Relapse: What Is It & When to Seek Help

What is a Relapse?

The National Cancer Institute defines a relapse as “the return of a disease or the signs and symptoms of a disease after a period of improvement.” Relapse is common with a range of chronic diseases, such as diabetes and heart disease. It’s also incredibly common with substance use disorders (SUD).[1]

When related to addiction, a relapse usually refers specifically to a person engaging in at least semi-consistent substance use after a period of drug abstinence while in recovery. In essence, a relapse means a person has re-entered a period in their recovery journey where they find it difficult to resist drugs or alcohol long enough to stay reliably sober. 

The severity of a relapse can vary, with some people relapsing to a rate of drug use similar or worse than before they began recovery. Others relapse to a rate of drug use that is problematic but less than they were engaging in before beginning the recovery process. 

Are Relapses a Normal Part of Recovery?

Yes, relapse can be a normal part of the recovery process. This is because substance addiction is considered a chronic, relapsing disease, with similar relapse rates to medical conditions like diabetes and hypertension. [2] Much like recovery, relapse is a process that someone goes through—emotional, mental, and finally physical relapse—and is not a single event.

Addiction has a relapse rate of between 40% and 60%, which is similar to the relapse rates for hypertension, diabetes, and asthma.

[2]

While some people quit using drugs and alcohol and never experience a slip or relapse, other people may relapse once or several times before achieving sustained recovery. Instead of viewing relapse as a failure, it’s important to view it as a potential step in the long-term recovery journey. It’s a vital step because a relapse provides the person and their treatment team with information about their needs. Maybe they were in an outpatient treatment program and need more intensive treatment like partial hospitalization or inpatient rehab.

If a relapse does occur, it should be taken seriously. Most often, connecting with an addiction treatment professional as soon as possible can help to regain control and stop further drug use. 

Recognizing the Warning Signs of a Relapse

Many of the signs of drug abuse can also signal a person has relapsed. [4] Others might overlap with the emotional, mental, and physical stages of relapse or triggers. For example, depression and isolation can be signs of relapse and also triggers. These are some of the warning signs: [4]

• Changes to appearance, such as changes to pupil size, smell, and weight
• Changes to the people one associates with, their favorite hangouts, and hobbies
• Increased engagement in risky behaviors
• Amplified feelings of paranoia and suspicion 
• Legal trouble, including legal trouble seemingly unrelated to drug use
• Neglecting important responsibilities, even to the detriment of one’s own life and the lives of their loved ones
• Unexplained changes to mood, personality, or attitude
• Spending time with people associated with past substance use
• Spending time in places associated with past use
• Not going to support group meetings
• Depression
• Isolation

Sometimes, a person’s relapse will be obvious. They may even be willing to talk about it, which is generally a healthier way of dealing with a relapse than hiding it. 

No matter what, it’s essential to approach relapses with care and compassion. Don’t blame or judge the person. Instead, approach them with empathy and a desire to help. If you intend to talk to them about their drug use, make sure to research the realities of the drug you think they’re using and the best ways to combat addiction.

If you are the person who has relapsed, reach out for help immediately. Call your therapist, doctor, or treatment program to reinitiate care. If you have a sponsor, call them and begin returning to meetings as soon as possible.

Triggers and Risk Factors for Relapse

There are many factors and influences that can trigger a relapse, such as:

• Depression
• Stress
• Exhaustion
• Social isolation
• Major life changes, such as divorce or job loss
• Interpersonal issues, such as family conflict
• Being around people drinking or using drugs
• Being in a setting in which the person used to use substances
• Peer pressure
• Negative feelings or challenging emotions
• Times of celebration
• Cravings

Additionally, undiagnosed or untreated co-occurring mental health disorders, such as depression, anxiety, bipolar disorder, and posttraumatic stress disorder (PTSD), can increase a person’s risk of relapse. [5] This is because they may be experiencing significant mood swings, negative emotional states, and suicidality, and without proper treatment and coping skills, they may return to drug use to relieve these symptoms.

