A Guide to Addiction Relapse

Relapse is a normal part of the recovery process for many people. If it happens to you, a relapse can be a powerful learning experience that helps you prevent future relapses.

There’s often a negative perception that surrounds relapse. While no one wants to experience a relapse, it can be a normal part of the addiction recovery process. Thankfully, you can get back on track after a relapse happens. Getting back on track can look different for everyone, but it may mean recommitting to aftercare programs or returning to treatment. Sometimes, a relapse can indicate that the treatment plan needs to change or shift to meet current needs.

What Does It Mean to Relapse?

In medical terms, when someone relapses, it means their clinical condition worsens after a period of improvement. For example, a relapse can occur with a chronic illness like diabetes. Initially, a person’s diabetes might have been well-controlled with a treatment plan. Then, that plan may no longer work, so they relapse and begin to experience elevated blood sugar levels again.

In addiction treatment, relapse is when someone begins using a substance after a period of abstinence. A relapse can occur after a few weeks of abstinence or after years. Anywhere from 40–60% of people with addictions are estimated to relapse at some point. Anyone with a substance use disorder may be at risk of relapse.

Alcohol Relapse

Research shows 65–70% of people with alcohol dependence relapse within one year of abstinence. The risk is especially high in the first three months. With long-term sobriety, these relapse rates do tend to decrease, but this underscores the importance of proper aftercare and follow-up once someone receives treatment.

Drug Relapse

Opioids tend to have the highest relapse rates and are the most difficult to stop using for many people. Some research puts relapse rates for opioids at 91% in the first year. More than half of people with stimulant use disorders relapse within a year of treatment. An additional 25% relapse two to five years after treatment.

What Is the Difference Between a Slip, a Lapse, and a Relapse?

People may use the terms “slip,” “lapse” and relapse interchangeably, but there are differences between these three.

A slip is characterized by a single instance of using a substance after a person has entered recovery. Someone who has slipped has usually done so because they couldn’t manage their internal dialogue about using, and it tricked them into thinking they could use in moderation.

During a slip, a person remembers why they started recovery and quickly realizes they made the wrong decision. Often, a slip can lead to a strengthened determination to stay sober afterward because they have been reminded of a life they no longer wish to live.

A lapse is multiple uses of a substance. In contrast to a slip, a person uses the substance more than once in a lapse. However, the person has not fully returned to their previous pattern of substance abuse.

In a full-blown relapse episode, the person returns to their previous patterns of substance abuse. In a relapse, the person forgoes their recovery completely. Quite simply, relapsing means they continue to abuse alcohol or drugs for an extended length of time regardless of the consequences.

Does Relapse Mean Failure?

Relapse doesn’t mean that the person is a failure, nor does it mean treatment was a failure. It can feel like a failure, but relapse is part of the recovery process for many people. When someone experiences a relapse, they may need a modified treatment plan and additional supportive services. Reasons relapse isn’t a failure include:

Addiction is chronic disease and relapse is a part of its course. Research and scientific evidence show addiction is a brain disease, and it weakens the ability to experience pleasure and motivation. Addiction also affects the stress response and causes cravings;when those cravings aren’t met, it leads to negative emotions and side effects.

Many people with other chronic illnesses experience relapse as part of their recovery process. In fact, the relapse rate for addiction is similar to other illnesses like high blood pressure and asthma.

Being in recovery isn’t a one-time event. Instead, it’s a journey and process that continues throughout a person’s life. There’s not a point in time in which someone with an addiction is suddenly cured. They’re always working on their recovery.

Types of Relapse

A relapse can be categorized in two general ways — a traditional relapse or a “freelapse.” A traditional relapse occurs when someone consciously decides to return to using drugs or alcohol. For example, someone might feel they’re okay to have a glass of wine because they can handle it. With a “freelapse,” someone accidentally and unintentionally relapses. In this scenario, a person might drink something they’re given without realizing it’s alcohol.

