DiscoverCounselor Toolbox PodcastRelapse Prevention Groups for Addiction and Mental Health Disorders
Relapse Prevention Groups for Addiction and Mental Health Disorders

Relapse Prevention Groups for Addiction and Mental Health Disorders

Update: 2019-08-131


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.









Relapse Prevention Groups for Addiction and Mental Health Disorders

Relapse Prevention Groups for Addiction and Mental Health Disorders

Charles Snipes