How to Deal with Triggers and Stressors

If you are experiencing relapse triggers and want to reduce your risk of returning to substance use, you’ll want to have a relapse prevention plan in place. This plan will include strategies that you know work for you and can help you through hard times and get back on track. Here are some examples of components of relapse prevention plans:

• Mindfulness and meditation
• Yoga
• Gratitude practice
• Journaling
• Exercising regularly
• Eating a balanced, healthy diet
• Using a calendar or app to manage time
• Distractions, such as listening to music or reading a book
• Attend therapy regularly
• Attend support group meetings
• Positive self-talk
• Relaxation and breathing techniques
• Have a plan and support person before going into high-risk situations

Relapse vs. Slip

While the line between a relapse and a slip isn’t always well-defined, there is a significant difference between the two. 

Defining a Slip or Lapse

A slip, also known as a lapse, refers to when a person temporarily engages in any kind of harmful drug use after a period of sobriety. It is generally a one-time use of a substance. It may occur due to especially strong drug cravings or being in similar circumstances to those that initially drove the person to drug use. [6]

With a slip, the person still feels mostly in control after their drug use. Then, they continue to avoid drugs after using once or after a brief period of drug use. While having a slip isn’t ideal, especially if a person engages in particularly heavy drug use, it doesn’t necessarily significantly impact recovery. [6]

An example of a lapse might be if someone in recovery has a glass of wine at a holiday party but after that, returns to abstinence.

Defining a Relapse

Relapsing is different, and it signals a person re-entering a period of drug use where they have lost control. While similar circumstances can lead to a relapse and a slip, a relapse isn’t necessarily temporary—it may be characterized by sustained substance use. It often requires that a person re-engage in many (although not necessarily all) of the steps they initially took to regain control over their drug use and stop using. [7]

An example of a relapse might involve a person coping with a difficult circumstance, such as a death in the family, by returning to drug use that is ongoing. They may return to the amount they were using before they quit and they may feel like they are back in the throes of addiction.

At the very least, a relapse usually requires a person to talk with a drug treatment professional and possibly go through detox again if they want to stop using drugs. 

Identifying the Stages of Relapse

Generally, relapse is thought of as a process occurring in three stages: emotional, mental, and physical relapse.

Emotional Relapse

Emotional relapse is the first phase of relapse. During this stage, the individual hasn’t returned to substance use yet and they aren’t thinking about using alcohol or drugs. However, their emotions, moods, and behaviors may be setting them up for an eventual physical relapse.

Some signs of an emotional relapse may include:

• Denial
• Isolation
• Mood swings
• Not enjoying sober life
• Failing to attend support group meetings
• Poor sleeping and eating habits
• Failing to manage stressors in a healthy way
• Poor self-care

Mental Relapse

Mental relapse, which is the second stage of relapse, is characterized by an inner battle. One part of the person may want to use drugs and alcohol while the other wants to remain abstinent. Many people may fantasize about abusing substances during this phase.

Some warning signs someone has progressed to mental relapse include:

• Planning a physical relapse
• Thinking about using substances
• Imagining how they will control drug or alcohol use
• Spending time with people who use drugs
• Minimizing past consequences of substance abuse
• Cravings

Physical Relapse

The third and final stage of relapse is physical relapse, which involves a return to drug or alcohol abuse. This tends to happen if someone fails to make changes during the emotional or mental relapse phase, such as attending support groups, going to therapy, or consulting with a sponsor.

Understanding the Physiological and Psychological Dynamics of Relapse

Relapse is a complex process influenced by many important changes in the brain. One of the most influential mechanisms behind relapse is that of conditioning and learning.[8] Chronic drug use creates a relationship between the substance use itself and the environmental stimuli associated with it, such as:

• Bars
• Friends’ houses
• Paraphernalia
• Friends who use
• Songs or films associated with past drug use
• Meeting places to buy drugs

The brain learns that these stimuli are connected to substance use and a rush of the pleasure neurotransmitter, dopamine. And because of this connection, you may experience cravings to use when you experience environmental triggers, despite long-term abstinence.[8]

Another neurochemical mechanism underlying relapse is the fact that long-term substance use can increase a person’s sensitivity to the effects of stressors, making it harder to effectively manage them without returning to drug use.[8]

However, despite these drug-related cues and triggers, you can still live a life of recovery. One of the best ways to reduce these triggers is to avoid the settings and people associated with alcohol and drug use. If it’s unavoidable, find a support person and prepare yourself ahead of time by creating an exit strategy and practicing coping skills.

Immediate Steps Following a Relapse

Relapsing can be incredibly stressful and disheartening. After working hard to stop using drugs, a relapse can feel like some kind of failure and like your progress has been reset. 