The Stages of Relapse

Relapse isn’t a sudden occurrence. Instead, it tends to occur in stages or phases. By recognizing the earlier phases of relapse, it’s possible to take steps to prevent later steps from occurring. These stages include:

• Emotional relapse: the person isn’t actively thinking about returning to using drugs or alcohol. Instead, their behaviors and emotions might set the stage for a relapse later. Warning signs include not attending recovery meetings, isolation, poor eating and sleeping habits or not practicing self-care.
• Mental relapse: not working on the symptoms of emotional relapse puts a person at greater risk of moving onto this stage. During a mental relapse, someone might think about using drugs or alcohol. A person could have cravings to use or start reminiscing about the people, places, and things they associate with their substance use. Minimizing the consequences of their past use or glamorizing it can also happen during the second stage of relapse.
• Physical relapse: when someone uses drugs or alcohol. This phase may start with having one drink or using drugs one time. It can quickly become a full-blown relapse characterized by a complete lack of control.

What Causes Someone to Relapse?

While everyone is different, certain factors tend to be common triggers for relapse. These triggers include:

• Stress: Any time someone is experiencing high levels of stress in their recovery, they may be at a higher risk of relapsing. Relying on drugs or alcohol to deal with stress is a maladaptive coping strategy.
• Being around the wrong people or places: If a person in recovery returns to hanging out with the people they did when they were in active addiction or puts themselves in the same situations, it can increase the risk of relapse.
• Uncomfortable or challenging emotions: Problems dealing with difficult emotions may be why someone began using drugs or alcohol in the first place as a way to cope. Once they’re in recovery, they must learn how to “sit” with those difficult emotions, which is not easy.
• Objects that remind you of drug use: If you’re even around things that remind you of active addiction, like drinking in a bar or seeing drug use in a movie, it could trigger a relapse.
• Mental or physical health conditions: Addiction is very often a co-occurring disorder. Most people with a substance use disorder have at least one co-occurring mental or physical health condition. These conditions could lead someone to use drugs or alcohol as a way to self-medicate. If underlying mental and physical conditions aren’t properly treated, it will create a higher relapse risk.

Why Do People with Addictions Relapse When Things Are Good?

We tend to associate a relapse with negative situations and feelings. A loss or death can lead to a relapse, as can a stressful work or relationship situation. While relapse can stem from negative situations, positive things can also lead to relapse.

There are a few key reasons someone might relapse when things are going well.

• You may feel like things are going so well that you’re out of the woods with your recovery, and you can use drugs or alcohol without it leading to a full-blown addiction.
• Drugs and alcohol are associated with celebrations for some people. In our culture, we tend to think about celebrating with a drink or some other substance.
• When you’re feeling great, you might associate those feelings with the need to drink or use substances.

Risk of Overdose From Relapse

While relapse can be a part of recovery, returning to substance misuse after a period of sobriety has a high risk of overdose. When someone uses drugs or alcohol, they develop a tolerance. They use more and more to get the same effects as their body adjusts to the presence of the substance. Then, after a period of abstinence, their tolerance declines.

If someone relapses and uses the same amount of the substance they did before, without realizing their tolerance is lower, they are at a high risk of overdose.

Signs of Relapse

The onset of a slip, lapse, or relapse may begin with various warning signs. Some of the early signs of a potential relapse include:

• Cravings for the substance
• Thinking you can use it without becoming addicted again
• Romanticizing about using in a way that glamorizes the substance
• Withdrawing or isolating from people who have supported your recovery
• Putting yourself in triggering environments
• Stressful conditions or changes in behavior
• Stopping support groups or social relationships that foster recovery
• Displaying withdrawal symptoms
• Losing interest in hobbies or remaining active

What To Do After a Relapse

If you do relapse, don’t dwell on it. Instead, refocus your attention and consider what you will do moving forward. If you’re too hard on yourself, you’ll go deeper into your relapse and negative feelings. If you’re proactive, your relapse becomes a powerful learning experience and a critical part of your recovery process.

