During addiction recovery, it is common for individuals to experience a relapse, which typically occurs in three stages. Being able to recognize signs of each stage can help with the implementation of prevention strategies and avoiding a full relapse.
- The three stages of relapse are emotional relapse, mental relapse, and physical relapse. Catching the signs of earlier stages helps prevent one from spiraling into a return to substance use during recovery.
- Each stage has certain manifestations and will benefit from appropriate coping strategies so the individual can better prevent a potential relapse.
- Various treatment options are available that can help with each stage of relapse, including therapy and group meetings.
The three stages of relapse
Relapse is common in addiction recovery and can occur several times throughout the recovery process regardless of the duration of abstinence. Often, this occurs in stages that can take place within days, weeks, or months of each other.
These stages are: [1]
- Stage 1: Emotional relapse. External triggers, mood changes, and decline in self-care predispose the individual to be vulnerable to relapse; no thoughts of returning to substance use yet.
- Stage 2: Mental relapse. Thoughts of using return and cravings become harder to resist; being torn between sobriety and relapsing.
- Stage 3: Physical relapse. Returning to substance use behaviors.
Stage 1: Emotional relapse
Emotional relapse is the first stage of relapse. In this stage, the individual is not thinking of using substances and is maintaining their sobriety. However, emotional changes begin to occur which may be linked to triggers that previously preceded substance use. [2]
Many studies have found strong links between mood fluctuations and substance use or relapse. [3][4][5]
During an emotional relapse, an individual might experience a challenging or distressing event or experience a deterioration in their psychological state, prompting a desire to use substances to mask or alter emotions. [2]
Signs of an emotional relapse
At this stage, the individual might be unaware or be in denial that these emotional and behavioral changes can influence their recovery. The items below can be used as a checklist for changes in self-care, mood, and behavior to look out for: [1][2][5]
Changes in self-care
- Changes in sleep patterns, sleeping too much or too little
- Changes in appetite and eating habits
- Poor physical self-care, such as a decline in hygiene
Changes in mood
- Low mood, symptoms of depression
- Loneliness
- Anger
- Stress
- Symptoms of anxiety
- Mood swings
- Short-lived bouts of extreme happiness or euphoria
Changes in behaviors
- Avoiding social events
- Isolating at home alone
- Missing recovery meetings
- Not speaking to people about emotions
- Ruminating or overthinking
- Neglecting to use coping skills
- Avoiding work or responsibilities
Tips on how to handle an emotional relapse
During this stage, the individual does not want to relapse, so if they can implement prevention strategies and self-care techniques, thoughts of using again may be avoided. [6]
- Using the acronym HALT (hungry, angry, lonely, tired) to recognize signs of emotional relapse. Regularly checking these four aspects of the self to identify any changes.
- Engaging in enriching activities and hobbies, such as exercise, mindfulness, and relaxation exercises, to help regulate emotions.
- Engaging in therapy, such as cognitive behavioral therapy (CBT) to learn coping skills and recognize and manage negative emotions and thoughts.
- Talking to friends and family when negative emotions arise.
Stage 2: Mental relapse
Mental relapse is the second stage of relapse. During this stage, the individual will begin thinking about using substances again and may even plan when and how they will use them. [1]
With emotional distress unchecked from the previous stage, cravings that are prompted by people or places associated with the individual’s past substance use return and become more difficult to resist at this stage. [5]
Despite being still abstinent, they will likely be torn between maintaining their sobriety and the impulse to use the substance again. If the individual gives in, they start to make excuses and discount the potential harm associated with fantasizing and approaching substance use cravings. [2]
Signs of a mental relapse
Signs of a mental relapse might include: [1][2]
- Thinking about substance use in a positive light, ignoring negative effects or aspects of previous use
- Fantasizing about using
- Bargaining or rationalizing about why using is not an issue
- Considering spending time with people or in places associated with past use
- Making plans to obtain the substance and use
- Lying to friends and family about these thoughts or denying or hiding their occurrence during meetings
Tips on how to handle a mental relapse
Mental relapse is likely to occur several times throughout the recovery process and can be managed effectively if the individual is honest about the direction of their thoughts.