It’s important to understand that relapsing, while not ideal, isn’t shameful. Addiction is a chronic disease, and it isn’t easy to learn how to manage it. Think of relapse as more of a setback or important information about your recovery process.

A relapse also doesn’t mean all your progress in recovery is reset. The same techniques you learned talking to treatment professionals and in counseling sessions can still help you. The main goal in the short term is to regain control, so you can continue with your addiction treatment plan. 

If you have experienced a relapse to substance use, follow these steps:

1. Stop using drugs or alcohol, if you haven’t already.
2. Stop blaming or shaming yourself.
3. Take a step back and examine your behaviors and attitudes leading up to the relapse.
4. Identify the triggers that contributed to your relapse
5. Reach out to your support networks and an addiction professional

When you relapse, don’t treat it as an all-or-nothing scenario where there’s no point in resisting any of your cravings. The shorter your return to substance use, the less those drugs can affect your health and expose you to any associated risks, such as overdose. 

As soon as you can, talk to an addiction treatment professional about your relapse. Try to work with them to identify what may have caused it. They can help you implement further strategies to regain control over your drug use again and to continue on your path to recovery. Oftentimes, a relapse signifies that some aspect of the treatment plan should be tweaked.

Post-Relapse Treatment and Support Options

If you have experienced a relapse (as opposed to a lapse or slip), you may need addiction treatment services to help you get back on track and stop using substances. There are many post-relapse treatment and support options, such as:

• Inpatient rehab: You reside at the facility and receive 24/7 intensive care, structure, and support while you get back on track.
• Partial hospitalization: You continue living at home while attending up to 30 hours of care per week.
• Intensive outpatient: You live at home and attend between 9 and 20 hours of therapy each week.
• Outpatient treatment: You live at home and attend a few hours of therapy per week.
• Medication-assisted treatment (MAT): If you have an alcohol or opioid addiction and are not currently taking medication, you may want to consider MAT, which combines addiction medications and counseling.

A relapse typically indicates that you may need to adjust your treatment type or frequency. During this time, it can be beneficial to attend therapy more frequently than usual and to increase your support group attendance. You may even want to attend a meeting every day until you feel more stable.

Treatment Considerations

It’s important to understand that relapse and addiction recovery can vary across different cultures and demographics. Some populations like refugees or immigrants may have a mistrust of clinicians, which may cause them to avoid entering treatment when they need it. [9]

Moreover, some cultures view mental health disorders and addiction more negatively than the general U.S. population does, leading to stigma and avoiding necessary care. On the other hand, many providers are not culturally competent and don’t provide inclusive, knowledgeable care. [9]

These things need to be considered when finding diverse populations appropriate and compassionate addiction treatment, especially after a relapse.

The Role of CBT

Cognitive behavioral therapy (CBT) can help people who struggle with multiple relapses figure out what’s causing them and ultimately break the cycle.

CBT examines the connection between a person’s thoughts, feelings, and behaviors in order to create lasting behavioral change. How a person thinks can affect how they feel and behave, and vice versa is true too: how someone acts can affect their feelings and thoughts.

Because of this connection, relapse is often due to maladaptive or problematic patterns of thoughts and feelings. CBT can help people identify their cognitive and emotional patterns to help them maintain abstinent behaviors in the long run.

How to Support Someone After Relapse

Relationships play an essential role in helping individuals gain and maintain sobriety. And providing support when a loved one has relapsed can help them return to healthy behaviors.

Practice care when trying to help someone who has relapsed. They’re likely in a vulnerable and emotional state, as a relapse can be extremely stressful, especially if they felt in control of their drug use for a significant period of time. Now, they might be afraid that they’re going to fall back into full-blown addiction.

Before talking to them, do some research on drug use, addiction, the causes of relapse, and recovery. Try to come to them informed about the topic and with some useful treatment resources you can share with them if they’re willing to listen. 

If possible, talk to them in an environment where they’re comfortable. It’s usually best to talk to them individually, so they don’t feel like you’re engaging in some kind of attack or otherwise trying to ostracize them. 

Oftentimes, people relapse as a result of stressors in their lives. In some cases, these may be very serious events, such as the loss of someone they cared about, relationship troubles that can’t necessarily be repaired, or financial problems. [10]

What to Do

What you do will largely depend on your loved one’s perspective of their relapse and whether they think it’s a problem or not. Some people may think they have their substance use under control when they really don’t.

