A relapse occurs when someone who is in recovery from drug or alcohol addiction returns to substance use. Typically, a drug relapse does not occur without warning. There are many common signs and triggers of relapse to be aware of—both in yourself and in someone else. Recognizing the warning signs of a relapse can give you the opportunity to seek out help or approach your loved one.
What is a Relapse?
As of 2018, nearly 20.3 million people ages 12 and above were reported to have a substance use disorder.1 If you or someone you care about is in recovery from alcohol or drug addiction, it’s important to understand that recovery is a lifelong process and relapses may occur along the way—however, relapse prevention is always the goal.
Relapsing is a term that refers to a return to previous use or abuse of alcohol or drugs – whether it’s a single occurrence or repeated behavior. Because substance addiction is a chronic condition, relapse is often considered a normal part of the recovery process. In fact, research has revealed that the relapse rates for drug and alcohol addiction are similar to those of other chronic diseases, such as hypertension and asthma.2
With a relapse rate of approximately 40%-60%, professionals agree that a substance disorder should be treated like any other chronic illness—and that relapse is a sign that it’s time to resume, modify, or begin a new treatment program.
What’s vital to understand is that a relapse does not indicate failure on your part. Remember, substance use disorder is a chronic condition, so relapse isn’t uncommon. You should never feel ashamed of a relapse, or shame someone else for relapsing. Instead, see it as the opportunity to reevaluate your current treatment and reconsider your options.
Is a Slip the Same as a Relapse?
A slip typically refers to accidental one-time use of alcohol or drugs, such as an alcoholic who has a single drink in a social setting. Some people consider a slip to be the same as a relapse, while others differentiate the two by determining that relapse occurs when someone has abandoned their recovery plan altogether.
So, the difference is often determined by the recovering person’s intentions. If you didn’t plan to take a pill or have a drink and immediately go to a meeting or go to your therapist to get back on track, that would be considered a slip. Meanwhile, if you have made the conscious decision to start using or drinking again and are not taking any steps to return to sobriety, then you have relapsed. A slip can lead to a relapse, but it doesn’t always, especially if you are diligent about getting back on track.
The Stages of Relapse
Relapse is often considered a one-time occurrence, but it’s more like a multi-step process involving three separate stages: emotional relapse, followed by a mental relapse, and ultimately leading to physical relapse.3 This process takes place over time, and if you can recognize the early signs of each stage, you may be able to prevent a relapse in yourself or someone else. Along with identifying warning signs of a relapse, you’ll also need to have a relapse prevention plan in place for each stage.
The first stage in relapse that most individuals go through is emotional relapse. This stage is characterized by negative moods and emotions, such as depression, anger, and/or anxiety. These emotions are laying the foundation for a physical relapse to occur in the future if you or your loved one doesn’t recognize the early signs. People who are currently experiencing an emotional relapse aren’t typically planning to relapse.3
Signs of an emotional relapse include:3
- Poor eating habits
- Poor sleeping habits
- Focusing on other people’s issues
- Not attending AA or NA meetings
- Not sharing in AA or NA meetings
- Abandoning following the 12 steps of recovery
An individual in recovery may be in denial that they are at risk of relapse during this stage. As such, the main goals of intervening with an emotional relapse involve:
- Emphasize the importance of self-care in managing their unwanted emotions
- Try to help the person recognize their denial so they can take the steps necessary to stop the relapse from progressing
The next stage is mental relapse, in which the patient has an internal struggle between the desire to stay sober and the desire to return to drinking or drug use.3
These internal battles are common, and they can be overwhelming and intense. Some patients have trouble staving off the urge to use substances, even if they want to. It’s important to realize that these urges are very normal and will occur throughout the recovery process. What matters most is how you or someone else will deal with these urges. Recognizing that you want to use drugs or alcohol is a meaningful part of relapse prevention—once you admit these urges, you can use coping strategies to work through this difficult time.
Some signs of a mental relapse may include:3
- Experiencing cravings for drugs or alcohol
- Being preoccupied with thoughts of situations, places, and people associated with past use
- Planning ways to return to use without losing control
- Seeking opportunities to relapse
During the mental stage of relapse, you or your loved one must consciously work to avoid opportunities and situations that may lead to physical relapse. If someone is experiencing a mental relapse, it’s important to avoid all high-risk situations, such as holiday parties or social gatherings. You may also want to attend extra NA or AA meetings during this time and spend time with your sober friends who can help ground you by reminding you of all the reasons you got sober in the first place.
