Warning Signs of Relapse: A Road With an Exit for Each Sign

About the technique

Relapse prevention is a cognitive-behavioral approach developed by G. Alan Marlatt and Judith Gordon in the 1980s for alcohol and drug use. It treats relapse as a process rather than an event: high-risk situations and the person’s coping responses shape whether a lapse occurs, and how the person interprets a lapse shapes whether it becomes a full relapse (Witkiewitz & Marlatt, 2004). Steven Melemis later described relapse in three stages, emotional, mental and physical, with warning signs that appear well before use (Melemis, 2015).

The central exercise is mapping: naming the client’s own warning signs and high-risk situations, and planning a specific exit for each, so the process can be interrupted in the emotional or mental stage when changing course is easier (Melemis, 2015). Cognitive-behavioral relapse prevention is supported by trials and reviews (Witkiewitz & Marlatt, 2004), and in a randomized trial both standard relapse prevention and a mindfulness-based version reduced relapse risk compared with treatment as usual, with the mindfulness-based version showing advantages at 12 months (Bowen et al., 2014).

It suits adults and teens in substance use treatment, individually or in groups. Plan for lapses as well as prevention, so a slip is treated as information rather than proof of failure, the reaction Marlatt called the abstinence violation effect (Witkiewitz & Marlatt, 2004). Stopping alcohol, benzodiazepines or opioids can be medically dangerous and should be supervised. After a period of abstinence tolerance drops, which raises overdose risk, so include naloxone and not using alone in the lapse plan. In groups, agree that members’ triggers stay in the room.