What to Do After a Relapse


Published On: May 24, 2023

In reference to addiction, relapse is defined as the worsening or deterioration after a period of improvement and success. When a patient relapses, they tend to engage in old drug or alcohol habits after a period of treatment and abstinence.

There are multiple philosophies associated with relapse, many of which view relapse as negative or a sign of weakness. This is a view that becomes harmful to many who struggle with addiction, only making them foster feelings of guilt or shaming, pushing them to hide their relapse and mental struggles.

In reality, relapse is part of the rehabilitation cycle. Without battling feelings of relapse and the emotions that go with it, you are not able to personally develop.

Relapse ought to be viewed as a learning curve, and not as a shameful or weak process.

ASAM (The American Society of Addiction Medicine) states that relapse follows active remission, whereby the patient behaves in a way that mirrors past addiction. Someone that has stopped drinking for a couple of months and has been involved in active rehabilitation, would be relapsing if they started drinking in excess again. [1]

Research has shown that relapse is common following treatment for alcohol use and drug use disorders. Up to 70% of patients struggle to stay sober from drugs and alcohol within the first year of addiction treatment. [2]

Understanding the cause of relapse can help patients avoid triggers. It is commonly stated that relapse often starts with a risky situation or a trigger and is then followed by poor coping mechanisms and a lack of support.

A careful review of the literature has shown the following are causes or tiggers of addiction relapse: [3]

  1. Exposure to dosing
  2. Environmental cues associated with addiction
  3. Stress and emotion

The greater the risk, the higher the likelihood of relapse. Triggers can be both social and environmental, reminding you of a time or occasion that you used drugs or drank alcohol.

Social cues involve seeing friends or family consuming the substance in question, or you may be surrounded by environmental cues such as places you associate with addiction. Triggers can quickly lead to intense cravings. [4]

Stress is one of the biggest factors contributing to relapse. Stress and interpersonal conflict have immensely power and often negatively affect those in recovery from addiction.

Stress, along with lacking the ability to cope with stress, produces negative emotions such as anxiety, anger, and depression. Stress has been scientifically linked to cravings, leading to strong and powerful urges to drink or use drugs. [5] [6] [7]

Evidence suggests that the neurological circuits in the brain that are involved in stress tend to overlap with the brain’s reward system that remains in action during addiction. [8]

Types and Stages of Addiction Relapse

sleeping

A traditional relapse is defined as a conscious decision to drink alcohol or use drugs following the decision to stop or receive addiction treatment.

A ‘freelapse’ happens when someone relapses by accident, unintentionally using drugs or drinking alcohol by mistake. Accidentally drinking an alcoholic drink when asking for a non-alcoholic drink is common, taking drugs by accident is less common.

There are three stages of relapse. The first stage is called the emotional relapse stage, which starts with the first thought of drinking or using drugs.

This usually begins when someone is having difficulty coping with the rollercoaster of emotions that accompany treatment and sobriety.

These feelings lead to:

  • Denial, specifically that the person has a problem with alcohol or drugs
  • Social isolation
  • Self-doubt and fear of judgment
  • Emotional avoidance

This is quickly followed by the mental relapse stage; this is where someone becomes fully aware of the mental conflict they are suffering from. This involves a constant internal battle between staying sober and holding off cravings.

Those in this stage are constantly thinking about different ways to relapse and often how to do this in secret.

This may involve changing history; to start using again, some people tend to glorify their addiction history, or talk about how they ‘didn’t have a problem’, or ‘it wasn’t that bad’.

Those in the mental relapse ways educate themselves on ways to minimise the consequences of relapse and think about ways to get high or drunk ‘just the once’.

The last stage of relapse is the physical stage. This is the physical and actual use of drugs or alcohol. This can quickly lead to a total lack of control. [9]

For many patients, the feeling of shame and guilt associated with relapse is enough to force them to relieve these feelings by starting to use drugs or drink again. This chain of events is the cycle of addiction, notoriously difficult to break out of.

Warnings Signs: What Does Relapse Look Like?

A man turning away

Maintaining sobriety is challenging, and relapse will always be on the minds of patients. The potential for relapse will always be there, but how much of a risk the relapse becomes is dependent on self-sufficiency, coping mechanisms, and treatment.

Knowing the warning signs of impending relapse can help you prevent it, as well as educate yourself on your personal triggers. The NIDA (National Institute of Drug Abuse) states that any person recovering from addiction is likely to relapse at least once during their recovery journey.

However, relapse can be life-threatening for someone who abused substances for a long period and has been sober for a long period too. Sobriety decreases tolerance to substances, so taking or consuming the same amount as they did at the peak of addiction is likely to risk their lives.

The biggest warning sign is romanticising addiction. As soon as a patient in recovery changes the way they think about addiction, believing it to be positive rather than negative, relapse becomes highly likely.

Reliving addiction in a different light ignores the negative consequences that accompany using. This will trigger the first mental stage of relapse, followed by the physical relapse.

