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415 -Relapse Prevention Groups for Addiction and Mental Health Disorders
Part of the Co-Occurring Disorders Recovery Coaching Series
Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC
Executive Director, AllCEUs
~ Define Relapse
~ Identify triggers and warning signs of relapse
~ Review Relapse Syndrome and possible interventions
~ Explore the acronym DREAM
~ Define and identify vulnerabilities
~ Define and identify exceptions
~ Develop a relapse prevention plan
Types of Relapse
~ Emotional relapse
~ Mental relapse
~ Physical relapse
~ Behavioral Relapse

Relapse Warning Signs
~ Emotional Cues
~ Anger and irritability
~ Anxiety
~ Depression
~ Resentment
~ Mood Swings
~ Boredom

~ Mental Cues
~ Negativity
~ All or none thinking
~ Concentration problems
~ Memory problems
~ Rigidity/Problem solving difficulties
~ Physical Cues
~ Sleep problems
~ Appetite problems
~ Medication noncompliance
~ Fatigue
~ Pain
~ Tension
~ Social Cues
~ Unhelpful friends
~ Isolation
~ Not asking for help
~ Secrets
~ Stop meetings/support groups/counseling

Relapse Warning Signs
~ Discuss the above relapse warning signs
~ How they are rewarding
~ Best ways to address them
Relapse Warning Signs and Triggers
~ Family Feud
~ Preparation
~ There are 4 questions for the first part of the game
~ Name the top 5 emotional relapse warning signs
~ Name the top 5 cognitive relapse warning signs
~ Name the top 5 physical relapse warning signs
~ Name the top 5 social relapse warning signs
~ Write the first letter of each word of the 5 warning signs to guide people (You can make your own warning signs if you want)

Name the Top 5 Emotional Relapse Warning Signs
Name the Top 5 Emotional Relapse Warning Signs
Relapse Warning Signs and Triggers
~ Discussion
~ Have people identify the key questions to address each relapse warning sign
~ How are you feeling?
~ Why are you doing this/feeling this way?
~ Who can help you?
~ What 3 things can you do to change the situation or how you feel about the situation?
~ When will you do it?
~ As you discuss each warning sign, have clients fill out a worksheet with solutions for themselves
Recovery Signals
~ Dot Chart (Bingo markers)

10 Most Common Triggers of Relapse
~ Withdrawal symptoms (anxiety, nausea, physical weakness, psychological withdrawal and craving)
~ Post-acute withdrawal symptoms (anxiety, irritability, mood swings, poor sleep)
~ Poor self-care (stress management, eating, sleeping)
~ People
~ Places (where you used or where you used to buy drugs)
~ Things (that were part of your using, or that remind you of using)
~ Uncomfortable emotions (H.A.L.T.: hungry, angry, lonely, tired)
~ Relationships and sex (can be stressful if anything goes wrong)
~ Isolation (gives you too much time to be with your own thoughts)
~ Pride and overconfidence (thinking you don’t have a drug or alcohol problem, or that it is behind you)

Recovery Triggers
~ Recovery triggers are things that remind you to do the next right thing to keep moving toward your goals (Design plan (car, home, work))
~ Mood (Happiness, compassion, gratitude, hope, optimism, courage, determination)
~ People (That inspire you to move forward and support and encourage you)
~ Sights (décor (dishes, pictures, blankets, pillows, framed memories), mobile device)
~ Smells (that trigger a recovery mood or remind you of a goal or to do something)
~ Sounds (That help you relax, get energized or focused)
Goal Awareness
~ Recovery is about heading toward a happier, healthier life.
~ Define what that looks like
~ Relationships with…
~ Kids that trust and confide in me and want to spend time with me
~ Pets that are happy
~ Activities
~ Run a marathon
~ Foster rescue animals
~ Health
~ Have ample energy to get through the day
~ Be in good health
~ Things
~ Own my house
~ Be able to comfortably pay my bills

Goal Awareness Worksheet
~ Hot Potato/Beach Ball OR Small Group Work
~ First write the symptoms on the board and discuss what might cause these symptoms in recovery from depression, anxiety, PTSD or addiction
~ Write each symptom on the beach ball and pass it around discussing what to do to mitigate each symptom
~ Post Acute Recovery Syndrome
~ Inability to think clearly
~ Memory problems
~ Emotional overreactions or numbness
~ Sleep disturbances
~ Physical coordination problems
~ Stress sensitivity
~ Cravings

~ Ask everyone as they come in how they are doing.
~ Note how many vague/non-mindful answers you get.
~ Being aware of how you feel emotionally and physically and what your urges and thoughts are is essential to sustained recovery. (Turn off autopilot)
~ Nonjudgmental acceptance of the present moment
~ Willingness to explore how to improve the next moment
~ Go around the room and have each person complete the mindfulness worksheet
~ Give them 21 copies to complete during the next week at each meal
~ How am I feeling/thinking
~ Emotionally
~ Mentally (attitude, concentration)
~ Physically
~ What are my urges

~ Why do I feel or think this way
~ Emotionally
~ Mentally (attitude, concentration)
~ Physically
~ What are my urges
~ What can I do about issues
~ Emotionally
~ Mentally (attitude, concentration)
~ Physically
~ What are my urges

