a substance abuse
program, They might say, “I want to never have to think about using again.”

It can be frightening when they discover that they still have occasional
cravings. They feel they are doing something wrong and that they have let
themselves and their families down. They are sometimes reluctant to even
mention thoughts of using because they are so embarrassed by them.

Warning signs are when thoughts of using change in character and

become more insistent or increase in frequency.

12. Looking at your past relapse, did you have increasing thoughts
about using? Did you talk to someone about those thoughts? Why
or why not?

13. Do you have those thoughts now? How do you feel when you have
those thoughts? Are you able to talk to someone now? Why or why
not?

14. When you have these thoughts, do you try to ignore them or do you
address them? How do you address them (i.e., talking about them in
a meeting, journaling). Why or why not?

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Physical Relapse

Physical relapse is when you physically use the substance again.

Most physical relapses are relapses of opportunity. They occur when the
person has a window in which they feel they will not get caught.

Part of relapse prevention involves rehearsing these situations and

developing healthy exit strategies.

15. When you look at your past relapse, did you feel that you could just
have ‘one drink’ or use ‘that one time’ and ‘not get caught’? What
happened?

16. What were your thoughts as you entered the situation where you
were obtaining the drink or drug?

17. What were your thoughts about the consequences if you were
caught?

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18. Negative Thinking

This is a short list of the types of negative thinking that are
obstacles to recovery. Write down your thoughts about each
statement.

● My problem is because of other people

● I don’t think I can handle life without using

● Maybe I can just use occasionally

● Life won’t be fun — I won’t be fun — without using

● I’m worried I will turn into someone I don’t like

● I can’t make all the necessary changes; I can’t change my friends

● I don’t want to abandon my family

● Recovery is too much work

● My cravings will be overwhelming; I won’t be able to resist them

● If I stop, I’ll only start up again; I have never finished anything

● No one has to know if I relapse

● I’m worried I have been so damaged by my addiction that I won’t be

able to recover.

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19. The negative thinking that underlies addictive thinking is usually

all-or-nothing thinking, disqualifying the positives, catastrophizing,
and negatively self-labeling. These thoughts can lead to anxiety,
resentments, stress, and depression, all of which can lead to relapse.
What other thoughts do you have, or have had, that have
contributed to your use? Finish these statements:

● I can’t stop because:

● I don’t believe I can stop because:

● I have never been able to:

● I won’t be able to:

● People say I’m:

● My friends says I’m too:

● I’m a failure because:

● I don’t want to stop drinking or using because:

Reflect on those statements. Can you change any of those statements into
a positive thought? Why or why not?

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Fear

Fear is a common negative thinking pattern in addiction. These are some

of the categories of fearful thinking:
● fear of not measuring up
● fear of being judged
● fear of feeling like a fraud and being discovered
● fear of not knowing how to live in the world without drugs or alcohol
● fear of success; and
● fear of relapse.

A basic fear of recovery is that we are not capable of recovery. The belief
is that recovery requires some special strength or willpower that we do not
possess.
Past relapses are taken as proof that we do not have what it takes to
recover.
20. Write a statement answering each of these fears:

● I am fearful of not measuring up because:

● I am fearful of being judged because:

● I am fearful of feeling like a fraud and being discovered because:

● I am fearful of not knowing how to live in the world without drugs or

alcohol because:

● I am fearful of success because:

● I am fearful of relapse because:

21. What other things about recovery and failure are you fearful of?

● I am fearful:

● I am fearful:

● I am fearful:

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Redefining Fun

One of the important goals in recovery is to learn to redefine fun. Many

times when we are under stress, we revert backwards and glamorize our
past use, We might think about it longingly in terms of relaxation and
reward.

We begin to disqualify the positives we have gained through recovery. The

challenge is to acknowledge that recovery is sometimes hard work but
addiction is even harder. If addiction were so easy, people wouldn’t want
to quit and wouldn’t have to quit.

22. Remember times when you were sober or in recovery. What types of
things, places or people made you happy? What did you enjoy
doing?

23. Many times, things we enjoyed before our addiction or alcoholism

were stopped or interrupted because of our use. Can you remember
things you used to enjoy?
a. Learning new things (school, classes, reading)

b. Exercising (Hiking, walking, running, swimming)

c. Traveling (Going to new places, visiting friends or relatives,

beaches or mountains)

d. Eating (Cooking, restaurants, trying new foods)

e. Pets, Nature, Photography____________

f. Reading, Writing, Crafts_______________

g. Other: _________________________________

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Romancing the High & Magical Thinking

Romancing the drink or drug is when people in recovery begin to

remember all the good things about their former addiction.

