Clients with both mental health conditions and AOD use disorders can potentially experience a relapse of either condition, which is likely to worsen the symptoms of the other. Even after full remission, clients with co-occurring conditions are vulnerable to relapse due to various risk factors, including exacerbation of mental health symptoms, a lack of social support, social pressures within neighbourhoods or AOD-using networks, a lack of meaningful activity, or a lack of treatments for co-occurring mental and AOD use disorders [771]. As such, the goal of relapse prevention is to enable clients to recognise the factors which increase their own risk of relapse, and intervene at earlier points in this process [102].
Relapse prevention strategies that are already used in AOD treatment can also be used to reduce risk of relapse of the mental health condition. For example, relapse prevention for AOD use has been shown to be effective in reducing PTSD symptom severity [772], and the quantity, frequency, and severity of AOD use among people with co-occurring PTSD and AOD use [772, 773]. Some simple strategies that can be useful in helping a client reduce the risk of relapse include [102, 774–777]:
- Discuss and normalise the issue of relapse in therapy – this helps the client prepare and self-monitor.
- Enhance the client’s commitment to change – regularly review costs of use and benefits of change in order to strengthen commitment.
- Explain that lapses are a temporary setback and that they do not need to lead to relapse. Feelings of shame, failure, and guilt are likely to follow single lapses in AOD conditions, which is likely to be detrimental to mental health. This pattern presents the risk of complete relapse. To avoid this situation, it can be useful to normalise lapses and explore the events that led to a lapse, and how it could be avoided.
- Encourage the client to practise and use any of the strategies they have learnt about managing their mental health condition.
- Identify and plan for high-risk situations – including emotions, thoughts, places, events, and people which are likely to make the client vulnerable to mental distress or substance use; plan ahead to anticipate these situations, monitor warning signs and triggers, and develop coping strategies to deal with them.
- Consider social factors and support – relapse is more likely when social factors are difficult and support levels are low. Support the client in making changes in their life to develop healthy and protective environments. It can be useful to discuss supports with the client and plan for any foreseeable issues (e.g., housing, family, relationship). It may also be useful to provide the client with information on services and organisations that can assist in such situations.