The final stage of relapse is a physical relapse. This stage occurs when the patient gives in to their cravings and begins using the substance again. This is the stage that most people consider to be a relapse, but it’s easy to see that many factors led to physical relapse; it doesn’t occur in a vacuum. If you or someone you care about experiences a physical relapse, all is not lost. Having a recovery plan in place for stressful times like this can help you work through your relapse and return to a life of sobriety.
Warning Signs of a Relapse
The more you know about relapse signs, the better prepared you will be to prevent it. Here are some additional relapse warning signs to look out for:
- Romanticizing the chosen substance: This is the most obvious sign that a patient is being drawn toward their old habits of using substances and will relapse if they are not careful. When someone begins to discuss using substances again, it’s imperative that you explain the dangers of doing so, in order to better prepare them for this possibility.
- Negative ideals: The more an individual begins to associate the substance with a better life, the more likely they are to use it again. If they start talking about how good the substance made them feel or how they were better off when they were using, this is a sure sign that they have started moving into the second phase of relapse – and it’s time to intervene.
- Sudden behavior changes: A sudden change in a person’s behavior is a sure sign that they are on the brink of relapse. If you see that their behavior has become erratic and unpredictable, this is a sign that they should be seeking help.
- Negative association with positive treatments: Similar to changes in behavior, a negative association with a positive treatment is another sign that someone is beginning to move into the final phase of relapse. These individuals often get angered or upset when they are reminded of the positive changes that have occurred. They may even become upset when you show them what a great recovery they are making, or remind them that they can beat this addiction.
Alcohol and Drug Relapse Triggers
Addiction triggers can stimulate the desire to use substances and make a person more likely to start using again. The triggers are often very powerful and can cause relapse, even if the patient thinks they have their addiction under control. Some of the most common drug and alcohol triggers include, but are not limited to:
- Alcohol consumption: Alcohol can heighten the temptation to use drugs of abuse. Alcohol is a depressant, and when used in combination with other substances, it can have a strong effect on the brain. If a person with a substance use disorder begins to drink, it can heighten their desire to use other substances.
- Stress: This is a significant trigger for some people recovering from a substance use disorder. If you see that someone is experiencing significant stress, it’s important to communicate that substance use is not a healthy way to cope with their feelings. Instead, encourage them to seek out a support system, as well as additional therapy or treatment.
- Paraphernalia: Paraphernalia is the equipment that people use to enjoy their substance. People who are in recovery usually have to keep paraphernalia out of sight and avoid situations in which other people may be using.
- People/Places: For some patients, their environment can trigger an urge to use. Being around people, places, and situations associated with substance use can make a patient more likely to relapse.
What to Do if You Are Experiencing Relapse Triggers
Identifying relapse triggers is crucial in helping yourself or those close to you who may be struggling with their recovery. Should you notice that you or a loved one are battling with relapse triggers, take the time to seek out support through:
- Individual therapy
- Group therapy
- Support groups (AA, NA, SMART Recovery, etc.)
The more support you can receive, the better your chances of avoiding a potential relapse. Another way you can combat these triggers is by revisiting your coping skills, which may include:
- Positive Reframing
- Spiritual Practices
- Art Therapy
Treatment for a Relapse on Drugs or Alcohol
If you or someone you care about has experienced a relapse on drugs or alcohol, it’s okay—it doesn’t mean failure. Recovery is a lifelong journey, and relapse indicates that you may need some extra support and treatment right now. The best way to respond to a drug relapse is to find a treatment program and get help immediately. An addiction treatment program can help you establish abstinence again as well as reinforce your relapse prevention skills, coping strategies, impulse control skills, and more.
If you or a loved one has relapsed, you aren’t alone. Call our 24/7 hotline at 1-800-429-7690 to find a rehab that will help you get back on track.
- Substance Abuse and Mental Health Services Administration. (2020). Substance use disorders and disasters.
- National Institute on Drug Abuse. (2020). Treatment and recovery.
- Guenzel N, McChargue D. Addiction Relapse Prevention. [Updated 2021 Jul 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan.
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