The pain and suffering we experienced as a result of substance abuse is

pushed to one side. We are drawn back to the nicer times ​when things felt
a bit more comfortable​. ​We may remember the early days of our drug use
when we felt in control and had fun. Our imaginations fill in any gaps to
make these times appear even more enjoyable then what they actually
were.

24. While it is common to remember ‘good times’, it is important to play

these thoughts through to the end. Did ‘Romancing the High’ have
any part of your relapse? Do you find yourself thinking that way
now?

25. We might have been told by a friend in recovery to ‘Play the Tape
Through’ when we experience romancing or reminiscing. What does
that phrase mean to you?

26. ‘Playing the Tape Through’ means taking a romantic or fond

memory of use and continuing that thought through to real or
possible consequences of acting upon the thought of returning or
continuing to use. Play the tape on the following statements:
a. I think I could have one glass of wine; it’s been a while.

b. One last time won’t hurt, I know what I’m doing now.

c. I deserve this after the day I have had.

d. These are my friends. Nothing bad will happen.

e. No one will now. Just this once.

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27. Sometimes, we expect that not using drugs or alcohol will lead to
the emotional pain or boredom that we tried to escape. Did you
drink or use drugs to escape? What happened? Play the tape
through.

Expectations in Recovery and Setbacks

In recovery, we tend to see setbacks as failures because we are unusually

hard on ourselves. We may have set an unrealistic expectation of what
recovery should look like and feel like. We have an idea that if we just stop
using, things will be better in our life. This is often reinforced by family
and friends who tell us; “If you just stop drinking or using…”
Examples of unrealistic expectations usually begin with “If I quit drinking
or using, I will be…”
● Happy
● Healthy
● loved
● Forgiven
● Richer
● Thinner
● Reunited
● Smarter

The fact is, these may be quite true, but most often, it takes time and work
to get there! Relationships need mending and are not always repairable.
The job you held may not be the one you keep in a recovering life. You
might have health set-backs. You might eat more before you eat healthy.
You have to learn to love yourself before you can truly feel the love for
you.

28. Did unrealistic expectations in recovery have an impact on your

last relapse? What expectations do you have for your recovery
today?

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29. How realistic are your expectations for your recovery? What do
you think you might have to do to make those a reality?

Setbacks
How we deal with setbacks plays a major role in recovery. A setback can
be any behavior that moves us closer to physical relapse. Some examples
of setbacks are:
● not setting healthy boundaries
● not asking for help
● not avoiding high-risk situations, and
● not practicing self-care.

A setback does not have to end in relapse to be worthy of discussion.

● Setbacks can set up a vicious cycle, in which we view setbacks as

confirming our negative view of ourselves. We begin to feel that we
cannot live life on life's terms.
● This can lead to more using and a greater sense of failure.
Eventually, we stop focusing on the progress we have made and
begin to see the road ahead as overwhelming.
● Setbacks are a normal part of progress. They are not failures. They
are caused by insufficient coping skills and/or inadequate planning,
which are issues that can be fixed.

30. Challenge your thinking by looking at past successes and

acknowledging the strengths they bring to recovery. Below, write
down 5 accomplishments you have made in your life. These can be
about finishing a project, having a child, training a pet. Anything
goes!
1.
2.
3.
4.
5.

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Abstinence Violation Effect

When we pick up or use after a period of recovery or abstinence, we are

especially hard on ourselves and begin making global statements, such
as, “This proves I’m a failure.”

When we take an all-or-nothing, dichotomous view of recovery, we are

more likely to feel overwhelmed and abandon long-term goals in favor of
short-term relief. This reaction is termed the Abstinence Violation Effect.
This is a coffin maker for people in recovery from addiction or alcoholism.

Many people consider a relapse as a normal part of recovery, but in

reality, it is a component of the disease of addiction and alcoholism. It is a
symptom of the disease, from which we can learn from and better protect
ourselves in our recovery. By examining our use and our relapse, we can
identify where our defenses against this disease are vulnerable and fortify
these areas.

Some people call this a Relapse Autopsy.

The purpose of this Relapse Autopsy is to help you recognize what issues,
patterns, and choices contributed to your relapse so that you can learn
from it.
A Relapse Autopsy will walk you through various aspects of your relapse
and current recovery to help you identify
● what you have minimized that contributed to your relapse
● what you might have missed that allowed your relapse to occur, and
● what changes you can make in your recovery to avoid repeating
these patterns.

