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Article Summary

Change, Recovery and Relapse Prevention

Recovery from a substance use problem can mean different things to different people. In general, recovery is a process involving a series of small steps whereby people gain control over their substance use and increase their self-confidence and responsibilities. No treatment is guaranteed to work. To recover, people need to learn to believe in themselves, be prepared to struggle and be determined to reach their goals. This takes time and support. Preventing relapse, or a return to problem substance use, is the goal of treatment. However, relapse is possible at any stage and is often part of the recovery process.

For many people, the biggest step toward recovery is deciding to make a change.

People with substance use problems often put off getting professional help or attending self-help groups. They do so because they aren't sure that they are ready or able to quit using substances. Feeling uncertain or ambivalent about change is normal. Deciding to change is a big step. Most treatment programs today recognize that change and recovery is a process. Many programs and self-help groups welcome people who are not yet ready to change their substance use, but who may be ready to begin exploring their use and how it affects their lives.

Setting goals for change

When people do decide to change their substance use, their goals for change may differ depending on their situation, and where they are in the process of change. They may, for example, choose to:

  • abstain (not use substances at all)
  • reduce their substance use
  • stop using one drug but not another (e.g., stop using alcohol but continue using marijuana)
  • reduce the harm of their substance use (e.g., continue to drink but not to drink and drive).

Each goal may suit some people but not others. Some may choose to reduce their use but find it hard, for example, to stop at only one or two drinks. Through this experience, they may come to realize that abstinence is a more realistic goal for them.

The stages of change

Change can be hard, and even deciding to change may take a long time. Change is also a process—it generally doesn't happen all at once, but in stages. In the first stage of the change process, precontemplation, people don't connect their substance use to the problems they are having. If substance use is not a problem, why even think of changing it? But if, for example, these same people got assessed, they might see that their substance use causes them problems.

This new thinking might "tip the balance" from precontemplation to the next stage in the change process: contemplation, or thinking about change. In this stage, people can see the not-so-good things about using. However, they also see the good things, and may feel torn between the two.

At some point, though, the not-so-good things might begin to outweigh the good things. Then the balance might tip again, this time toward the preparation stage. In this stage, people decide to change and come up with realistic strategies, such as attending a treatment program, going to a self-help group or setting a date to change their substance use.

Once people actually start to make the changes—for example, by cutting down or quitting substance use—they are in the action stage. When people continue with these changes for two to six months, they are in the maintenance stage.

The diagram above shows all the stages of change as wedges within a wheel. Arrows circling outside the wheel show where people can slip out of the cycle of change into relapse, and where they can slip in again. Relapse is often referred to as a slip backwards. This is not always the case, though. While it's always better to try to avoid relapse, what people learn from the experience can help to bring them closer to lasting change.

Practical strategies for making and maintaining change

Strategies for promoting change differ, depending on what stage people are at. Here are some simple tips for each stage of change:

Strategies in the precontemplation stage

  • Even if you're not convinced you need to change, keep track of your substance use. Write down when you use, what and how much you use, how you were feeling, where you were and who you were with. This will give you more information about the role of substance use in your life.
  • Consider exploring your use to determine whether or not it is a problem; for example, take one of these short online questionnaires about your drinking: Feedback or Alcohol Help Center.
  • Consider making an appointment for an addiction assessment.
  • Ask a friend or family member how he or she feels about your substance use.
  • If any of these activities do raise some doubts in your mind, give yourself credit for seeing that your substance use may be a problem.

Strategies in the contemplation stage

  • Write down the pros and cons of changing your substance use.
  • Ask yourself, "What do I need in order to be able to change?"
  • Think about what's most important to you (e.g., family, job, health). How does your substance use affect it?
  • Don't be discouraged if you're not sure about making the change; many people feel the same way.

Strategies in the preparation stage

  • Set a goal for change, such as a quit date or a target for cutting down on substance use.
  • Learn about different addiction programs and services.
  • Remind yourself of your reasons for making a change.
  • Try not to expect big changes, and don't minimize small changes.
  • Get support from your friends and family.
  • Think about your strengths and supports that will help you to change.

Strategies in the action stage

  • Seek support from others, such as family, friends and health professionals (e.g., your counselor or doctor).
  • Attend an addiction treatment program and/or a self-help group.
  • Avoid people, places and things that put you at risk of exceeding your substance use goals.
  • Explore other treatment options, such as medication to reduce cravings, or residential treatment.

Strategies in the maintenance stage

  • Be aware of urges and temptations to stray from your substance use goals.
  • Continue to remind yourself of your reasons for making a change.
  • Reward yourself for making the change. For example, do something "just for you" that you enjoy—perhaps a hobby or fun activity. However, don't reward yourself with alcohol or another drug by having "just one."
  • Consider attending a relapse prevention group, aftercare program or self-help group.

Managing relapse

It can be hard to reduce or stop substance use. It's not surprising, then, that people who make these changes may return to problem drinking or other drug use. Relapse can be discouraging. It can make people feel vulnerable and weak. It can make recovery seem like an impossible dream. When relapse happens, regard it as a temporary setback, learn from it, note what skills you used to pull out of it and don't see it as a failure. Look for changes that you have maintained, such as:

  • using less of a drug or using less often
  • positive lifestyle changes (e.g., staying in school, keeping a job and not using during class or work hours)
  • reducing or eliminating other high-risk behaviors.

What causes relapse?

Various "triggers" can put people at risk of relapsing into old patterns of substance use. Causes of relapse can differ for each person. Some common ones include:

  • negative emotional states (such as anger, sadness, trauma or stress)
  • physical discomfort (such as withdrawal symptoms or physical pain)
  • positive emotional states (wanting to feel even better)
  • testing personal control ("I can have just one drink")
  • strong temptations or urges (cravings to use)
  • conflict with others (such as an argument with a spouse or partner)
  • social pressures to use (situations where it seems as though everyone else is drinking or using other drugs)
  • good times with others (such as having fun with friends or family) (Marlatt, 1996).

When relapse occurs, it's important to identify what the triggers were and to develop positive ways to make these risky situations easier to deal with.

Recovery can be seen as a hike up a bumpy hill, as illustrated below. Some people are able to take a straight path to the top of Mount Recovery, but most people experience "slips," or relapses, along the way. Each "bump in the road" is a chance to think about what has worked and what changes should be made.

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