Urge Surfing and Distress Tolerance
~ Discuss the difference between avoidance and distress tolerance
~ Identify distress tolerance skills (PAVES the way) on construction paper “bricks” that line a wall
~ Pushing Away
~ Activities
~ Visualization
~ Encouragement
~ Sensations

Unhooking and Improving the Next Moment
~ Explain that unhooking means
~ Changing language from
~ I have to  I am having the thought that I have to
~ Have a cigarette
~ I will never  I am having the thought that I will never
~ Be safe
~ I am  I am having the thought that I am
~ A burden to my family
~ I can’t  I am having the thought that I can’t
~ Stand feeling this way
~ Accepting thoughts and feelings as they are
~ Choosing what to do next to improve the next moment

Unhooking and Improving the Next Moment
~ Thoughts come and go
~ When you have unpleasant thoughts, how can you improve the next moment?
~ What would other’s say? (Parent, sponsor, friend, HP…)
~ What would you tell your child?
~ How do you need to handle the situation to keep moving toward your goals?
~ Change the situation
~ Change your feelings about the situation
~ Develop an attitude of gratitude
~ Use Distress Tolerance activities until the urge passes

~ Think about your vacations…how quickly they pass and you often cannot remember what exactly you did because “time flew”
~ When you focus on savoring the good things you will pay less attention to the unpleasant things.
~ Savoring means using all of your senses to soak in the wondrousness of the moment
~ Waking up to the birds chirping and the sunshine or the smell of fresh coffee. The sunrise on the way to work…
~ Savor the smell of crisp spring air or freshly baked bread
~ Savor memories from the week*

Vulnerability Prevention: H.A.L.T.
~ Small group activity
~ Hungry
~ Teach about what nutrients are necessary for health and wellbeing
~ Discuss how to get these in your diet daily
~ Angry
~ Teach that anger is also irritation, resentment, guilt and envy
~ Identify 3 ways to handle each emotion
~ Lonely
~ Talk about the difference between being alone and lonely
~ Identify 5 ways to develop and nurture relationships
~ Tired
~ Explain the importance of adequate sleep in mental and physical health
~ Discuss the top 10 sleep hygiene problems and fixes
~ Keep gratitude ever present
~ Gratitude tree
~ Shrinky Dink windchime
~ Photo collage
~ Button pins
~ Gratitude garden

Compassion and Kindness

~ Self-compassion can help us be kinder to ourselves and reduce guilt and self-anger.
~ Compassion toward others can reduce anger and resentment.
~ Create compassion cards on “business card” stock
~ Write a compassionate or uplifting statement on each one.
~ Hand them out to people (including yourself) who seem to be having a bad day.
~ Create compassion bags for the homeless
Finding Meaning

~ When things happen, they do not automatically have meaning. We have to make meaning from them.
~ Have members go around the room and look at several figure-ground pictures.

~ How can you make meaning from depression?

Optimism and Dialectics

~ Have the group apply optimism and dialectics to 20 things that your group regularly complains about such as…
~ Overbearing mother
~ Too much work
~ Kids make a mess
~ Too heavy/thin
~ Expensive house payment
~ Car trouble
~ Traffic
~ Homesickness
~ Passed over for promotion / didn’t get job
~ Unhealthy
~ Relationship ended
~ Won’t stop raining
~ You embarrassed yourself
Just the Facts Ma’am
~ Emotional reasoning can lead to anxiety and feeling hopeless and helpless.
~ Make a list of 10 beliefs that keep people stuck or cause stress
~ Relapse is inevitable
~ I am a burden and useless
~ People are horrible
~ Check the facts
~ What are the facts for and against your belief?
~ What is the probability of your belief?
~ Is this worth your energy?
~ If so, what can you do about it.
Adding the Positive
~ Just eliminating the negative won’t get the job done.
~ Get plastic balls or eggs.
~ On each one write something people are commonly eliminating to be happy (resentment, bad relationship, money problems, hated job…)
~ Put them in a box decorated with a heart
~ Explain to the group that it represents their heart and happiness.
~ Take out each egg one by one and discuss how that helps people be happy (usually it is by reducing stress and freeing up energy)
~ When the box is empty show them that life and their heart may be empty if they don’t focus on also putting good things in.
~ Have them write on eggs (or choose from ones already labeled) the things they need to make sure to spend energy on to ADD to their life.
Dare to DREAM
~ Determination
~ Forgo the easy or immediate reward to achieve longer term goals
~ Resilience
~ Commitment, Control, Creativity and Challenge
~ Exceptions
~ Nothing happens all the time
~ Awareness
~ Physical, emotional, cognitive, interpersonal, environmental
~ Motivation (CoPES)
~ Cognitive, Physical, Emotional, Social

~ Strengthen the motivation to change throughout the change process.
~ Identify high-risk situations
~ Develop coping strategies and skills to avoid high-risk situations and to deal with them when they are unavoidable.
~ Recognize and implement changes to the environment and lifestyle to minimize the frequency of high-risk situations and to strengthen commitment to change.