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31. Answer the following questions about your last relapse.

● What was the Nature of your relapse?

● What choices did you make or behaviors did you do

immediately before your relapse? What behaviors or choices
did you make before that? And before that? And before that?
Etc.

● After reviewing your behaviors and choices, what are some

similarities to past relapses?

● After reviewing your behaviors and choices, what contributed

to your relapse? What changes are there to be made to your
inner circle, middle circle, or sobriety plan?

● What justification or denial did you use to convince yourself

that acting out was OK or that you were not really acting out?

● After reviewing your justification and denial, what are some

similarities to past relapses?

● After reviewing your justification and denial, what changes are

there to make to your sobriety plan?

● What events, situations, or interactions happened immediately

before your relapse?

● What events, situations, or interactions happened the day of

your relapse?

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● What significant events, situations, or interactions took place

the week before your relapse?

● What significant events, situations, or interactions took place

two weeks or more before your relapse?

● What events or situations are/were scheduled to take place

later the day of your relapse?

● What events or situations are/were scheduled to take place

the day after your relapse?

● What significant events or situations are/were scheduled to

take place the week after your relapse?

● What significant events or situations are/were scheduled to

take place two weeks or more after your relapse?

● After reviewing the events, situations, and interactions, what

are some similarities to past relapses?

● After reviewing the events, situations, and interactions, are

there changes to make to your sobriety plan?

● What emotions were you feeling immediately before your

relapse?

● What significant emotions did you feel the day of your relapse?

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● What significant emotions did you feel the day before your
relapse?
● After reviewing your emotional experiences, what are some
similarities to past relapses?

● After reviewing your emotional experiences, are there changes

to make to your sobriety plan or sobriety first aid kit?

● What physical sensations (see, hear, smell, taste, feel on your

skin) did you experience immediately before your relapse?

● What significant physical sensations (see, hear, smell, taste, feel

on your skin) did you experience the day of your relapse?

● What significant physical sensations (see, hear, smell, taste, feel

on your skin) did you experience the day before your relapse?

● After reviewing your physical sensations, what are some

similarities to past relapses?

● After reviewing your physical sensations, are there changes to

make to your sobriety plan or sobriety first aid kit?

● Reviewing the previous sections of this Relapse Autopsy, what

secrets did you keep? What situations, experiences, or
thoughts did you not share with others?

● Thinking about your past addictive behaviors and past

situations you feel shame or guilt around, what secrets are you
still keeping?

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● After reviewing your kept secrets, what are some similarities to

past relapses?

● After reviewing your kept secrets, what changes are there to

make to your sobriety plan?

● After reviewing your kept secrets, what actions are there for
you to take regarding rigorous honesty and/or amends?

● What self-care tools did you use the day of your relapse?

● What self-care tools would have been helpful the day of your
relapse that you did not use?

● Was there a change in your self-care routine in the week

before your relapse?

● After reviewing your self-care experiences, what are some

similarities to past relapses?

● After reviewing your self-care experiences, what contributed to

your relapse? Are there changes to be made to your sobriety
plan, sobriety first aid kit, or self-care routine?

● What impact or consequences has your relapse had on you?

● What impact or consequences has your relapse had on

others?

● After reviewing the impact and consequences, what are some

similarities to past relapses?

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● After reviewing the impact and consequences of your relapse,

are there changes to be made to your sobriety plan or sobriety
first aid kit?

● Prior to and during this relapse, what was your motivation for
staying sober and resisting the urge to act out?

● What parts of your motivation were effective? (Helped you hold

on to your desire to stay sober and resist the urge to act out.)

● What parts of your motivation were NOT effective? (Did NOT

help you hold on to your desire to stay sober and resist the
urge to act out.)

● After reviewing your motivation to stay sober, what are some

similarities to past relapses?

● After reviewing your motivation to stay sober, are there

changes to be made to your sobriety plan or sobriety first aid
kit? (​Where in your sobriety plan and first aid kit is your
motivation to stay sober identified and reinforced? How easy is
it to remind yourself of your motivation to stay sober when you
are in the middle of your addictive urges?)

