Relapse, which happens when a person returns to using drugs and alcohol after a period of abstinence, is part of recovering from substance addiction. However, as much as it is a normal part of recovery, it’s a part of the journey that perhaps isn’t talked about as much as it should be or discussed in the proper context.
Using addictive substances over time can change the structure of the brain as well as its functioning. This means that even if a person does not use a substance anymore, they must relearn how to live without using it. This takes time to do, especially as a person in recovery receives therapies, counseling, and medications to manage life without abusing substances. Still, despite their best efforts, many people can expect to relapse along the way.
According to the National Institute on Drug Abuse (NIDA), relapse happens to 40% to 60% of people in recovery, including people who have received professional help at an addiction treatment facility. This rate is on par with people who have other chronic illnesses, such as high blood pressure, asthma, and diabetes, per NIDA.
As the government health agency explains it, the chronic nature of addiction means relapse is likely. It also says, “Relapse serves as a sign for resumed, modified, or new treatment.” This explains why it is important that people recovering from substance use should be aware that returning to substance use after stopping for some time does not mean professional treatment failed. However, should a relapse happen, it should not be ignored.
A relapse for a person recovering from substance use is dangerous for several reasons. Overdose risks are high for a person whose body is no longer used to being chemically dependent on a particular substance. A person who hasn’t used a substance in a while could mistakenly think they can go back to using their usual dose without consequences. This is when a usual dose can turn into a deadly one. They can also take more, thinking they can handle it, but the opposite ends up being the case.
Lapse Vs. Relapse: Is There a Difference?
Yes, there is a difference. It is easy to think a person in recovery who uses a substance has relapsed, but that’s not exactly the situation every time. Having a “lapse” and a “relapse” are not the same event. Some may call a “lapse” a “slip,” which is when someone uses drugs or alcohol for a short time. Someone’s lapse does not always mean a relapse is going to happen. However, lapses can lead to substance use patterns that can become problematic.
An important thing to note is a relapse is a conscious decision to return to substance use, even if a person has a plan in place to stay drug- and alcohol-free. This is different from a lapse. After a lapse, a person gets back on the horse, so to speak, and continues with the plan to remain abstinent. A lapse can also lead a person to join outpatient treatment to keep them accountable or a support group, such as Alcoholics Anonymous. However, a decision to continue to use over and over again is a relapse.
How Does a Relapse Happen?
Once a relapse becomes evident to the user and others around them, it is usually in its final stage. This is why it helps for a person in recovery to learn and recognize their triggers. Knowing what their triggers are can help them realize when things are not going as planned. It can also help them avoid situations that could lead them back to using substances to cope with anger, stress, anxiety, depression, and other emotions, feelings, or states of mind.
While it may seem like a relapse happens all at once, it actually is a gradual processthat can unfold over weeks or months before a person takes the first drink or uses a drug, according to the Yale Journal of Biology and Medicine. The process also has distinct stages, and treatment aims to help people in recovery recognize the early stages when a person has a greater chance of preventing a relapse.
Per the article, the stages of the relapse cycle are:
Emotional relapse. During this phase, the person isn’t thinking about using substances. Instead, they are remembering their last relapse and trying not to repeat it. Denial plays a large part in an emotional relapse. Denial may play out by the person not wanting to attend meetings or withdrawing from others so that they remain in isolation.
Early warning signs of an emotional relapse may include:
- Attending support group meetings but keeping quiet about personal struggles
- Focusing on others to avoid focusing on one’s problems
- Practicing poor eating and sleeping habits
- Continuing on with one’s routine but keeping emotions hidden or bottled up
Mental relapse. In this phase, the person is going back and forth about whether they should return to using substances. “As individuals go deeper into mental relapse, their cognitive resistance to relapse diminishes and their need to escape increases,” according to the Yale Journal of Biology and Medicine article. It is dangerous to stay in this stage too long without an exit strategy. Not having one can lead to a physical relapse.
Early warning signs of a mental relapse may include:
- Drug or alcohol cravings
- Reminiscing about people, places, and things linked to past substance use
- Glamorizing past alcohol and drug use
- Minimizing the consequences of past substance use
- Seeking opportunities to return to using drugs or alcohol
- Entertaining unrealistic expectations about recovery (This can lead to doubts about whether abstinence is working or if it’s even worth it to continue.)
Physical relapse. At this point, the person who thought about using substances again has done so. People who reach this stage commonly rationalize that it’s “just this one time” or “it’s just one drink.” However, this stage is where it is harder to stop substance use, which is why relapse occurs. According to the journal article, “Most physical relapses are relapses of opportunity. They occur when the person has a window in which they feel they will not get caught.”
What to do After a Relapse Happens
The best thing to do after a relapse is to get back on track as quickly as possible. While a relapse is significant and serves as a warning that something needs to change, a relapse does not have to be the beginning of a permanent return to addiction. If you relapse, consider seeing it as an opportunity to get back on the path to recovery.
Addiction recovery is an active, lifelong process. There are many steps one can take to fight back against drug and alcohol use and addiction, but the commitment to live and remain sober starts with discipline and a plan.
People in recovery need a plan they can access quickly should they be faced with relapse triggers that signal that they need to avoid an oncoming relapse.
Before a relapse prevention plan is created, each person’s drug use patterns and drug-related medical, psychiatric, and social problems must be considered, NIDA advises.
Techniques to Avoid Relapse Include:
Knowing what your triggers are. Triggers are important to identify because they can help one recognize when they may be wading into dangerous territory. Some of these triggers include stress and anxiety, but others may be less obvious, such as setting unrealistic goals or taking on too many responsibilities at one time.
Getting clear on high-risk situations that are personally triggering for you.Your high-risk situation may not be someone else’s and vice versa, which is why you have to identify what situations you should avoid. Many events involve substance use, which may not be the ideal environment for someone who needs to remain substance-free. These include weddings, graduations, holiday gatherings or get-togethers, or any celebratory occasion.
Often, events such as these may serve alcohol, which can lead to a “slip” that can later become a relapse. Other times, it might not be the alcohol but the high stress that happens at these events. Develop a sound exit strategy that keeps you safe and in control of yourself and the situation. For example, you can take your own car so that you can leave if things take a turn you are uncomfortable with, or you can limit your outing to a set number of hours and leave at that time. The goal is to protect yourself at all times.
Stay in touch with your emotions. Rely on healthy coping strategies to manage your feelings. A dip in energy or feeling down in the dumps could be an early warning sign. Go for a walk, dial a trusted friend, or take a trip away to gather your thoughts and feelings. Everyone needs a timeout. Losing touch with how you feel could allow you to get caught up in a negative moment and make a decision you will regret later.
Find a support group. Join a recovery group, attend support meetings, or keep contact information handy for friends and family who you can check in with when you’re experiencing cravings or changes in mood. Stay connected to a community that understands the unique challenges of addiction and the journey of recovering from it.
Groups, such as 12-Step programs, Alcoholics Anonymous and Narcotics Anonymous, help provide accountability and fellowship as participants likely will better understand what struggles a person in recovery is facing. There are many people who can reach out to you and help you stay motivated and on the right path.
Attend therapy. Cognitive behavioral therapy (CBT) is one tool used to change the negative thinking that leads to relapse. It also encourages the use of healthy coping strategies that promote achieving and maintaining sobriety. Any therapy that keeps you focused on your sobriety and shows you how to take care of your mental health is the one you should receive.
As mentioned earlier, if you need additional support or feel like you are on the verge of relapse, you can enter a program to ensure that you can stay on top of your goal of living your best life, leaving substance use far behind.