How to Help Clients Avoid Relapse During Times of High Stress
Relapse prevention is a key component of high-quality mental health with substance use treatment.
By definition, addiction is a chronic, relapsing disorder. And many clinicians believe that relapse prevention is the primary reason people seek treatment. “By the time most individuals seek help, they have already tried to quit on their own and are looking for a better solution.”
Yet for many behavioral health providers—it can be challenging to know how relapse prevention fits into an overall treatment plan.
Common areas of uncertainty are:
- Should relapse prevention be addressed in every session?
- Is it best to wait until stability or abstinence is achieved before focusing on relapse?
- Which particular high-risk situations should providers be aware of?
The exact answer to each of these questions depends on each client’s individual circumstances.
But there is one factor that is common across all people in mental health with substance use treatment: During times of high stress, an individual’s risk of relapse dramatically increases.
Stress and Substance Misuse
Drug and alcohol researchers have long highlighted the important role stress plays in developing and maintaining. The presence of both chronic and acute stress increases a person’s risk of developing a substance use disorder, then experiencing the cycles of relapse characteristic of addiction.
In terms of relapse specifically, a fascinating study from 2016 conducted by the University of Michigan’s Center for the Study of Drugs, Alcohol, Smoking, and Health, examined associations between stressful life events and drug use in over 900 adults.
In short, researchers found that the more stressful life events a person experiences after achieving sobriety, the greater their risk of relapse. They also observed a strong correlation between the number and severity of stressful events and the propensity for relapse.
Not surprisingly, results from the study led to a recommendation that, “Treatment for drug use disorders and relapse prevention programs should include assessment of stressful life events.”
Now, that recommendation certainly seems like solid advice. But it still leaves some questions about how on a practical level, mental health with substance use recovery providers can help clients avoid relapse during times of high stress.
To unpack that a little further, let’s take a look at some stressful life events that may increase the risk of relapse. Then, we’ll cover some examples of specific strategies providers can use to support their clients.
What is Stress?
There is no universally agreed-upon definition of stress. But most scholars describe stress as a process in which the environmental demands placed on a person exceed their perceived ability to cope.
In clinical practice, it’s essential to keep the client’s perception of the event front and center when assessing a potentially stressful event. This is because how an individual views an event is arguably just as important as the event itself.
For example, the ending of a relationship or loss of a job might be devastating for one person and mark the beginning of a time of high stress. While for others, the event might be a relief, signaling the end of a stressful and challenging aspect of their life.
Nevertheless, there are several life events that are usually experienced as highly stressful for the majority of clients in mental health with substance use recovery treatment.
Assessing High-Stress Situations
If your client experiences any of the following events, please consider conducting a risk assessment to determine if additional actions are required to reduce the risk of relapse:
- Relationship strain (marital, family, or friends)
- Financial crisis
- Death of a relative or close friend
- Difficulties with boss or coworker
- Serious illness or injury
- Sober anniversary or milestone
- Loss of a job
- Legal problems
- Reminders of drug or alcohol use (ie. seeing old acquaintances, alcohol-related social events)
- Being the victim of a crime
- A big change in life circumstances (moving house, changing jobs, new relationship)
Our Procentive EHR solution for behavioral health practices includes dynamic forms and clinical templates that you can use to guide client assessments during times of high stress.
Whether you use a formal or informal assessment process, it’s essential to ascertain:
- What is your client’s perceived level of stress (or distress) around the current situation?
- How is this impacting their thoughts, actions, and behaviors around substance use?
- Is their mental health being impacted? (i.e., worsening of mood, increase in anxiety, thoughts of self-harm or suicide)
Once you have some clarity around these areas, it’s time to work with your client on a plan to avoid relapse (or if they have resumed using, to minimize the damage).
Responding to Identified Risks
There is no “one-size-fits-all” approach to helping clients avoid relapse during times of high stress. But in many cases, one or a combination of the following strategies can assist in safely navigating a challenging time.
Planning Ahead
Encourage your client to identify and plan ahead for potential high-stress events, like sober anniversaries, changing jobs, kids moving out of home, and the birthdays of deceased loved ones.
All too often, people take a “wait and see” approach with events like these, meaning that help might not be readily available right when they need it most.
You may even want to include relapse prevention in your client’s current treatment plan. We’ve partnered with Wiley, the leader in practice planning, to make this process as seamless as possible with our EHR solution for behavioral health providers.
Increasing Services
One of the simplest and most effective ways to support a client during a time of high stress is to temporarily increase services. This might look like attending weekly individual or group therapy sessions instead of fortnightly, adding in some extra telehealth appointments, or booking into an intensive outpatient program.
