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 health and AOD use disorders [401].
Relapse prevention strategies that are already used in AOD treatment can also be used to reduce risk of relapse of the mental health condition. Some simple strategies that can be useful in helping a client reduce the risk of relapse include [299, 401-403]:
- 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 inorder 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 bedetrimental to mental health. This presents the risk of complete relapse. To avoid this, it can be useful to normalise lapses and explore the events that lead to a lapse, and how this could be avoided.
- Encourage the client to practise and use any of the strategies he/she has learnt about managing his/ her mental health condition.
- Identify and plan for high-risk situations – this includes 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 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 his/her life to develop healthy and protective environments. It can be useful to discuss this with the client and plan for any foreseeable issues (e.g., housing, family, relationship). It may be useful to provide the client with information on services and organisations that can assist in such situations.