Addiction should not be thought of in a positive way; addiction does more harm than it does good, and it will remain a chronic brain condition. It is not possible for an individual to use drugs casually, or drink on social occasions, regardless of the techniques they have learned in therapy.

Once the brain is wired toward addiction, old habits die hard. It is a sign of relapse if someone begins to talk about casual consumption, as this is a sign of mental relapse.

Someone’s behaviour will be a telling warning sign. It is evidence of a preceded relapse if the individual becomes socially isolated and starts to avoid their treatment options.

If this person starts to voice their doubts about recovery and their treatment process, then it is highly likely they have fallen into mental relapse already.

Relapse Prevention Techniques

Beer

There are four pillars to relapse prevention. Relapse happens gradually with clear and defined stages. The goal of addiction treatment is to identify the early stages of relapse and uncover the best ways for the individual to prevent it. [10]

This is a personal journey for all patients, whilst each stage of recovery marks a developmental milestone, each stage also represents a risk of relapse.

To treat these risks, patients are urged to use relapse prevention tools to target negative thoughts and to help develop healthy coping mechanisms. This helps address the mental urges that accompany the thoughts during the mental relapse phase.

If this is tackled quickly, the risk of relapse decreases. [11] [12]

Cognitive behavioural therapy has been clinically proven to change people’s negative thought patterns, therefore improving behaviour. [13] [14]

Some of the thoughts that treatment can work on are: [15]

  • It’s not my problem
  • I can’t handle my life without it
  • I can use it socially
  • Life isn’t fun without it
  • I’m turning into someone I don’t like
  • I can’t stop my friends from doing it and I can’t change my friends
  • I have abandoned my family
  • Recovery is too much-wasted effort
  • I won’t be able to stay sober
  • I never manage to finish anything

Cognitive therapy aims to break these thought cycles and seek out the root cause of negative behaviour. The thoughts stated above often lead to feelings of anger, depression, anxiety, shame, and negative self-labelling, all putting someone at a higher risk of relapse.

To help return the brains circuits to healthier thoughts, cognitive behavioural therapy aims to do the following:

  • Prove that recovery is about coping skills, not willpower or weakness
  • Help to avoid romanticising addiction and redefine ‘fun’
  • Help patients learn from setbacks and set different boundaries
  • Help the patients face their fears and be self-sufficient

Any attempts patients make towards healthier choices, negative thoughts can quickly undermine these efforts. Addressing destructive and negative beliefs will change someone’s behaviour.

If you are struggling with mental urges, and find yourself in the first stage of relapse, talk to someone. Chat with a loved one or professional about your cravings and thoughts to help bring rational thoughts and realistic outcomes back into the conversation.

If you find yourself changing history and romanticising addiction, do what is called ‘playing the tape through’. Talk to people who were around you when you were in active addiction and discuss the negative consequences it had on you and everyone around you.

If you have photos of yourself, look back at what addiction did to you, mentally and physically. This will remind you of why you wanted to become sober in the first place, and how far you have come.

If the urges become overpowering, think about returning to inpatient or outpatient treatment and revisit where your journey of sobriety started. Sometimes this is enough to prevent relapse, as the patient wants to stay on the path to recovery but just needed more support.

This shows the important role that support plays in addiction recovery. If family and close loved ones educate themselves on recovery and relapse, they can look for early warning signs and monitor their loved one in recovery.

What If I Have Just Relapsed?

Woman talking on a mobile phone, sat down on floor outside

If relapse occurs, it is important to act quickly. Relapsing is a learning process and a known part of recovery. If you have just relapsed, there are numerous things you can do and practice to help get you back on track.

The first thing to avoid is self-hatred. No matter how good and steady your course of recovery was, relapse is always a risk. Just because you have relapsed does not mean all your hard work is ‘out the window’, or that you will never be able to overcome the urges.

Use the relapse as part of the process, learn from what has gone wrong and what triggers you. This can help clarify and modify your future relapse prevention plan as you have found your biggest trigger(s).

Once you have found the cause of the relapse, you will be able to put stronger prevention plans in place in the future.

Relapse can also show people where you are mentally, and how they might be able to help you in the future. This enables you to find new and more effective ways of coping with difficult thoughts and cravings.

What to do after a relapse depends entirely on its severity and your mental state. It is your decision whether you tell someone, but there are massive benefits to talking about it.

However, a relapse, whilst not a personal failure, is still serious. Do not ignore a relapse as it may lead to falling back into addiction and serious health problems.

Prompt and immediate action is always the best way to address an addiction relapse – recognise it as a relapse and identify the causes and the safeguarding to be put in place following the setback. Try to recraft your relapse prevention plan; use the help of those around you to ensure that it does not happen again.

This will not guarantee that you won’t relapse, but it will be your best chance of a successful recovery.