Some strategies to use include: [2][3][5][6]
- Accepting that cravings will occur and reminding yourself that they can pass
- Considering what has triggered these thoughts and finding ways to regulate emotions and behaviors that might have led to their occurrence
- Having a written plan that can be implemented when these thoughts arise which might include skills and techniques learned in therapy or meetings
- Finding ways to change thought patterns or distract from thoughts of using
- Using a sponsor or accountability friend who can be contacted when these thoughts arise
- Attending meetings or talking to loved ones
- Avoiding people and places that might be triggering or serve as reminders of past use
The most basic ways to combat mental relapse are to have an exercise schedule, maintain community through commitments and planned social activities that are in line with recovery, journaling, receive unbiased feedback on a regular basis (therapy), and building coping skills that thwart things like increased conflict with people around you, disproportionate reactions, and conspiracy thinking. [10]
Medical advisor
MBA, CADC II, CAI, CRPS
Stage 3: Physical relapse
Physical relapse is the third and final stage of a relapse, in which the individual uses the substance.
It typically follows stages one and two if prevention strategies have not been utilized and may occur days, weeks, or months after the initial relapse signs have begun. [7] This stage is often considered in terms of a ‘lapse’ and a ‘relapse’.
During this stage, it is common to experience feelings of guilt, frustration, and shame. This is normal and may help the individual recognize and change their behaviors. However, it is also important to not focus on these negative emotions and find ways to forgive yourself. [8]
Lapse vs. relapse
- A lapse is the initial transgression or return to substance-using behaviors. It might be short-lived and occur just once before the individual returns to their recovery process.
- A full relapse is when a full return to previous substance use has occurred. [8]
While a lapse is not as critical as a relapse, it can still create harmful effects that may impact recovery, particularly if the individual is unable to accept or admit to this setback in their progress. Denying use or believing that control over use has not been lost can be detrimental to recovering from a lapse. [1]
What to do when you relapse
Following a lapse or relapse, individuals need to accept that this transgression has occurred and the harm that it has or could cause. By accepting and admitting to themselves and others that they have experienced a relapse, they can begin to seek the support needed to return to the recovery process.
Managing a relapse could include: [1][2][6][8]
- Speaking to loved ones or in meetings about the transgression
- Accepting its occurrence and the feelings of shame or frustration it might have caused, and releasing these negative emotions
- Asking for professional help, such as outpatient or inpatient rehab, specialist therapy, or medically-assisted withdrawal
- Being honest with yourself and others about what led to the relapse, without making excuses or attempting to rationalize this transgression
- Making lifestyle changes, such as avoiding triggering social circles or places, removing the substance from the home or accessible places, and recommencing prevention strategies
- Making healthy choices to improve sleep, diet, and other aspects of mental and physical well-being
If someone has no one to reach out to, they can call a free hotline or show up at a recovery meeting and ask the group for help. Recovering communities believe it is their responsibility to help the new person and will step up when someone asking for help is in need. [10]
Medical advisor
MBA, CADC II, CAI, CRPS
The importance of recognizing relapse stages
Relapse is common, with statistics showing that it occurs in around 40-60% of individuals in the first year of abstinence. [9] Recognizing signs of relapse can help individuals put prevention strategies in place. Spotting these signs early, particularly in the emotional or mental relapse stages, can improve the chances of preventing relapse, so it is crucial to learn and understand these signs and how to spot them. [6]
There are risks when relapses occur, including impacts on mental health and the risk of overdose. For some people, tolerance decreases significantly during abstinence, and a sudden return to using the substance in the same quantities as previously can result in the body being unable to cope and experiencing an overdose. [9]
The most common triggers for relapse
Various circumstances can trigger a relapse and it can be helpful to be aware of your triggers, to recognize and manage them. After experiencing a trigger, it can be helpful to check in with your thoughts and feelings to notice if any relapse signs have begun to occur.
Common relapse triggers can include: [1][4][8]
- Distressing experiences in relationships, works, or other aspects of life
- The onset or worsening of mental health issues
- Medical issues, such as a diagnosis of disease or chronic pain conditions
- Exposure to people or places associated with past use
- A decline in self-care
- Withdrawal symptoms
- Becoming isolated from friends and family
- Happy or celebratory occurrences such as holidays, weddings, or parties
Worried you might be relapsing?
If you are regularly checking in with your thoughts and emotions and are noticing signs such as a decline in self-care and hygiene, changes in your mood and behavior, or thoughts of wanting to use substances, this may be an early indication of a potential relapse.
Reaching out for help at this time can help you prevent a relapse. Various treatment options are available and can help you get the support you need.
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