Last updated: 21 August 2023 & medically reviewed by Dr. Jenni Jacobsen
Relapse is one of the most difficult parts of recovery to manage and is often a constant battle for those who are overcoming addiction. While avoiding relapse will often be a lifelong challenge, it does not need to be an ordeal and there are many ways to avoid substance misuse.
Key takeaways:
Relapse is often the first motivator for people to seek treatment in a rehab setting. When attempting to stop substance use on their own, substance abusers will often relapse due to a lack of support and an inability to manage triggers such as withdrawal symptoms.
The stages of relapse are often broken down into three categories. These start out as thoughts about substance abuse and will eventually lead to full physical relapse.
Relapse prevention starts well before the point of resisting drugs or alcohol at the point of taking them. If a person hasn’t recognized the signs of emotional and mental relapse or hasn’t developed the skills to deal with these stages, then physical relapse is often inevitable.
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Table of contents
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What is relapse?
When most people consider the term relapse in relation to recovery, they will automatically assume it refers to someone who has had addiction treatment and overcome a substance use disorder returning to their old ways and abusing substances again. While this may sometimes be the case, relapse can come in many forms with varying stages of severity.
Relapse is often the first motivator for people to seek treatment in a rehab setting. When attempting to stop substance use on their own, substance abusers will often relapse due to a lack of support and an inability to manage triggers such as withdrawal symptoms.[1]
Some stages of relapse may only involve thinking about using drugs and alcohol with no intention of following through. Others may be a battle in the mind between the desire to use and controlling impulses. While those in recovery will almost always experience some form of relapse, the severity, and longevity of it are different for everyone and it is never irreversible.
The stages of relapse
An important thing to remember about relapse is that it isn’t an event; rather it’s a process that can occur gradually over time. The physical act of relapse, that is abusing substances or engaging in negative behaviors, can happen weeks or months after the initial stages of relapse have begun.
The stages of relapse are often broken down into three categories. These start out as thoughts about substance abuse and will eventually lead to full physical relapse. The stages of relapse most widely used are:
- Emotional relapse
- Mental relapse
- Physical relapse[1]
Emotional relapse
Emotional relapse does not involve taking or even thinking about abusing substances. Instead, emotions and behaviors are setting you up for a relapse in the future, often occurring subconsciously.[1]
This means the person experiencing emotional relapse will often experience a high level of denial, as they do not equate their emotional state to substance misuse. It is also often accompanied by a low level of self-care; emotionally, mentally, and physically.
Signs of emotional relapse include:
Poor eating and sleeping habits
Bottling up emotions
Isolating
Not attending meetings (in a support group setting)
Not sharing during meetings
Focusing on other people's emotional state over your own
While most people going through emotional relapse won’t realize it due to denial, it is important to recognize the above indicators to avoid progressing relapse. HALT (hungry, angry, lonely, tired) is an important acronym to remember throughout recovery as poor self-care during any of these states is a strong indicator that relapse is forming.
Related blog: 100 inspiring recovery quotes
Mental relapse
At the stage of mental relapse, the individual will be experiencing a battle in their mind between wanting to use again and the desire to remain sober. This is a strong indicator that relapse is imminent, and is characterized by:
Thinking about people, places, and things associated with prior use
Fantasizing about using
Glamorizing past use
Thinking about relapse
Planning to relapse (setting, timings, specific substances, etc.)
Associating with people linked to previous use
Lying to others about these thoughts[1]
This stage of relapse involves a high level of bargaining and rationalization in the person’s mind, often making trade-offs and deals in order to lead themselves closer to relapse. This may include believing that they won’t be fully recovered unless they can remain strong in high-risk scenarios. This is a recipe for failure as the person will almost always relapse and will have excused themselves for doing so.
Occasional thoughts of using again are common throughout recovery and most people will go through a period of mental relapse. In order to avoid full relapse, it is important for those experiencing mental relapse to open up and speak to someone about their thoughts about wanting to use again. Counselors and therapists will often be able to use cognitive techniques to affirm the client's recovery journey and realign their thoughts toward relapse.
How to combat mental relapse
Mental relapse is often a pivotal moment for people in recovery and overcoming it can lead to greater success in recovery. Ashley Loeb Blassingame, co-founder of Lionrock Recovery, had this to say on combating mental relapse:
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. [4]
Medical advisor
MBA, CADC II, CAI, CRPS
Physical relapse
Physical relapse is the final stage of the relapse journey in involves partaking in the use of alcohol, drugs, and addictive behaviors. Physical relapse is sometimes broken down into “lapse” where someone uses drugs or alcohol once and “relapse” where uncontrollable use takes hold again. Evidence has shown that bargaining or rationalizing around a lapse in use will often lead to a full physical relapse.[1]
This is due to the person forcing themselves to believe that one drink or instance of drug use has not impacted their recovery and that they have developed control over substances through their recovery journey. This is a fallacy and one that will almost always lead the individual to engage in increasingly risky behavior until a full relapse occurs.