The following are the steps you should think about after you have relapsed:

  1. Reach out and ask for help. This can involve talking to loved ones or seeking the support of your therapist. Talking about feelings and why it happened will remind you that you are not on this journey alone.
  2. Attend self-help and group therapy sessions. Groups such as Alcoholics Anonymous and Narcotics Anonymous are 12-step group recovery sessions, designed for mutual support. These therapy sessions provide a safe and secure environment to discuss past and present feelings and stories. This provides patients with the best opportunity to learn from each other’s mistakes and setbacks.
  3. Know and avoid your triggers. Therapy will help you identify what set off your relapse but avoiding these straight after relapse will help reduce the likelihood of it happening again. If these triggers cannot be avoided for whatever reason, aim to minimise or reduce contact with whatever caused the last relapse.
  4. Set boundaries to protect yourself. Weak and loose boundaries are not protective, but instead lead to negative emotions and exposure to triggers. The emotions connected with loose boundaries are anger, sadness, stress, and anxiety. As previously mentioned, emotions are a slippery slope to relapsing if not dealt with properly.
  5. Take care of yourself. Engaging in self-care both mentally and physically after a relapse is crucial. Self-care such as yoga, exercise, reading, and eating healthily can dramatically change your mood, reducing the negative emotions that can trigger a relapse. Reflecting after your relapse, to view it as an experience rather than a failure, can help you do things differently in the future.

A proper and revised relapse plan will help you stay sober following a relapse. Write or journal about the experience, and what triggered the relapse. Write this plan in detail and include the coping mechanisms that haven’t worked for you, but also include the ones you are going to test out in the future.

Try and list your support and contacts, this may be individual people or self-help groups.

Relapse does not mean that treatment has failed; relapse is merely an indicator that you require more treatment or a different treatment. Treatment has different levels and different forms of care, but the same one does not work for everyone.

Reach out and talk to previous treatment providers to discuss what worked and what didn’t, and tailor your future plan to this. If you have seriously relapsed, consider a detox or medical detox, followed by behavioural therapy.

The recovery process is not linear, as addictive behaviours and mental health are difficult to control. However, addiction is a chronic disease, so there are different treatment options and recovery plans available to everyone.

The rate of relapse and whether you lapse into a full-blown relapse will depend on the person and the circumstance, but it is not a sign of failure.

Alcohol addiction and substance use disorders will include high-risk situations, but there is a recovery path for everyone. This might be a long-term process, but it is worth it in the long run.

Watch for the signs of relapse, including emotional relapse, mental relapse, and physical relapse. Aim to avoid or minimise triggers and reach out to people for help.

The earlier you intervene, the better your chances are of staying sober.

References

[1] Parks GA, Marlatt GA. Chapter 6: Relapse prevention therapy. In The Essentials Handbook of Treatment and Prevention of Alcohol Problems. Heather N, Stockwell T. (Eds.). Wiley; 2003.

[2] O’Brien CP, McLellan AT. Myths about the treatment of addiction. Lancet. 1996 Jan 27;347(8996):237–240.

[3] Shalev U, Grimm JW, Shaham Y. Neurobiology of relapse to heroin and cocaine seeking: a review. Pharmacol Rev. 2002 Mar;54(1):1–42.

[4] Moos, R.H. & Moos, B.S. (2006). Rates and predictors of relapse after natural and treated remission from alcohol use disordersAddiction101(2), 212–222.

[5] Mohammadpoorasl, A., Fakhari, A., Akbari, H., Karimi, F., Arshadi Bostanabad, M., Rostami, F., & Hajizadeh, M. (2012). Addiction relapse and its predictors: A prospective studyJournal of Addiction Research & Therapy3(1), 1–3.

[6] Sinha R. How does stress increase risk of drug abuse and relapse? Psychopharmacology (Berlin) 2001;158(4):343–359

[7] Cooney NL, Litt MD, Cooney JL, et al. Alcohol and tobacco cessation in alcohol-dependent smokers: Analysis of real-time reports. Psychology of Addictive Behaviors. 2007;21(3):277–286.

[8] Sinha R. How does stress increase risk of drug abuse and relapse? Psychopharmacology (Berlin) 2001;158(4):343–

[9] Melemis, S.M. (2015). Relapse prevention and the five rules of recoveryThe Yale Journal of Biology and Medicine88(3), 325–332.

[10] Gorski T, Miller M. Staying Sober: A Guide for Relapse Prevention. Independence, MO: Independence Press; 1986.

[11] Brown S. Treating the Alcoholic: A Developmental Model of Recovery. New York: Wiley; 1985.

[12] Marlatt GA, George WH. Relapse prevention: introduction and overview of the model. Br J Addict. 1984;79(3):261–273.

[13] Beck AT, Wright FD, Newman CF, Liese BS. Cognitive Therapy of Substance Abuse. New York: Guilford Press; 1993.

[14] Connors GJ, Longabaugh R, Miller WR. Looking forward and back to relapse: implications for research and practice. Addiction. 1996;91 Suppl:S191–S196.

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