● Having worked through this Relapse Autopsy, I am making the

following changes to my circles (inner, middle, and outer):

● Having worked through this Relapse Autopsy, I am making the

following changes to my sobriety plan:

● Having worked through this Relapse Autopsy, I am making the

following changes to my sobriety first aid kit:

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● Having worked through this Relapse Autopsy, I am making the

following changes to my selfcare routine:

● Having worked through this Relapse Autopsy, I will explore the

following actions regarding rigorous honesty and/or amends
with my therapist, sponsor, and/or support group:

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Sobriety First Aid Kit

(From Living Sober https://livingsober.org.nz/sober-first-aid-kit-repost/)

1. Something smelly
A really good smell can be incredibly transporting, and when you're stressed and freaking
out, a scent you love can totally calm you down and reset your equilibrium. What kinds of
smells do you love? Tropical, earthy, spicy, floral, fruity? It can be a tiny bottle of
aromatherapy oil -- you can get single scents or blends for different effects. I love
frankincense. It just takes me somewhere far above the crap I'm dealing with and reminds
me of my wise, loving self who's always there for me. Lavender and rose do it for me too.
It might be a favourite perfume. A crushed leaf from the rosemary plant. A scented
candle.
Find your scent -- the one that will remind you of a better you than boozer you, and when
you need it, take a deep slow mindful sniff.

2. Something sweet
There's a lot of talk about the evils of refined sugars, and I'm totally on board with that.
But please, please, please don't eliminate all the sweetness from your life! We need
sweetness, and it's no accident that we are drawn to sweet flavors. Nature gives them to
us for a purpose, and I think it's to sweeten up our lives (our first food, breast milk, is
sweet. Go figure.) So have some healthy sweet things in your first aid kit. I go for dates,
raisins, dried bits of mango. Honey is good too -- you can get those little honey packs
and suck on one in an emergency. Dark chocolate in tiny packs is great too. See if you
can suck the chocolate rather than wolf it down... much more satisfying.

3. Something inspiring
We're sober because we want to be better versions of ourselves. We don't want to be the
lost, lonely, out-of-control boozehound we once were. We were inspired to do all that hard
work to get sober, and we need to keep on inspiring ourselves, especially during these
holidays, which can bring us face to face with all our old demons, memories, traditions,
and habits. Make sure your first aid kit has a reminder of what inspires you. It could be a
photo of your kids to remind you of your future, a quote you really relate to, a card or a
stone or a crystal or whatever reminds you about your hopes and dreams for yourself.

4. Something soft and cosy

Often when we get that "I WANNA WINE" impulse, we just want to be soothed from
something uncomfortable. Now I'm all for blankies, but I don't recommend wrapping up in
one and crawling under the tree during the family Christmas lunch. I do love to have
something on hand that's soft and comfy though, and that I can slip on and feel relaxed.
My default for when I'm in public is a soft silk neck scarf -- a mini blankie (even better if it's
got a drop of my favourite smell on it already -- a double whammy). If I'm staying away
from home, I always make sure I've got extra cosy pyjamas, socks and slippers, and my
hottie. A soft hoodie is also a very nice thing to curl up in. Or a onesie if you're that way
inclined! Just pack with your own comfort in mind, and when you need to escape the
party, go to your room and rug up!

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5. Something supportive
Your Phone or computer! Don't forget to use your emergency help line and text a sober
friend or jump on the Living Sober page and share what's going on. The point here is
"Just because it's Christmas or New Year doesn't mean you're cut off from sober support."
Have your phone charged, and your numbers loaded, and Use Them!

6. Something pampering
I think as boozers we get very very good at neglecting ourselves. We get hard wired to
think that booze is our treat and what we deserve, and we neglect so much else about our
health and grooming. So put some pampering things into your first aid kit. Hand cream,
face cream, lip balm, a facial mist spray, a hair brush or comb... when you're feeling a bit
scratchy or frazzled, giving your hair a brush and moisturizing your skin can be a
game-changer. Blokes, you can do this too. For sure!

7. Something nourishing
If you're off to a party or somewhere the food isn't guaranteed to be good, take
something good and nourishing with you. Some fruit, nuts, energy bars, drinks... whatever
you like to snack on when you're needing a pick up. I really think junk food and booze are
very close buddies, and one nudges us toward the other. So eat well to protect yourself
from that double agent.

8. Something surprising
How about delighting yourself with a surprise? I'm going to put a lucky dip component
into my first aid kit. I think I'll get myself some tiny presents this year, wrap them up
individually, and open one when I feel like I need a lift. Totally optional, this one. It was just
a random idea.

9. Wrapping it up
Put your first aid gear in a nice bag or box so you can feel good about keeping it out and
on hand. Whatever works for you. I keep mine in one of those pouches you get on the air
planes (from someone else who travelled business class!). I wouldn't judge you for shoving
your stuff in a plastic supermarket bag (hey, at least you've got a first aid kit), but do think
about making this something special. It's your own personal message to yourself and to
your addict voice, that you mean business this year. You're sober, and you're staying
sober. If you can, make your sober first aid kit a statement!

