Cognitive Behavioral Therapy for Relapse Prevention

Rubin Khoddam Ph.D.

Incidence of Concurrent Conditions

A significant statistical connection exists between post-traumatic stress disorder (PTSD) and addiction. In the general population, approximately 3-7 percent of people grapple with a substance use disorder (SUD). However, when examining those with PTSD, the prevalence of SUD escalates to as high as 35 percent, while alcohol use disorder (AUD) stands at 52 percent. Conversely, around 8 percent of the general population experiences PTSD, but within the subset dealing with a substance use disorder, this figure surges to between 26-52 percent.

Traumatic experiences can drive individuals to use substances as a way to cope with the emotional pain and distress caused by the trauma. This connection between trauma and addiction makes it crucial to address both issues simultaneously. By addressing the trauma at its root, individuals are better equipped to prevent relapse and achieve lasting recovery.

Understanding Relapse

Before we dive into the role of cognitive behavioral therapy in preventing relapse, let’s understand what relapse is and why it’s so common.

Relapse is the return to substance use after a period of abstinence. According to the National Institute on Drug Abuse (NIDA), the relapse rates for addiction are estimated to be between 40 to 60 percent, which highlights the formidable challenge of maintaining sobriety.

Relapse can occur frequently in individuals dealing with various challenges, including addiction, mental health disorders, and other behavioral issues, for several reasons:

  1. Chronic Nature of Conditions: Many conditions, such as substance use disorders and certain mental health disorders, are chronic in nature. This means that they can persist over a person’s lifetime, making relapse a possible event at any point.
  2. Triggers and Stressors: External triggers and stressors can be powerful catalysts for relapse. Environmental cues, people, places, or situations associated with past addictive behaviors or mental health struggles can trigger cravings or emotional distress, leading to relapse.
  3. Psychological Factors: Mental health disorders often involve psychological factors such as depressionanxiety, and low self-esteem. These factors can increase vulnerability to relapse, as individuals may use substances or engage in harmful behaviors to self-medicate or cope with emotional distress.
  4. Lack of Coping Skills: Many people with addiction or mental health issues lack effective coping strategies to deal with life’s challenges. Without healthy coping mechanisms, individuals may resort to familiar, albeit harmful, behaviors as a way to manage stress and discomfort.
  5. Social and Peer Pressure: Social circles and peer pressure can play a significant role in relapse, especially in cases of substance abuse. Associating with individuals who encourage or normalize substance use can make it difficult to stay in recovery.
  6. Underlying Trauma: Unresolved trauma from the past, including adverse childhood experiences, can contribute to the risk of relapse. Trauma-related triggers and emotions can resurface and drive individuals to revert to their previous coping mechanisms.
  7. Withdrawal Symptoms: For individuals with substance use disorders, the physical and psychological discomfort of withdrawal can be overwhelming. Some may relapse to alleviate these symptoms.
  8. Complacency: In the case of addiction, individuals who have achieved a period of sobriety may become complacent and underestimate the ongoing need for support and self-care, leading to relapse.
  9. Unrealistic Expectations: Unrealistic expectations about recovery, such as anticipating that it will be a smooth and linear process, can lead to disappointment and frustration when setbacks occur, potentially leading to relapse.
  10. Stigmatization and Shame: The stigma associated with addiction and mental health issues can create feelings of shame and isolation. These negative emotions may make individuals reluctant to seek help or disclose their struggles, increasing the risk of relapse.

What Role Does Trauma Play in Relapse?

One recent 2022 study revealed that trauma plays a significant role in relapse. The study involved 335 adult psychiatric patients. The findings revealed that among the participants, 298 individuals (88.9 percent) had encountered childhood adversities, with 44.4 percent of them reporting more than five childhood traumas. Notably, relapse was observed in 40.9 percent of the participants, while an extended hospital stay was recorded in 71.1 percent of cases. Predictors for prolonged hospitalization included experiences of emotional abuse, substance use, and residing in rural areas.

Furthermore, the study identified that employment status and exposure to childhood trauma inflicted by a parent increased the risk of relapse in individuals with mental health issues stemming from childhood trauma. Conversely, undergoing childhood trauma-focused interventions reduced the risk of relapse and shortened hospitalization durations.

The findings reveal, in short, that individuals who have experienced trauma are more susceptible to relapse, underscoring the importance of addressing trauma in addiction treatment. In addition, relapse often ties back to past trauma, particularly when attempting to combat addiction without expert guidance.

The Power of Cognitive Behavioral Therapy

Cognitive behavioral therapy is a well-established therapeutic approach that focuses on identifying and changing negative thought patterns and behaviors. It has gained prominence as an effective method for addiction treatment and relapse prevention.

Recent studies have shown promising results in the use of CBT for relapse prevention. According to the Substance Abuse and Mental Health Services Administration, CBT can reduce relapse rates by up to 60 percent when compared to traditional treatment methods.

CBT helps individuals in recovery by:

  1. Identifying Triggers: CBT helps individuals recognize the thoughts, feelings, and situations that trigger their cravings for substances. By understanding these triggers, they can develop strategies to avoid or cope with them.
  2. Building Coping Skills: CBT equips individuals with practical skills to manage stress, anxiety, and negative emotions without resorting to substance use. These skills are essential for maintaining sobriety.
  3. Challenging Negative Beliefs: Many individuals struggling with addiction have negative beliefs about themselves and their ability to change. CBT helps challenge and reframe these beliefs, fostering self-empowerment.

Many treatment programs incorporate cognitive-behavioral therapy and counseling to delve into one’s personal history and the emotions underlying their struggles with recovery. Cognitive-behavioral therapy entails examining life experiences and thought patterns, and reshaping one’s thinking positively rather than succumbing to negative self-talk. A comprehensive treatment regimen should encompass one’s mental, physical, and spiritual well-being, fostering healing from within.

If someone has already undergone a treatment program with counseling and therapy but continue to relapse, it might be time to explore alternative care or enter an extended, intensive treatment program. Trauma may not have been adequately addressed, necessitating more effective techniques or a longer duration of treatment. Top-quality care should consist of a team of knowledgeable, empathetic professionals capable of helping someone confront their past and equipping them with strategies to handle painful memories and emotions.

Regardless of the reasons behind a relapse, it’s crucial to understand that it doesn’t signify failure. Each attempt at lifelong sobriety serves as a valuable learning experience and a step in the right direction. With the right support and the essential tools for recovery, the next attempt could be the one that endures.


Addiction and relapse are formidable foes, but with the right tools and support, lasting recovery is within reach. Cognitive behavioral therapy, especially when integrated with trauma-informed care, has proven to be a beacon of hope for individuals battling addiction.

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