They Don’t Think It’s a Problem

For example, if your loved one doesn’t acknowledge it’s a problem, then gently express your love for them and desire to see them live a happy, healthy life. Also, let them know that they can share their feelings with you.

They Are Wavering

If they acknowledge the relapse is an issue but they aren’t sure if they want to enter treatment or stop using, you may want to discuss the pros and cons of abstinence with them and express confidence in their ability to stop using again.

They Want to Get Sober

Some people may be ready to abstain from substances again but are still in the preparation stage. In this case, you may want to help them create a plan for entering treatment, figure out finances and insurance, and address barriers like transportation or childcare issues.

They Are Ready for Change

Once they are ready to enter active recovery again, help them remove substances from the home, avoid people they used substances with, and carry out their plan. You will want to provide a lot of praise and empowerment during this time.

Ultimately, pushing someone toward sobriety when they aren’t ready isn’t likely to work and may cause defensiveness and isolation. It’s more important to meet your loved one where they are at.

Addressing the Emotional Aftermath of Relapse

People dealing with addiction and relapse often experience a lot of guilt and shame associated with their substance use. They may feel that they’ve let down their friends, family, sponsor, and themselves. And one or several relapses can compound this shame and cause recovering individuals to blame themselves and view themselves as failures.

In this way, many people get caught in the shame-addiction cycle, in which they continue misusing substances in order to cope with their profound guilt and shame—and then the drug and alcohol abuse causes more shame. It can be an inescapable cycle that leads to severe distress, low self-esteem, depression, and beyond.

However, breaking this cycle of guilt and shame can help you avoid additional relapses in the future. Here are some strategies and tips:

• Forgive yourself and accept that you are a complex and flawed human
• Let go of the negative self-talk and replace it with positive self-talk
• Don’t give up—relapse is common among those in recovery and it doesn’t mean you can’t return to active recovery
• Learn from your relapse by analyzing what led to the relapse
• Recommit to your recovery by returning to support groups, going to therapy, or entering rehab

How to Cope with a Loved One’s Relapse

Some tips and strategies for coping with your loved one’s relapse include:

• Attend talk therapy
• Attend support group meetings for families
• Attend family therapy
• Avoiding blaming yourself or believing there was more you could have done
• Get adequate sleep
• Exercise moderately
• Eat healthy meals
• Engage in relaxation techniques, such as taking a bath or meditating
• Socialize with loved ones
• Understand that relapsing can be a normal part of the recovery process

Creating a Comprehensive Relapse Prevention Plan

Once you stop using drugs and are ready to enter active recovery, you’ll want to create a comprehensive and tailored relapse prevention plan that addresses you and your specific needs. This plan will include your individualized information, coping skills that work for you, and direct action items.

Evaluate Your Substance Use History

First, evaluate your substance abuse history. You can guide your relapse prevention plan creation by asking yourself questions like:

• Are there specific people connected to your substance use?
• Are there specific settings or locations?
• Were there certain times you noticed you were more prone to use?
• What thoughts and feelings make you more likely to use drugs or alcohol?
• What triggers or stressors led to your relapse?

Brainstorm Relapse Scenarios and Warning Signs

After that, brainstorm a list of possible scenarios that could lead to a relapse, such as attending a birthday party or experiencing stress at work. Write down anything plausible and then list the warning signs of a relapse—especially those you’ve noticed in yourself.

Determine an Action Plan

Create and establish an action plan you can turn to when you are feeling tempted to relapse. This list should have actionable items and behaviors you can engage in instead of substance use.

For example, if family problems could lead to a relapse, consider other ways to manage your distress and emotions. List these strategies. They could include calling a friend, attending a meeting, playing a sport, or going for a walk. Be as specific as possible—name the people you would call, list the location of meetings, etc.

Embracing the Journey Post-Relapse

Relapse is not the end of active recovery or a happy, sober life. It may just be a step on the road to sustained recovery. You can’t control your past lapse or relapse but you can control how you respond to it and what you do moving forward. You have the power and insight to enter active recovery again.

Medically Reviewed By Dr. Alison Tarlow

Dr. Alison Tarlow is a Licensed Clinical Psychologist in the States of Florida and Pennsylvania, and a Certified Addictions Professional (CAP). She has been a practicing psychologist for over 15 years. Sh... Read More