Understanding Relapse in Addiction Recovery

Risks of relapse

Relapse can lead to severe risks, including returning to dangerous behaviors, being vulnerable to harm or exploitation from others, and an increased risk of overdose after tolerance declines during abstinence.^[1]

This risk might vary depending on individual circumstances and the type of substance used. Opioid relapse, particularly heroin, might lead to a significant risk of overdose.^[9]

Many recovery programs or treatment services will include education and skills development in relapse prevention. This can help individuals learn how to recognize and manage relapse, return to recovery, and let go of any shame or other negative emotions that arise during relapse.^[3]

Common triggers for relapse

Although this varies from person to person, it is common for relapse to be triggered by one or more of the following circumstances:^[2][3][4][7]

• Withdrawal symptoms: People often experience cravings during withdrawal, particularly in the first few weeks when withdrawal symptoms are at their most severe. People might return to using substances to get relief from withdrawal symptoms.
• Mental health: Existing or worsening mental health, such as symptoms of depression, anxiety, or stress, can increase the risk of relapse.
• Physical health: Medical conditions, including chronic pain conditions, can increase the risk of relapse and substances might be used to relieve physical symptoms.
• Relationships: Issues within friendships, romantic relationships, or family relationships can cause an increased risk of relapse.
• Pressure or exposure: Being around others who are using substances can be triggering, as they might pressure the individual to use or might cause increased temptation.
• Isolation: A lack of social connection and support, loneliness, or boredom can be triggers for relapse and can occur when an individual is isolated.
• Loss of control over sobriety: Becoming overconfident, stopping attending meetings, believing you have overcome your addiction, or not utilizing prevention skills can all lead to a relapse.
• Decline in self-care: Poor sleep or diet and not managing mental well-being could lead to a relapse.
• Positive events: Relapse might not always be caused by negative circumstances or emotions. Attending a party or celebration might lead to a relapse.

In the event of any of these triggers, it can be helpful to check in with emotions and thoughts, recognize any signs of relapse, and implement prevention strategies.

The three stages of relapse

Typically, relapse occurs in three stages. The first is an emotional relapse, then a mental relapse, and finally a physical relapse. There are indicators as to what the individual experiences in every stage and recognizing them early allows them to implement strategies appropriate for every stage that can help prevent a full-blown relapse.^[3]

Stage 1: Emotional relapse

An emotional relapse typically involves an individual who is avoiding relapse and maintaining sobriety but subconsciously, triggers begin affecting the individual’s behaviors and emotions, changing how they manage their self-care and resilience within recovery.^[3]

This can include:

• Increase in negative thoughts and emotions
• Decline in self-care, such as poor sleep and diet
• Isolating at home and avoiding friends
• Taking time off work or declining performance at work
• Missing recovery meetings or treatment sessions

Stage 2: Mental relapse

A mental relapse involves the individual beginning to think about using again. While the individual still desires to maintain sobriety, they might start making excuses or rationalizations to themselves or others.^[3]

This can also include:

• Increasingly thinking about past substance use
• Forgetting or choosing not to recall the negative effects of substance use, thinking of past use in a positive light
• Considering spending time with people or in places that were associated with past use
• Contemplating using again or making plans to use
• Hiding or lying about thoughts of substance use from others

Stage 3: Physical relapse

Physical relapse is the act of using substances again after a period of abstinence. Often, this is described as a ‘lapse’, in which a single occurrence of substance use takes place, and a ‘relapse’, in which the individual returns to regular use.^[4]

Physical relapse is a setback on the path to recovery and can cause negative emotions, which may in turn increase the risk of prolonged relapse. Recognizing the reasons for the relapse and implementing prevention or recovery skills can help reduce the emotional and physical impact of relapse and allow the individual to return to the recovery process.^[8]

How to help someone who has relapsed

There are strategies you can use to best support someone you know who has relapsed.

The following might be helpful for them:^[4][6]

• Listen: Take time to talk to them or just listen, offering support in managing any emotional difficulties they are facing that may have led to their relapse.
• Offer practical support: If their self-care has declined, they might appreciate help with cooking, cleaning, or managing other aspects of daily functioning, so that they can focus on returning to recovery.
• Offer to attend a meeting or appointment with them: They might feel scared or ashamed to seek professional help or return to a meeting. Going with them might make this feel a little easier.
• Be non-judgmental: Providing advice and support in returning to their recovery will be useful but ensure that you do this in a non-judgmental manner, showing compassion and understanding.

Strategies for preventing relapse long-term

Strategies for preventing relapse might vary from person to person, depending on the needs of the individual. Typically, the following techniques can help manage signs and prevent relapse and could be included in a relapse prevention plan:^[1][3][4][8]

• HALT: Being aware of the key changes associated with relapse–hunger, anger, loneliness, and tiredness–can be useful. Checking in on these aspects can allow you to recognize when your mental and emotional state is changing, allowing you to act early.
• Self-care: Self-care involves regularly engaging in activities and behaviors that improve well-being, such as maintaining a good diet and sleep schedule, engaging in enjoyable hobbies, spending time with friends, and physical exercise.
• Attend meetings: Group support, such as Alcoholics Anonymous or Narcotics Anonymous, can be a significantly beneficial tool for people in recovery, providing advice, accountability, and community.
• Mindfulness: Mindfulness includes various techniques such as breathing exercises, meditation, and yoga. These activities can help you to be more aware of your physical and emotional state, improve resilience and self-reflection, and reduce negative thoughts and feelings.
• Be honest: Speaking to people during challenging moments in recovery can help provide support in managing triggers and cravings. One or more friends might be able to act as a spotter, helping you recognize concerning changes in your well-being and encouraging you to utilize relapse prevention skills.
• Professional treatment: Professional support can be sought at any time during recovery. Inpatient facilities or outpatient support can help monitor and manage relapse signs and provide helpful treatment. Therapy can help manage cravings and triggers and teach valuable skills.