Two barriers to be aware of with this approach, especially for elderly clients, are transport to appointments and familiarity with telehealth.
Be sure to check if any of these are an issue for your client and assist them if needed. Regarding telehealth, it’s best practice to use an EHR solution like Procentive, with an integrated HIPPA-certified system.
Reviewing Medications
Many people in mental health with substance use recovery utilize medication-assisted therapy as part of a comprehensive treatment plan.
Whether prescribing is done through a psychiatrist, addictions specialist, or primary care physician, reviewing medications during a time of high stress can be a great relapse prevention strategy.
In many cases, adjusting existing medications, or considering new options, can help reduce the risk that a client will resort to harmful substances as a coping mechanism to get through a stressful time.
Engaging Outside Supports
Don’t be afraid to get creative with your client and think about some new options for managing a high-stress time.
Attending a 12-step or substance use support group, engaging a mentor, or even joining a sports team or community interest group can be a great source of additional support.
Also, especially for men, encourage your clients to reach out to friends or family for support. Many people with addictions tend to bottle up emotions and not ask for help when they are stressed, meaning that even those they are close to may not know they are struggling.
Specialized Therapy
Some high-stress situations your clients encounter will fall outside your area of expertise. Relationship problems, trauma following an assault or serious illness, or the loss of a job are common examples.
In each of these scenarios, it’s important to be compassionate and understanding. But be clear with your client that they might benefit from specialized therapy, in addition to continuing mental health with substance use treatment.
You might want to encourage your client to speak with their insurer, a social worker/care coordinator, or primary care physician to find a suitable specialist for their particular challenge.
Stress Can Be an Opportunity for Growth
Promoting the idea that when handled constructively, stress can be an opportunity for growth, is one of the most beneficial things mental health with substance use recovery providers can do to support their clients.
For many people, substance use and addiction began as a coping mechanism to deal with life stressors. And in the absence of other skills, a pattern of resorting to drugs and alcohol in high-stress times is what maintains their destructive habit.
By supporting clients to see that there are more effective ways to manage times of high stress, behavioral health providers can start laying the foundations for true healing and recovery.
If you struggle to incorporate relapse prevention into your practice due to the competing demands of working as a mental health with substance use provider—take a look at our full-featured, simple EHR solution for behavioral health practices—Procentive.
It includes everything you need to power your practice, all in one place. Including an easy-to-use interface, a full library of dynamic forms and clinical templates, 24/7 web access, and an optional integrated HIPPA-certified telehealth feature.
Procentive takes the hassle out of running a mental health with substance use recovery practice. Allowing you to spend less time on administration—and more time caring. Interested in learning more? Get a free demo of Procentive today!
References
- National Institute on Drug Abuse (NIDA). ‘What is Drug Addiction’. Retrieved 17th Nov 2022. https://nida.nih.gov/publications/drugs-brains-behavior-science-addiction/drug-misuse-addiction
- Melemis S. M. (2015). Relapse Prevention and the Five Rules of Recovery. The Yale journal of biology and medicine, 88(3), 325–332. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4553654/
- Sinha R. (2008). Chronic stress, drug use, and vulnerability to addiction. Annals of the New York Academy of Sciences, 1141, 105–130. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2732004/
- Sinha, Rajita. (2002). Sinha R. How does stress increase risk of drug abuse and relapse? Psychopharmacology (Berl) 158: 343-359. Psychopharmacology. 158. 343-59. 10.1007/s002130100917
- McCabe, S. E., Cranford, J. A., & Boyd, C. J. (2016). Stressful Events and Other Predictors of Remission from Drug Dependence in the United States: Longitudinal Results from a National Survey. Journal of substance abuse treatment, 71, 41–47. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5096384/
- Cohen S, Kessler RC, Gordon LU. Strategies for measuring stress in studies of psychiatric and physical disorders. In: Cohen S, Kessler RC, Gordon LU, editors. Measuring Stress: A Guide for Health and Social Scientists. Oxford University Press; New York: 1995. pp. 3–26. [Google Scholar]
The Role of Mentorship in Long-Term Substance Use Recovery
In long-term substance use recovery, mentorship helps individuals set achievable goals and connect to a sober community. Mentors also provide a good source of support and motivation during cravings, helping to avoid relapse. Mentors often serve as one of the most valuable resources for recovery in individuals experiencing substance use disorder.