How to restart recovery after physical relapse
Physical relapse can feel devastating to those who believed they had control over their substance misuse. Though physical relapse is a set back, it does not spell the end of the recovery process. Ashley had this to say on reseting after physical relapse:
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.
[4]
Medical advisor MBA, CADC II, CAI, CRPS
10 common causes of relapse
Withdrawal symptoms: Short-term uncomfortable/painful physical and mental symptoms that appear when substance use stops.
Post-acute withdrawal symptoms: Long-term withdrawal symptoms often present themselves as mental health issues such as depression and anxiety.
Poor self-care: sleeping, eating, personal hygiene, and organization become neglected.
People: Associating with people who you used to abuse substances with.
Places: Visiting places where you used to abuse substances or that you associate with the activity of doing so.
Things: Collecting or becoming interested in objects that you associate with substance abuse, such as drug paraphernalia.
Uncomfortable emotions: feeling like abusing substances because you are uncomfortable, such as with HALT responses.
Relationships and sex: Stress and sexual dysfunction can lead to relapse, as too can familiar habits
Isolation: Being alone with your thoughts and boredom can both lead to relapse
Pride and overconfidence: thinking you don’t have a drug or alcohol problem, or that it is behind you
Related: Warning signs of addiction
Early relapse prevention
Relapse prevention starts well before the point of resisting drugs or alcohol at the point of taking them. If a person hasn’t recognized the signs of emotional and mental relapse or hasn’t developed the skills to deal with these stages, then physical relapse is often inevitable. In fact, physical relapse is often the end result of wanting to relieve the anguish of emotional and mental relapse that has become unmanageable.[3]
While support groups, doctors, counselors, and addiction specialists will be able to best help individuals identify and avoid early relapse signs, there are some daily practices that anyone can perform.
Techniques for dealing with emotional and mental relapse
Self-care
Self-care may seem like a ubiquitous answer to most of life's ills. For managing early relapse symptoms though it is very important. Post-acute withdrawal symptoms, those that can occur and last long after the initial stages of withdrawal, can be extremely uncomfortable (including insomnia, depression, anxiety, and fatigue) and often influence early relapse signs. Incorporating physical exercise, a healthy diet, and a structured sleep pattern can all help emotional and mental health which can alleviate relapse triggers.
Being aware of HALT
Hunger, anger, loneliness, and tiredness are all closely linked to carvings and relapse. Being mindful and regularly checking in with your HALT state can help you remain vigilant of negative emotional responses to these. It is also important to reflect on periods where you have felt a HALT state and how it made you feel like you wanted to use drugs or alcohol, whether you relapsed on that occasion or not.
Practice mindfulness
When practicing mindfulness meditation, individuals focus on their breath and body sensations, allowing them to become more aware of their thoughts and feelings in the present moment. Individuals can use mindfulness to become aware of their triggers and warning signs of relapse and to take necessary steps to prevent it. Mindfulness meditation can help individuals to remain in the present moment and reflect on the consequences of their actions, rather than focusing on the pleasurable feeling of addiction. This can help them to make healthier decisions, which can help to prevent relapse.
Use support groups
Joining a support group such as Alcoholics Anonymous (AA), Narcotics Anonymous (NA), or SMART Recovery can help prevent early relapse. Support groups promote recovery through accountability, education, and peer support while adhering to a structured treatment plan. They can help reduce feelings of isolation in recovery as well as offer an understanding ear to those struggling with triggers.
Have spotters
Handling all aspects of recovery alone can be difficult and the temptation to relapse is no different. Having a list of people you can depend on in early relapse scenarios can help get passed the cravings. Friends, family, or other recovering addicts can provide support (as long as you trust their advice and comfort) and it’s important to utilize any available assistance during recovery.
Seek treatment
No matter what stage of relapse you are in, seeking help is always an option. Relapse symptoms can appear regardless of how prepared you're, what tools you have learned to cope, and if you have a large support network. While these things can set you up to be as strong in the face of relapse as possible, occasionally returning or initiating treatment is the best option. Inpatient rehabs or outpatient treatment facilities are prepared to support those who are struggling with any stage of relapse and will be able to offer care and prepare future relapse prevention skills.
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