Relapse Prevention Strategies
There are two effective approaches to relapse prevention, and we employ a combination of the two. The first is a practical, CBT-based approach. The second applies the practice of mindfulness to develop a calm awareness of urges and the ability to experience discomfort without giving in to them.
Relapse prevention at the heart of the programme
At City Addictions, relapse prevention is built right into the core of our ten month treatment programme, with the final phase of therapy dedicated to it. That’s around six months of relapse prevention therapy, plus additional check-in sessions afterwards. With a gradual de-escalation of treatment intensity, it’s a programme that provides the time needed for individuals to gradually ease into and adjust to their new way of life, their new choices and their new healthy behaviours, whilst supporting them appropriately throughout.
Naturally there’s also still the opportunity to check in afterwards for an individual 1:1 session at any time, however the aim is for individuals to ultimately live their lives free of addiction, and without the need for regular therapy.
We achieve this using a number of techniques. Cognitive Behavioural Therapy (CBT) is one approach we use, which is covered in detail in the article on CBT for addiction. We also use related approaches including Acceptance and Commitment Therapy (ACT), and Mindfulness Based Relapse Prevention (MBRP) which is discussed in detail below. also advocate abstinence based treatment, however we work with individuals to support their choices, whatever they may be.
A mindful approach to preventing relapse
Mindfulness has experienced a recent surge in popularity in the West – but what is it and how can it help in addiction therapy? Essentially mindfulness is the psychological process of bringing one’s attention to the experiences occurring internally and externally in the present moment. It’s been practiced for thousands of years, dating back to early Buddhist teachings, and whilst it was originally practised through meditation, it doesn’t have to be. So if you’re a nine to five city worker you’ll be relieved to know that you don’t need to commit to Dalai Lama levels of meditation for five hours a day in order to be mindful!
In fact, mindfulness is an adaptable tool which can be used in any number of areas – including addiction therapy. It’s being implemented in schools in place of detention, in prisons, in government, and its utility is even being recognised by the NHS. Mindfulness is already being used to help people quit smoking, ease stress and even lose weight.
Ancient wisdom and 21st century science
Mindfulness based relapse prevention (MBRP) is an emerging, brand new approach to addiction disorder aftercare. It incorporates elements of traditional relapse prevention practices, such as focusing on an individual’s response to high risk situations, alongside new mindfulness-based techniques. The treatment integrates core elements of existing mindfulness therapies such as mindfulness based stress reduction (MBSR) and mindfulness based cognitive therapy (MBCT), combining ancient wisdom with 21st century science.
What MBRP involves
- Becoming acutely aware of personal triggers and blind reactions
- Learning to pause, think and feel before acting out
- Developing the ability to experience discomfort without self-medicating
- Becoming skilful at making non-addictive behavioural choices
- Having non-judgmental compassion for yourself and others who struggle
Building a mindful lifestyle which supports your goals
Central to the treatment is identifying high-risk situations that could trigger relapse. Rather than focusing on real-time responses in the moment, individuals are taught how to recognise their own early warning signs, through increased internal and external awareness. For example, these might be the emotional, cognitive or situational cues previously associated with their addiction. By learning to effectively monitor their internal reactions they can develop more skilful behavioural choices when high risk moments occur.
The treatment also focuses on increasing acceptance and encouraging tolerance of negative states, such as the craving for drugs or alcohol, and therefore aims to decrease the need to alleviate associated discomfort by engaging in substance use.
And does MBRP work? Research has found that mindfulness based relapse prevention treatments do indeed reduce relapse rates in individuals with addictions – in many cases more so than traditional 12 step aftercare treatments and mutual support groups, which still have relatively high relapse rates of about 60%.
It’s thought that the increased awareness, regulation and internal tolerance taught by MBRP improves people’s ability to anticipate and cope with relapse triggers, thereby interrupting the previous vicious cycle of automatic substance use behaviour. Additionally, should a relapse occur, awareness and acceptance of failure may help to minimise feels of self-blame and guilt that increase the likelihood of subsequent relapses.
In summary, the practice of mindfulness equips the individual with the tools to anticipate relapse, cope with triggers in the moment, and, if unsuccessful, reduce the unhelpful thinking that can fuel the cycle of addiction further. More research is being conducted every day, but the evidence is already there – an ancient solution for a very modern