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Build your Recovery First Aid Kit!

1. Aromas: What scents will you add?

2. What is your Sweet Treat?

3. What can you put in that will remind you to be inspired?

4. What soft and cozy item can you add?

5. How will you access your supports?

6. What is your reminder for pampering or your pampering tool?

7. What is your nourishing snack?

8. How will you add your surprise? What will that be?

9. What is your special and personal tote for your kit? This should be
something you can carry with you at all times!!

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Relapse Review: A different format for an Autopsy

​ outines that change too quickly could create distress, especially if

R​ R
there is no plan in place to deal with the consequences of the changes.
Were there unplanned stressors that hit too rapidly in your life?

E​ ​Examining your Moods, such as, have you been too Hungry, Angry,
Lonely or Tired? What have you noticed about yourself that could have
been a precursor to relapse?

​ ook to see if there is someone in any of your systems (Home, Work,

L​ L
Family of Origin, Old Friends, etc.) who want you to be as sick as they are
and maybe sabotaging your recovery.

​ ssess Resentments-are there resentments that you nursed, which were

A​ A
not discussed, weighed you down, causing you to seek some release via
passive-aggressive and acting out behaviors?

P​ ​Pride, Narcissism and being a Power Greater than Yourself feeds

entitled behavior where you are apt to think the rules don’t apply to
you…was this a factor with your relapse?

S​ ​Stinking Thinking means the employment of Rationalization (“Rational

Lies”), Justification, Minimization, and other Ego Defenses will be used and
usually proceed a relapse.

E​ ​Escaping Pain by Engaging in Pleasure oriented behaviors that “help”

you to momentarily avoid your pain, suffering and reality could be causal
factors. Was this true with you?

S​ ​Somehow, forgetting how bad it used to be and thinking you could go

back for another run and avoid all of the painful consequences connected
to the past using episodes crept in.

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Becoming Comfortable with Being Uncomfortable

The World Health Organization named stress the “Health Epidemic of the
21st Century”. It is experienced by nearly 80% of Americans daily. Affecting
the workplace, relationships, and health, stress has implications that
reach far and wide for the average individual.

However, for those suffering from addiction, stress can be one of the
strongest predictors of drug use, craving, and relapse. Often viewed as a
response to stress and emotional discomfort, substance abuse can be
even more difficult to overcome in the presence of stress.

Becoming comfortable with being uncomfortable in recovery means

learning to ‘sit’ in physical and emotional discomfort and not using drugs
or alcohol as a coping mechanism for these negative feelings.

Healthy coping skills for stress include: (add your own at the bottom)

● Walking, Running
● Swimming
● Hiking
● Mindful Meditation
● Yoga
● Healthy Eating
● Crafts
● Painting
● Journaling
● Puzzles
● Self-care (Bubble baths, nail and hair care, massages)
● Sleep
● ___________________
● ___________________
● ___________________
● ___________________
● ___________________
● ___________________

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The following are examples of stressful situations where you may have
escaped to drug or alcohol use. How would you cope with these today?

Calm down after a disagreement or conflict with a spouse, friend or family

member

Unwind after a stressful day

Numb traumatic memories

Feel “normal”

Relieve tension

Deal with rejection or loss

Feel more confident in social situations

Escape pressures of work, school, marriage, parenthood, etc.

Reduce physical pain from an injury or illness

Reward yourself

Other ___________

Other ___________

Other ___________

Other ___________

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Relapse Prevention Workbook

The Stages of Recovery

Recovery is a process of personal growth in which each stage has its own
risks of relapse and its own developmental tasks to reach the next stage.
The stages of recovery are not the same length for each person, but they
are a useful way of looking at recovery. Broadly speaking, there are three
stages of recovery.

Abstinence Stage
It is commonly held that the abstinence stage starts immediately after a
person stops using and usually lasts for 1 to 2 years. The main focus of
this stage is dealing with cravings and not using.Review each of these
tasks and write down your thoughts about each one:

1. Accept that you have an addiction

2. Practice honesty in life

3. Develop coping skills for dealing with cravings

4. Become active in self-help groups

5. Practice self-care and saying no

6. Understand the stages of relapse

7. Get rid of friends who are using

8. Understand the dangers of cross addiction

9. Deal with post-acute withdrawal

10. Develop healthy alternatives to using

11. See yourself as a non-user

There are many risks to recovery at this stage, including physical cravings,
poor self-care, wanting to use just one more time, and struggling with
whether one has an addiction. Where do you see yourself?

