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On the last track we will discussed smoking triggers. The four smoking triggers we examined were places, people, time, and feelings.
On this track we will discuss relapse. Because relapse is highly individualized, we will discuss two situations that cause relapse as well as the three rules of relapse. The two situations that cause relapse are emotional upset and boredom. The three rules of relapse are practical rules of avoidance that have been had a high rate of productivity in preventing relapse in clients who closely follow them. You might consider playing this track during your next session with a tobacco dependent client.
#1 - Emotional Upset
Therefore, the first predictable situation that may cause a relapse is emotional upsets. Do you find that clients who relapse due to emotional upsets may experience short term relief, but later feel much worse due to feelings of guilt, remorse, or failure? The dialogue I had in a session with Emma, age 33, helps illustrate the point that relapse brings about only short term relief. Emma stated, “Things were terrible at work. I borrowed some cigarettes from a coworker, and then later I bought a pack.” I asked Emma how having a cigarette mad her feel. Emma stated, “At the time, great. But not as great as I thought it would make me feel. Then, later, I just felt awful!”
Emma and I discussed ways she could avoid future relapses due to emotional upset. For example, Emma decided to use positive self talk such as telling herself that though she is unable to control what is upsetting her, she is able to control whether or not she smokes. Emma added that smoking doesn’t really make upsetting situations any better. She stated, “When you’re already upset, losing even more control to cigarettes just makes you feel that much worse.” At a later session Emma stated, “Things got really bad at work again. More than thirty people got laid off. I was spared, but I’m still freaked out. I may not be so lucky next time. But one of the things that keeps me going is that I’m not smoking. I’m really proud of myself.”
Another client mentioned that the idea of repeating smoking cessation is enough to deter future relapse due to emotional upset. Greg, age 29, stated, “I was so close to relapsing. In fact, I was on my way to buy a pack. Then I started thinking about how hard it was to quit in the first place. I spent a lot of time and effort on quitting. I realized I didn’t want to go through all that work again!”
#2 - Boredom
I stated to Jacob, “There are many things you can do instead of killing yourself! The key is alternatives. Give yourself a variety of things to do that will keep your hands or your mouth busy. Reading a book, doing a crossword, or having a light snack might help you keep busy.” As you know, some tobacco dependent clients gain weight after quitting smoking. Therefore, if food becomes an alternative to boredom, you might consider reviewing healthy eating habits with your client.
The Three Rules of Relapse
The three rules of relapse are:
Consider your tobacco dependent client. How could these rules help your client avoid relapse? Could your client benefit from carrying a card with the three rules of relapse printed on them?
On this track we have discussed relapse. Because relapse is highly individualized, we discussed two situations that cause relapse as well as the three rules of relapse. Two situations that cause relapse are emotional upset and boredom. Do you have a tobacco dependent client that would benefit from listening to this track during your next session?
On the next track we will discuss quitting for good. This track is meant to provide practical information regarding coping with cravings, charting progress and staying focused.
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