PLEASE DBT worksheet
Providing relapse psychoeducation can form part of an effective relapse prevention plan. This article provides an overview of key information to include in providing relapse psychoeducation, including strategies to prevent returning to use.
We’ve included a free downloadable relapse psychoeducation worksheet to use with clients and save to your electronic health record (EHR).
What is relapse in addiction?
Relapse occurs when a person in recovery from substance use disorder returns to use. These lapses may be momentary, or the person may continue to use substances for a while longer until they are ready to return to recovery.
There can be a lot of shame around relapse, as the person might feel like they have failed in their recovery. However, returning to use is more common than you might think. According to the National Institute on Drug Abuse (NIDA), rates of relapse for substance use disorder are similar to other chronic health conditions.
Between 50% and 70% of people with high blood pressure relapse. The same percentage of people with asthma also experience relapse. Rates of relapse for people in recovery are between 40% and 60%.
What is relapse prevention?
Relapse prevention is a skills-based and cognitive-behavioral approach that identifies and addresses the risk factors that may lead to relapse.
The key components of effective relapse prevention are:
Psychoeducation about relapse prevention
Identifying the internal and external risk factors of relapse
Recognizing the early warning signs of relapse
Strengthening coping strategies, such as changing unhelpful patterns of thinking and learning mindfulness-based relaxation techniques to prevent relapse
Experts in the field of substance use disorder treatment state that there are stages of relapse, beginning weeks or months before the person picks up a substance.
Steven Melemis, MD, PhD, a leading authority, has summarized these into three distinct phases:
Emotional relapse: The thoughts and behaviors that may make clients more vulnerable to relapse. These include avoidance, “bottling up emotions,” chronic or acute stress, poor sleep, and social withdrawal.
Mental relapse: In this phase, thoughts of using occur. Clients may feel conflicted as part of them wants to use, but the other part is determined to stay in recovery. This tension could lead to an eventual relapse.
Physical relapse: Using substances.
Research shows that addressing early warning signs significantly reduces the risk of relapse, and with practical coping skills, such as mindfulness, people in recovery gain the confidence to handle stressors that might lead to relapse.
Additionally, more recent research on mindfulness-based relapse prevention (MBRP) shows that incorporating mindfulness into relapse prevention enhances awareness, fosters detachment from negative thoughts and feelings, and strengthens the capacity for distress tolerance.
Tips for avoiding relapse
Use these relapse prevention strategies as part of your relapse psychoeducation to help clients build practical, everyday tools for staying in recovery:
Identify triggers: Help clients recognize potential triggers, such as thoughts of drinking or using, cravings, being around friends who use, visiting places associated with drug or alcohol use, stress, social isolation, reduced recovery activities, letting other responsibilities take over, grief and loss, and transitions.
Connect clients with their why: Encourage clients to regularly revisit their reasons for staying in recovery and the consequences of returning to use, since this can be a powerful motivator to maintain progress.
Introduce HALT: Teach clients this popular recovery phrase to build awareness of how feeling hungry, angry, lonely, or tired can increase vulnerability to relapse. Recommend habits like eating regular meals, checking in with their support community, getting enough sleep, maintaining their health, and processing their emotions to help mitigate these risk factors.
Strengthen coping skills: Guide clients toward emotional regulation and distress tolerance skills through regular exercise, mindfulness techniques, recovery meetings, and DBT skill-building in session.
Build a recovery plan for emergencies: Help clients plan ahead for high-risk situations that might lead to relapse, such as accidents, losing a loved one, work difficulties, or other stressful and overwhelming events. Their plan might include calling their therapist, speaking with a recovery mentor, using a distraction technique, or reaching out to a trusted friend.
How to use the relapse psychoeducation worksheet
You can download and use the relapse psychoeducation handout in several ways:
Use the handout to provide relapse psychoeducation.
Complete the worksheet as prompts to develop a relapse prevention plan with the client in the session.
Give the client the “What is relapse prevention?” handout to take home.
Use the worksheet in group therapy sessions to provide psychoeducation on relapse and encourage clients to collaborate on relapse prevention strategies.
Combine this worksheet with other substance use and recovery-related worksheets, including our substance use assessment form, relapse prevention worksheets, and money management in recovery worksheet.
Share the handout with coworkers or leave copies in your office for their reference.
Use the handout to provide training to interns or supervisees.
Sources
Grant, S., Hempel, S., Colaiaco, B., Motala, A., Shanman, R. M., et al. (2015). Mindfulness-based relapse prevention for substance use disorders: A systematic review. RAND National Defense Research Institute Report.
Guenzel, N., & McChargue, D. (2023). Addiction relapse prevention. StatPearls Publishing.
Melemis, S. M. (2015). Relapse prevention and the five rules of recovery. The Yale Journal of Biology and Medicine, 88(3), 325–332.
National Institute on Drug Abuse. (2020). Drugs, brains, and behavior: The science of addiction: Treatment and recovery.
Recovery Research Institute. (n.d.). Relapse prevention (RP) (MBRP).
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