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Post-Acute Withdrawal

Dealing with post-acute withdrawal is one of the tasks of the abstinence

stage. Post-acute withdrawal begins shortly after the acute phase of
withdrawal and is a common cause of relapse. Unlike acute withdrawal,
which has mostly physical symptoms, post-acute withdrawal syndrome
(PAWS) has mostly psychological and emotional symptoms. Its symptoms
also tend to be similar for most addictions, unlike acute withdrawal, which
tends to have specific symptoms for each addiction.

These are some of the symptoms of post-acute withdrawal

1. mood swings
2. Anxiety
3. Irritability
4. variable energy
5. low enthusiasm
6. variable concentration; and
7. disturbed sleep.

Many of the symptoms of post-acute withdrawal overlap with depression,

but post-acute withdrawal symptoms are expected to gradually improve
over time.

Probably the most important thing to understand about post-acute

withdrawal is its prolonged duration, which can last up to 2 years The
danger is that the symptoms tend to come and go. It is not unusual to
have no symptoms for 1 to 2 weeks, only to get hit again. This is when
people are at risk of relapse, when they are unprepared for the protracted
nature of post-acute withdrawal.

When people struggle with post-acute withdrawal, we tend to

catastrophize our chances of recovery. We think that we are not making
progress. The challenge is to encourage ourselves and to measure our
progress month-to-month rather than day-to-day or week-to-week.
(Coincidently, these ‘waves’ tend to follow the ‘coin presentations’ at 12 step
groups- 1 day, 1 month, 2 months, 3 months, 8 months, etc.)

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From the list below, write down how each has affected you and what you
did or can do to combat those feelings:

1. mood swings

2. Anxiety

3. Irritability

4. variable energy

5. low enthusiasm

6. variable concentration

7. disturbed sleep.

8. Other: ____________

9. Other: ____________

10. Other: ____________

11. Other: ____________

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Relapse Prevention Workbook

Repair Stage

In the second stage of recovery, the main task is to repair the damage
caused by addiction. This stage usually lasts 2 to 3 years.

In the abstinence stage of recovery, we usually feel increasingly better. We

are finally taking control of our lives. But in the repair stage of recovery, it
is not unusual for us to feel worse temporarily.

During this stage, we must confront the damage caused by addiction to

our relationships, employment, finances, physical health and self-esteem.
We must also overcome the guilt and negative self-labeling that evolved
during addiction. At times, we might think that we have been so damaged
by our addiction that we cannot experience joy, feel confident, or have
healthy relationships. These are some of the tasks of the repair stage of
recovery; write down your thoughts about these tasks:

1. Overcome negative self-labeling and catastrophizing

2. Understand that we are not our addiction

3. Repair relationships and make amends when possible

4. Start to feel comfortable with being uncomfortable

5. Improve self-care and make it an integral part of recovery

6. Develop a balanced and healthy lifestyle

7. Continue to engage in self-help groups

8. Develop more healthy alternatives to using

9. Begin addressing health and dental care that was neglected during
use

Common causes of relapse in this stage are poor self-care and not going
to self-help groups. What are your thoughts about self help groups?

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Growth Stage

The growth stage is about developing skills that individuals may have
never learned and that predisposed them to addiction. The repair stage
of recovery was about catching up, and the growth stage is about moving
forward. This stage usually starts 3 to 5 years after individuals have
stopped using drugs or alcohol and is a lifetime path.

This is also the time to deal with any family of origin issues or any past
trauma that may have occurred. These are issues that we are sometimes
eager to get to, but they can be stressful issues, and, if tackled too soon,
we may not have the necessary coping skills to handle them, which may
lead to relapse. Do you identify with any of these? Write a plane next to
each one about who can help you with these issues.

These are some of the tasks of the growth stage:

1. Identify and repair negative thinking and self-destructive patterns

2. Understand how negative familial patterns have been passed down,

which will help individuals let go of resentments and move forward

3. Challenge fears with therapy and mind-body relaxation

4. Set healthy boundaries

5. Begin to give back and help others

6. Reevaluate your lifestyle periodically and ensure you are on track

The tasks of this stage are similar to the tasks that non-addicts face in
everyday life. When non-addicts do not develop healthy life skills, the
consequence is that they may be unhappy in life. When recovering
individuals do not develop healthy life skills, the consequence is that they
also may be unhappy in life, but that can lead to relapse.

