Once you have made a change, how do
you maintain it? What is the difference between a lapse and
a relapse? How can I recognize when a relapse is likely?
A lifestyle change is not easy to make
or maintain. Lapses (a one-time return to addictive behavior
and relapses (a return to an addictive lifestyle) do occur.
Some people relapse several times before a new behavior becomes
a regular part of their lives. Thus, it is important to learn
about and use relapse prevention techniques. Before discussing
prevention, it is useful to understand the nature of relapse.
Relapse Process
The relapse process occurs in a series
of steps and in the direction of a return to addictive or
other self-destructive behavior. Along the way, there are
opportunities to use new ways of thinking and acting to reverse
the process. To understand relapse process and prevention
in the example below, imagine you are making one of these
lifestyle changes: stopping smoking, attending 12-step group
meetings, or beginning an exercise program.
Old ways of thinking and
acting
New ways of thinking and
acting
Sometime after actually making
a change, the demands of maintaining it appear to outweigh
whatever pleasure or support we have received for the
new behavior.
We may not remember that
this is normal. Resistance is part of the process of change.
Reaching out to talk with a supportive person at this
point would clarify our thinking.
We feel disappointed
by this turn of events.
We forget that
disappointment is a natural part of living.
We feel deprived,
victimized, resentful, and blame ourselves.
These are potential
"red flags" for a lapse. Talking with a supportive
person at this point would help to clarify the situation.
Then it occurs
to us that our old behavior (smoking, isolation, inactivity)
would help us to feel better.
If we would
consider why we made the change in the first place, we
would remember how the old behavior made us feel worse.
Talking to a supportive person, a distraction, or relaxation
at this point would help relieve pressure.
Cravings for the
old behavior begin, undermining our desire to continue
to care for ourselves in the new way.
Cravings are
a "red flag" for potential lapse. If we do not
have one, we need a plan to divert our attention.
A cigarette advertisement
attracts us, or a negative event with someone in a group,
or we strain ourselves by overdoing the exercise.
More "red
flags!" Acknowledge the difficulty of making a change.
Talk to a supportive person or distract yourself.
We say to ourselves, "I
told you so. This new stuff will never work." The
cravings increase.
This indicates we have an
immediate need to employ an option to divert our attention.
We then take an
action that risks our exposure to our old behavior. We
go to a smoke-filled bar, or hang out with support group
cynics, or phone a friend who berates anyone who exercises.
These are "dangerous
situations" that put us on a slippery slope toward
relapse. Put diversion plan into effect.
We ignore the "slippery
slope" awareness, focused as we are on the old behavior.
Now is the time
to put our alternative plan into action or we increase
the risk of a lapse.
The cravings keep
increasing.
"Red flags"
are waving. With our limited coping skills, failure to
employ an alternative plan, and unwillingness to talk
to anyone, we are steadily increasing the risk of going
back to our old behavior.
When we begin to
think the old behavior will reduce the cravings, a lapse
in maintaining the new behavior is likely to occur. We
smoke a cigarette, avoid support group meeting, or miss
our regular exercise appointment.
If we understand
that the lapse is a natural consequence of our resistance
to change and the steps we have followed prior to the
lapse, we will be able to go back to our new behavior
with minimal guilt. It would also be helpful to talk to
a supportive person to clarify the situation. We also
understand that there is no magic. The cravings will not
go away until we find ways of coping with them while maintaining
the new behavior. The good news is that a program of new
activities, ways of thinking and acting, psychotherapy
and self-help groups, diet and exercise can help us contain
and reduce the cravings
If our guilt is intense and in the absence of a plan,
we will likely relapse to old behavior. Which is where
we will remain until the next effort to change
Relapse Prevention
Preventing relapse requires that we develop
a plan tailored to maintaining new behavior. This involves
integrating into our behavior diversion activities, coping
skills, and emotional support. The decision to cope with cravings
is aided by knowing: (1) There is a difference between a lapse
and relapse; and (2) continued coping with cravings while
maintaining new behavior will eventually reduce the craving.
These coping skills can make the difference when things get
intense:
Ask for help from an experienced peer.
Develop alternative activities, recognize "red flags,"
avoid situations of known risk to maintaining new behavior,
find new ways of dealing with negative emotional to predictably
difficult events, and use stress management techniques and
relaxation skills to reduce the pressure associated with cravings.
Reward yourself in a way that does not undermine your self-caring
efforts.
Pay attention to diet and exercise to improve mood, reduce
mood swings, and provide added strength to deal with stressful
circumstances and secondary stress symptoms, including loss
of sleep, eating/elimination problems, sexual difficulties,
and breathing irregularities.
Ask for help from an experienced peer.