At Risk for Relapse?

Posted on September 2, 2014

7 Risk factors for relapse
-Bill Abbott, SMART Recovery® Facilitator

7 Risks for Relapse

Over the course of time I’ve observed several sets of circumstances that seem to increase the risk of a person with an addictive problem to sustain a relapse – that is, falling back to the former behavior. I must honestly state that this is an observational piece and I am not sure that there is any science behind it. Nevertheless it certainly does make sense that some of these circumstances do heighten the risk for  a temporary or even permanent stepping out of the stages-of-change process which we call addiction recovery.

7 Risk Factors for Relapse

      Persisting Frustration
      Intense Emotion
      Social Disconnection

What follows is a short description of each of these.

Fantasy By this I mean thinking about a possible future scenario

in which your behavior of choice has become usual or frequent. Falling into this category would be “romancing” the use of a particular substance or behavior. By this I mean forgetting the negatives and remembering the positives of the “using or doing” experience.

Rumination Rumination is the opposite of fantasy in some ways. This is thinking about the past in a circular fashion. Reinforcing  negative thoughts and continuing feelings of guilt or shame about one’s previous behavior would fall into this category.

Boredom Boredom is self-explanatory. When one is bored one is also prone to ruminate or fantasize.

Persistent frustration By this I mean a situation which is ongoing and for which there seems to be little opportunity or choice to make a change. For example, being “trapped” in a job that you do not like or responsible to a supervisor who is consistently and persistently difficult.

Intense emotion Any emotion that is extremely intense and tends to persist awhile would fall into this category. For example, grief over a loved one’s death or the loss of employment or a divorce.

Social disconnection This is a slightly harder one to understand. By this I mean being cut off or isolated from our usual activity or community. Man is a social animal and even though he does not need be with people all the time, to be separated can be painful and cause suffering. This might occur because of self-imposed isolation, or conversely it might be caused by rejection or ostracism.

Opportunity  This may be the biggest one of all and certainly adds to any of the previous ones should it arise. By this I mean having the time or space where one feels one can safely resume the previous behavior without being noticed or “caught”.

Suffice it to say that more than one of these can present itself at any point during the recovery process.

Being aware of these factors, I think, is the most important point I’m trying to make. Knowing in advance or knowing that it is occurring as a risk to relapse can arm oneself to taking measures to counteract it and not fall into the trap leading to lapse or relapse.

Bill Abbott is a long time SMART volunteers who, in addition to numerous other SMART volunteer activities, facilitates weekly SMART meetings in the Boston area and online.



5 thoughts on “At Risk for Relapse?

  1. Guy C. Lamunyon

    I have personally observed many with long term recovery (20 years) relapse when faced with the loss of a family member or close acquaintance.

  2. Guy C. Lamunyon

    Relapse Triggers According to Marlatt:

    Negative Emotional States 28-43 percent
    Social Pressure 18-34 percent
    Interpersonal Conflict 12-18 percent
    Urges and Temptations 6 – 11 percent
    Testing Personal Control 4 – 9 percent
    Positive Emotional States 3 – 16 percent
    Negative Physical States 3 – 9 percent

  3. Reid K Hester, Ph.D.

    Hi Bill,
    Much of what you say does have an empirical basis in research. Especially negative emotions.

    Identifying and developing a plan to deal with one’s triggers to drinking/using is both one of the points of SMART Recovery’s plan and it’s an important set of exercises in our web app for SMART Recovery. And one of the more popular features of our web app is its ability to send user generated, customized text messages and emails that remind the users of their plans to deal with their triggers! Currently the web app is sending out over 6,000 text messages a month!

  4. JudithAnn

    I was at a smart meeting last night and was trying to establish what took me back to drinking the last time.

    Fantasy, bordom and opportunity. Opportunity, that belief that I could return to drinking moderately. That moderate drinking did’nt come to pass, but my 3 days of detox and an incredibly insightful aftercare mixed with an education on cognitive behavior therapy did.

    Smart recovery is new for me and being proactive in my recovery feels so so good for me.
    I am so more hopeful now that I can approach my sobriety with a different eye.

  5. HughK

    Ta very much for these Bill.
    I got a lot from them – especially your point about being aware of them. Harder to step in a bear trap if I know where it is!
    Another one that has reared it’s head a bit recently is Anniversaries – “I’ll get to a year and then I’ll drink!”
    “3 months is fantastic, and I feel great, hand me that crystal meth!”
    Seems that anything our salesman can attach any significance to, and get me to buy in, is good enough!
    Most recently, my mother’s birthday. She has been gone for 4 years this October, but my salesman thought her 92nd Birthday was the ideal opportunity to undo all my good work.
    Regular attendance at SMART meetings, seeing this “anniversary syndrome” and re-reading my HoV and CBA all let the moment go past.
    “The price of freedom is eternal vigilance” and the price of sobriety is saying to my salesman, when I catch him at it, “mate, shut-up, I’m on a different road now!”

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