Understanding the less conscious elements of relapse can give a young person more control over their drug or alcohol use. Relapse never “just happens”, it is always a process. However, sometimes the process occurs very quickly and without conscious insight. The practitioner can explain to a young person that when a behaviour has been occurring for some time, it can become automatic. When examined more closely (usually after the event), it can become apparent that there were warning signs prior to the relapse occurring that the young person was unaware of. Exploring unsuccessful previous attempts made by a young person to make changes to their substance use, can assist them to gain insight into how a relapse has, or can occur. It can also increase the awareness of the choices made, hence provide a greater sense of control over future decisions.
The following outlines some of the common experiences that can result in lapse or relapse.
Seemingly Irrelevant Decisions
These are decisions that appear reasonable and unrelated to substance use, however impact directly by leading people into a high-risk situation. For example, feeling a bit lonely, a young person decides to pop in to a friend’s house to play video games for some company, but knows (even unconsciously) that the friend is likely to offer a bong.
Knowing that sometimes decisions can be made that appear reasonable, but can be motivated on a less conscious level, may encourage the young person to carefully consider their decisions before acting on them.
G2ii Chain Analysis
This element provides the practitioner with a framework to help a young person reflect upon an event such as a lapse or relapse and consider with some detail the chain of events that occurred prior to the event. The focus extends to considering what tools or strategies are available to the young person to prevent lapse/relapse in the future.
Positive outcome expectancies or the Problem of Instant Gratification
This can arise when there is a focus on the immediate, short-term outcome of the substance use, while losing sight of the longer-term impacts. For example, cannabis may make the young person feel calm momentarily but they find themselves more anxious as they come down, or they have spent money they needed for something else.
Teaching a young person to manage cravings is an important key to manage the problem of instant gratification. Understanding that cravings pass and having strategies such as Delay, Distract, Decide can be helpful.
C4i Psychoeducation (Reality Testing)
This element provides a framework the practitioner can use to assist the young person in testing the thoughts and feelings prior to lapse or relapse occurring. The idea of automatic thoughts is particularly useful in relapse prevention and becoming aware of these is a valuable step for the young person in preventing lapse or relapse occurring.
The abstinence violation effect or “what the hell”
For some young people, a slip or a lapse can lead very quickly to relapse. A young person who experiences a lapse may attribute this to personal weakness and create a narrative that they are “weak willed” and/or “incapable of change”. For the very vulnerable young person, even the desire to use can be viewed as a weakness, despite cravings being a natural part of recovery. Effectively, a negative narrative may result in a young person giving up on their recovery. Recognising the negative narrative and enabling the young person to refute the narrative is important in maintaining their belief and commitment to the goals they have set themselves.
H2. Contacting the present moment
Mindfulness techniques may also be useful to young people. Being aware of how their body feels, current thoughts and emotions will assist a young person recognise their risk of lapse or relapse. Listening to cravings and urges and allowing them to come and go without feeling panicked will also help the young person to maintain their goals of abstinence.