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Causes of Relapse in Late Stage Recovery

In late stage recovery, we are subject to special risks of relapse that are
not often seen in the early stages. The following are some of the causes of
relapse in the growth stage of recovery.

1) We often want to put our addiction behind us and forget that we ever
had an addiction. We feel we have lost part of our life to addiction and
don’t want to spend the rest of our life focused on recovery. We start to go
to fewer meetings, or stop altogether.

2) As life improves, we begin to focus less on self-care. We take on more

responsibilities and try to make up for lost time. In a sense, we are trying to
get back to our old life without using. We stop doing the healthy things
that contributed to our recovery.

3) We feel we are not learning anything new at self-help meetings and

begin to go less frequently or stop completely.
(We need to remember that one of the benefits of going to meetings is to be
reminded of what the “voice of addiction” sounds like, because it is easy to forget.)

4) Some of us may feel that we should be beyond the basics. We think it is

almost embarrassing to talk about the basics of recovery. We are
embarrassed to mention that we still have occasional cravings or that we
are no longer sure if we ever had an addiction.

5) Some of us think that we have a better understanding of drugs and

alcohol and, therefore, think we should be able to control a relapse or
avoid the negative consequences.

What are your thoughts about causes of relapse in late stage recovery?
How will you combat these defeating thoughts?

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The Five Rules of Recovery

Most relapses can be explained in terms of a few basic rules. Learning
these simple rules helps us to understand that recovery is not
complicated or beyond our control. 1) change your life; 2) be completely
honest; 3) ask for help; 4) practice self-care; and 5) don’t bend the rules. As
you read these rules, write down what you think when you reflect upon
them:

Rule 1: Change Your Life

The most important rule of recovery is that a person does not achieve
recovery by just not using. Recovery involves creating a new life in which it
is easier to not use. When individuals do not change their lives, then all the
factors that contributed to their addiction will eventually catch up with
them.
We often enter thinking, “We want our old life back — without the using.”
Try to see recovery as an opportunity for change. If we make the
necessary changes, we can go forward and be happier than they were
before. This is the “silver lining” of having an addiction. It forces us to
reevaluate our lives and make changes that non-addicts don’t have to
make.

Examples of Change

● Change negative thinking patterns

● Avoid people, places, and things associated with using
● Incorporate the five rules of recovery

What are your thoughts about this first rule?

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Relapse Prevention Workbook

Rule 2: Be Completely Honest

Addiction requires lying. Addicts and alcoholics must lie about getting our
drug, how much we are using, hiding the drug, denying the consequences,
and planning our next relapse. Eventually, we end up lying to ourselves.

When we feel they cannot be completely honest, it is a sign of emotional

relapse. It is often said that recovering individuals are as sick as their
secrets. One of the challenges is learning how to and then to practice
telling the truth, practice admitting when they have misspoken and
quickly correcting it.

How honest should a person be without jeopardizing his or her work or

relationships? We are encouraged to understand the concept of a
recovery support system. This is our group of people that includes family
members, our doctors, counselors, self-help groups, and sponsors. We are
encouraged to be completely honest within this recovery circle. As we feel
more comfortable, we may choose to expand the size of our circle.

Probably the most common misinterpretation of complete honesty is when

we feel we must be honest about what is wrong with other people.
Honesty, of course, is self-honesty. A common question about honesty is
how honest should a person be when dealing with past lies. The general
answer is that honesty is always preferable, except where it may harm
others or yourself.

While the people in our recovery support circle need our honesty to
support us, people outside of this circle may not be comfortable about
addiction and alcoholism. Ask yourself why you feel the need to discuss
your recovery with them-Do they need to know? Discuss questions with
your sponsor and recovery running buddies.

What are your thoughts about this second rule?

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Rule 3: Ask for Help

Most people start recovery by trying to do it on their own. They want to

prove that they have control over their addiction and they are not as
unhealthy as people think.

Joining a self-help group has been shown to significantly increase the

chances of long-term recovery. The combination of a substance abuse
program and self-help group is the most effective.

There are many self-help groups to choose from. Twelve-step groups

include Alcoholics Anonymous (AA), Narcotics Anonymous (NA), Marijuana
Anonymous (MA), Cocaine Anonymous (CA), Gamblers Anonymous (GA), and
Adult Children of Alcoholics (ACA). Every country, every town, and almost
every cruise ship has a 12-step meeting. There are other self-help groups,
including Women for Sobriety, Secular Organizations for Sobriety, Smart
Recovery, and Caduceus groups for health professionals. It has been
shown that the way to get the most out of 12-step groups is to attend
meetings regularly, have a sponsor, read 12-step materials, and have a
goal of abstinence.

