Relapse After Recovery

In addiction, relapse occurs when a person resumes drug or alcohol use after a period of sobriety. Relapse usually results from a mix of psychological, physical, and environmental triggers. While it is a common part of the recovery process, it can lead to dangerous behaviors that may harm both the relapsing individual and their loved ones.

Recovery is about more than not using drugs or alcohol. It's about creating a lifestyle that can help a person maintain their recovery goals. Part of the recovery process includes talking about relapse, and learning healthier ways to cope with triggers that can lead to it.

Read more to learn about types and stages of relapse in addiction, as well as relapse prevention strategies.

What Is a Relapse?

Substance abuse relapse occurs when a person who has attempted to stop using a substance begins to use it again. Relapse can occur very soon after attempting sobriety, or after several years of sustained sobriety.

Relapse requires a conscious decision to abandon the recovery process. But the decision is often motivated by triggers that can be very difficult for a person to cope with, such as:

• Psychological triggers, like loneliness, sadness, anger, poor coping skills, boredom, or stress
• Physical triggers, like physical illness or injury, drug dependence, post-surgical distress, or withdrawal symptoms
• Environmental triggers, like peer influence, family conflict, unemployment, money problems, or divorce

Another form of relapse is a "lapse." A person lapsing may have one or two drinks then return to sobriety. This, too, requires a conscious decision to abandon recovery. While it is more controlled and brief than a full relapse, a series of lapses can easily progress to relapse.

Less well-known is a "freelapse," which occurs when a person unintentionally becomes intoxicated. Examples of unintentional intoxication include:

• Intoxication due to anesthesia for a surgery or medical procedure
• Accidentally inhaling fumes from an intoxicating substance
• Accidentally eating or drinking something that contains an intoxicating substance

How Common Is Relapse?

No one is perfect, and managing addiction is challenging. For many, relapse is an unfortunate part of recovery. In fact, between 40% to 60% of people with a substance use disorder relapse at some point in their recovery journey.

According to a review of relapse prevention, lapse and relapse are particularly common within the first year of seeking treatment. Treatment for addiction can help clients work through a relapse and begin taking active steps to change their behavior. 

Why Does a Relapse Happen?

Addiction is a disease that causes imbalances in the brain's neurotransmitter (chemical messenger) systems. Affected neurotransmitter systems include the serotonin, opioid, and dopamine systems.

These imbalances affect brain processes that are responsible for:

• Motivation and reward
• Decision making
• The ability to experience emotion (affect)
• Stress responses

When an addicted person acts on their craving, a surge of neurotransmitters causes them to feel pleasure.

One such neurotransmitter, dopamine, reinforces the connection between drug use, pleasure, and any external triggers that remind the user of the substance. Over time, these dopamine surges teach the brain to seek the drug or alcohol any time the user encounters a trigger.

As a result of these brain changes, a person experiencing drug or alcohol dependence will have a particularly difficult time maintaining sobriety—especially when faced with a psychological, physical, or emotional trigger.

Stages of Relapse

Relapse is a gradual process. It can begin with an emotional relapse, followed by mental and then physical relapses. Awareness of thoughts, feelings, and behaviors can be indicators of where someone is and what they may need regarding recovery. 

A relapse may look different for each person, depending on how much they use and the circumstances surrounding the relapse.

Emotional Relapse

During this stage, a person may not be thinking about using drugs or alcohol, but their emotions may be placing them in jeopardy of relapse.

During an emotional relapse, a person can experience:

• Feelings of denial
• Isolation
• Low motivation to take care of oneself
• Not attending treatment
• Poor eating and sleeping habits

If a person is in therapy during emotional relapse, the focus of therapy may pivot towards reinforcing the importance of self-care. Learning various acronyms can help a person identify when they need to improve their self-care, such as HALT (Hungry, Angry, Lonely, Tired).

Focusing on emotional wellness each day reduces restlessness, irritability, and discontent, which can build up over time and lead to relapse.

Mental Relapse

Cravings are a normal part of recovery. But failure to cope with cravings and other mental stressors can result in a need to "escape" through relapse.

In addition to cravings, signs of a mental relapse include:

• Finding opportunities to use
• Thinking about people, places, or experiences associated with past use
• Glamorizing past use
• Downplaying consequences from past use
• Bargaining, for example, by convincing oneself it is okay to use on special occasions
• Being dishonest about thoughts and feelings

At this stage, working toward avoiding triggers or high-risk situations in which relapse could occur is critical. Therapy may focus on identifying high-risk situations and learning ways to avoid them. It may also involve normalizing occasional thoughts and relapse, and learning methods to let go of them quickly.

Physical Relapse

Physical relapse occurs when a person starts using again. Once this happens, it may not be easy to control behavior or stop using.

Some relapses start with lapses that become more prolonged or frequent until the individual returns to uncontrolled substance use.

Most physical relapses are considered relapses of opportunity, meaning that they occur when an individual feels they will not get caught.

Upon relapse, some individuals may require inpatient treatment to stop using and manage symptoms of withdrawal.

Risk Factors for Relapse

There are several factors that can increase the likelihood of relapse, including:

• Stress
• Exposure to triggers
• Peer pressure or being around people who use the substance
• Interpersonal problems
• Pain
• Lack of support
• Boredom
• Low self-efficacy
  

Self-efficacy refers to a person's confidence in their own ability to achieve something. When a person's self-efficacy is low, they may have a hard time believing in their ability to maintain sobriety.

Research shows that social support indicates long-term success, while peer pressure and unsupportive relationships can lead to relapse.

Dangers of Relapse

The following factors make the risk of overdose especially dangerous:

• History of overdose: A person who has overdosed before has a higher risk of overdosing again. Some factors that can increase risk are tolerance, mixing substances, or the quality of drugs.
• Opioid use: A relapse with opioids can be dangerous because these drugs slow a person's breathing, placing them at a higher risk of overdosing or leading to death.
• Lack of access to health care: Lack of access to health care means a person may be unable to get the treatment they require when an overdose occurs, or to manage symptoms of dependency and withdrawal.
  

Relapse Is Not a Failure

A person may feel defeated when they relapse. It can bring on feelings of shame, frustration, and often cause someone to feel as if they are incapable of changing their behavior or achieving their goals. 

Viewing relapse as a failure is one perspective. However, relapse can be an opportunity to reset, develop clear needs and goals, and continue. Relapse should always be taken seriously. Refocusing on recovery and further relapse prevention with a care team is crucial.

Relapse Prevention

Relapse prevention is a vital aspect of recovery and incorporates a host of strategies, including: 

• Lifestyle changes: Establishing a routine with regular sleep, exercising, managing stress, and implementing relaxation techniques can help.
• Cognitive and family therapy interventions: Through cognitive and family therapy interventions, individuals evaluate how they view themselves, their addictive behaviors, and recovery. Additionally, they can learn skills, find support, and identify ways to navigate familial and interpersonal relationships.
• Making a relapse prevention plan: Creating a relapse prevention plan allows people to recognize triggers and high-risk situations, explore lifestyle changes, and gain coping skills to deal with thoughts, emotions, and cravings.
  

Summary

Relapse is a return to a state of substance use. It often begins with a person's emotional and cognitive state. A relapse doesn't mean failure. Instead, it can be an opportunity to examine what lifestyle changes, coping skills, and adjustments may be needed to prevent relapse in the future.