Recovery mentors can help navigate health, employment, and even the criminal justice system. Hence, selecting a great mentor may require significant scrutiny by mental healthcare providers. Here are some of the major roles a recovery mentor plays in their relationship with an individual throughout their substance use recovery journey:
Benefits of Mentorship for People in Substance Use Recovery
The concept of recovery mentors is relatively new in substance use recovery. However, there are many benefits to working with a mentor during your recovery journey. Here are some of the significant advantages of having a mentor:
Accountability
Mentorship programs provide accountability for individuals going through substance use recovery. People going through recovery can check in with a mentor at specific times of the week and show accountability for their actions. Research also shows that accountability can be helpful in addiction recovery. Participants who had sponsors and engaged in 12-step programs were more successful at staying abstinent than those who started a sobriety journey without outside support [1].
Complete honesty and transparency about addiction experiences help in commitment to sobriety. It usually helps the person acknowledge responsibility to make better decisions regarding substance abuse. Honesty through accountability also helps the individual understand patterns of thinking and behaving that could cause relapse. With an understanding of these patterns, there can be a significant change.
Guidance
The journey to complete recovery may seem significantly complex. Hence, mentors provide continuous guidance for individuals going through recovery. With guidance from a mentor, the patient can get better insight and self-awareness to recover. Proper guidance also gives a new perspective and helps people identify any habits or behaviors that may need correction.
Mentor-provided guidance will help individuals revisit their coping strategies. When the individual feels the urge to consume any substance, they can call the mentor to get the guidance they need.
Mentors can also help provide the best advice for individuals when creating and repairing their relationships. They offer support in creating healthy relationships as an imperative part of recovery.
Get a free demo of Procentive today!
Relationship of Trust
Often, those who go through the addiction recovery process feel alone. Most individuals typically have damaged relationships and have little to no one they feel they can trust. A mentor always supports individuals, helping them repair and rebuild trust in themselves and others. Hence, a recovery mentor becomes an individual you can rely on.
Recovery mentors teach individuals experiencing substance use disorder how to regain the trust of loved ones. One of the methods commonly suggested is leaving the lines of communication open. Mentors may advise keeping contact with loved ones by setting up a time to talk to each other. In most cases, rebuilding the relationship is much easier when they observe a change in previous addiction patterns.
Continuous Support
Recovery mentors can help individuals by providing support and also helping them get the best out of “social support.” Continuous support gives a sense of belongingness and inclusion, hope and optimism, and safety and security [2].
Support from mentors and social support will help provide valuable information to help in recovery. It will also help offer desirable resources and concrete assistance on the road to recovery [3].
How Mental Health Providers Can Encourage Seeking Out Mentorship
Mentors significantly help the road to substance use recovery. How can mental health providers encourage others to seek out mentorship? Here are some of the most effective methods to consider:
Enlightenment on the Benefits of Mentorship
An effective method of encouraging individuals to seek out mentorship is by enlightening them on its benefits. Mental health providers should provide a detailed breakdown of how mentorship can help in accountability, guidance, and support.
Ensuring Mentorship is an Imperative Step for Recovery
Finding a qualified recovery mentor takes a lot of work. Recovery clinics should seek out the best prospective mentors based on their qualifications, including experience in the mental health field. Facilitating mentorship matches or assigning mentors can help ensure that qualified mentorship is achieved.
What Makes Up a Good Mentor
A significant level of scrutiny goes into selecting a good mentor. Apart from the necessary qualifications, here’s what makes a good mentor:
- Good communication skills: Mentors should be able to pass their message clearly without confusion. It’s also important that mentors are empathetic in their speeches.
- Experience working in the substance use recovery field: Significant experience in the substance use recovery field will help prospective mentors know how to approach addiction recovery situations.
- Relevant educational background: Depending on the recovery clinic’s requirement, the prospective mentor should possess the necessary diploma or any relevant degree.
Can Mental Health Providers Work as Mentors?
Mental health providers can also work as mentors as long as they have experience in long-term recovery. However, mentors don’t diagnose or treat addiction and mental health issues, unlike other mental health experts.
All mentors focus on helping those undergoing recovery to make the right decisions to improve their lifestyle. Compared to mental health experts, mentors must understand various recovery pathways. However, a major similarity between mentors and other mental health providers is in implementing the 12-step programs [4].
Get the Best as a Mental Health Provider Using Procentive
With the significantly long list of responsibilities of mentors and other mental health providers, utilizing a system for optimization is imperative. As a mental health provider, you can enjoy a full-featured, simple EHR solution for your practice. Every tool you need to power your practice is in one place.
Procentive is an EHR solution that offers an easy-to-use interface, 24/7 web-based access, comprehensive reporting, and easy scheduling with alerts. Providers can also get dynamic forms and clinical templates to speed up the documentation and adapt them to personal needs. Get everything you need to optimize your practice. See Procentive in action for yourself with a free demo.