These are some of the generally recognized benefits of active

participation in self-help groups:
● individuals feel that they are not alone
● they learn what the voice of addiction sounds like by hearing it in
others
● they learn how other people have done recovery and what coping
skills have been successful; and
● they have a safe place to go where they will not be judged.

There is one benefit of self-help groups that deserves special attention.

Guilt and shame are common emotions in addiction. These can be
obstacles to recovery, because we may feel that we have been damaged
by our addiction and we don’t deserve recovery or happiness.

Self-help groups help us overcome our guilt and shame of addiction by

learning that we are not alone. We begin to feel that recovery is within our
reach.

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These are some of the reasons people have given for not joining self-help
groups:
● If I join a group, I would be admitting that I am an addict or alcoholic;
● I want to do it on my own
● I don’t like groups
● I’m not a joiner
● I don’t like speaking in front of other people
● I don’t want to switch from one addiction to becoming addicted to
AA
● I’m afraid I’ll be recognized; and
● I don’t like the religious aspects.

Have you felt any of these feelings about joining a self-help group? Are
you aware that many groups are ‘virtual’ and you won’t have to leave your
home? What do you think about this third rule?

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Rule 4: Practice Self-Care

To understand the importance of self-care, it helps to understand why

most people use drugs and alcohol. Most people use alcohol or drugs to
escape, relax, or reward themselves. These are the primary benefits of
using. It helps to acknowledge these benefits in therapy so that individuals
can understand the importance of self-care and be motivated to find
healthy alternatives.

Despite its importance, self-care is one of the most overlooked aspects of

recovery. Without it, we can go to self-help meetings, have a sponsor, do
step work, and still relapse. Self-care is difficult because we tend to be
hard on ourselves.

This can present overtly, because we don’t feel we deserve to be good to

ourselves or we tend to put ourselves last, or it can show up covertly as we
say we can be good to ourselves but are actually ruthlessly critical of
ourselves. Self-care is especially difficult for adult children of addicts.

A missing piece of the puzzle for many of us is understanding the

difference between selfishness and self-care.

Selfishness is taking more than a person needs. Self-care is taking as

much as one needs. As addicted individuals, we typically take less than we
need, and, as a result, we become exhausted or resentful and turn to pir
addiction to relax or escape. Part of challenging addictive thinking is to
encourage ourselves to see that we cannot be good to others if we are
first not good to ourselves.

We use drugs and alcohol to escape negative emotions; however, we also

use it as a reward and/or to enhance positive emotions. Poor self-care
also plays a role in these situations. In these situations, poor self-care
often precedes drug or alcohol use.

What do you think about the fourth rule? What types of self-care
techniques have you done in the past? What would you like to try in the
future?

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Rule 5: Don't Bend the Rules

The purpose of this rule is to remind us not to resist or sabotage change

by insisting that we do recovery without support and following the basic
rules. A simple test of whether you are bending the rules is if you look for
loopholes in recovery.

A warning sign is when you ask for help and consistently ignore the advice.

Broadly speaking, once we have been in recovery for a while, we can be

divided into two categories: non-users and denied users. Non-users say
that using might have been fun but acknowledge that it has not been fun
lately. They want to start the next chapter of their life.

Denied users will not or cannot fully acknowledge the extent of their
addiction. They cannot imagine life without using. Denied users invariably
make a secret deal with themselves that at some point they will try using
again. Important milestones such as recovery anniversaries are often seen
as reasons to use.

Alternatively, once a milestone is reached, individuals feel they have

recovered enough that they can determine when and how to use safely. It
is remarkable how many people have relapsed this way 5, 10, or 15 years
after recovery.

What do you think about the fifth rule? Are you in denial? What do you
want the next chapter in your life to look like>

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Recovery is very individual, but basic tenets apply across the board-

1. We need to safely detox from substances, and many times this might
require medication
2. We need to examine ourselves closely, and make changes in
ourselves to live a sober life. This means to surround ourselves with
people who will support us and help us along the way.
3. We need to learn to love ourselves so that we can love others. We
need to be patient with ourselves and change at our own pace.
4. Relapse is a symptom of our disease, reminding us how strong it is.
5. We are not defined by our addictions-they are a part of us, for sure,
but not who we are.

We do not achieve recovery by just not using. Recovery involves creating a

new life in which it is easier to not use. If we do not change our lives, then
all the factors that contributed to our addiction will still be there.

https://www.healthline.com/

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