• Prepare yourself for difficult emotions: After a relapse, even if you can tell yourself it’s part of the process, you will feel powerful negative emotions. These emotions are a natural response. You may feel guilty, embarrassed or experience shame.
• Forgive yourself: Once you accept the negative emotions you’re feeling, forgive yourself. The recovery journey centers on forgiveness, including toward yourself.
• Refocus: After you’ve prepared yourself for hard emotions and made the conscious decision to forgive yourself, it’s time to move forward. How are you going to refocus your attention and efforts? What do you need to do to return to where you feel best?
• Decide if you need to go back to rehab: Depending on your situation, going back to treatment may be the right next step. If you just had a short slip, you might need to work through it in your 12-step meetings or with your therapist. If you went into a full-blown relapse, it could indicate your treatment plan needs to be tweaked or changed, and returning to rehab could be beneficial.
• Reach out to your support system: Don’t let shame prevent you from reaching out. You most need your support system during a relapse or right after.
• Seek professional help: Whether you go back to rehab or not, professional help can be key if you relapse. This may mean reconnecting with a therapist, or it could include a return to an inpatient rehab or an intensive outpatient program.

Addiction Recovery After Relapse

Following a relapse, you may feel like you’re returning to square one. That’s not necessarily true. You’ve done this once before, and that experience you have is something you can use going forward. For many people, the addiction recovery process after a relapse is significantly easier than their early recovery. Think about all of your knowledge and understanding at this point versus at the beginning of your recovery.

You know your triggers. You know what you can do when dealing with them, and you have experience. You know what works and doesn’t work in your recovery. You can also go into the situation with the empowering understanding that you’ve done this before and can do it again.

Relapse Prevention

Relapse prevention isn’t just avoiding drugs or alcohol. A relapse prevention plan serves as a blueprint for everything you do in your daily life to support your recovery.

• Create a relapse prevention plan. When you have a plan, it’s a critical tool in your recovery.
• Know your triggers. If you’ve already gone through the addiction recovery process, you may have a solid understanding of your triggers. A recent slip or relapse could have also helped uncover triggers you weren’t aware of. As you work to identify triggers, think about who you could see that would remind you of drug use and the addictive thoughts and places that might be triggering. You also want to identify feelings, negative and positive, that are linked to relapse.
• Join a support group. If you weren’t already part of a support group when you relapsed, or maybe you stopped attending meetings, commit to yourself that you’ll participate.
• Use mindfulness-based relapse prevention. Mindfulness-based relapse prevention or MBRP is a strategy focusing on the period after treatment when someone is most likely to relapse. The approach uses mindfulness to help manage urges that could be problematic for sobriety.
• Consider relapse prevention therapy. Relapse prevention therapy is a type of cognitive behavioral therapy. The goal of RPT is to help limit or avoid relapses by helping a participant anticipate situations that could lead to relapse.

How To Help a Friend’s Relapse

A friend’s relapse can be difficult for a person in recovery to manage. You may have spent many hours in rehab talking about your addictions and life, discovering what you have in common, and planning your sober future after rehab. Your friend has decided to give up on sobriety and continue using drugs or alcohol.

While it is never easy to deal with a friend’s relapse, handling this situation well while protecting your sobriety and needs is possible.

Challenging Friends’ Thinking About Relapse

Your initial reaction when friends relapse or say they want to relapse is to try to talk them out of it. It is worth trying to explain to your friend why using is a bad idea and encouraging them to resume treatment.

It is important to understand, however, that you are unlikely to convince your friend to return to sobriety in many if not most cases. Friends who persist in their relapse can cause significant emotional turmoil for their sober friends like you, as you watch them spiral downward even though they cannot see what they are doing to themselves.

.If your friend does not respond to your initial attempts to help them return to sobriety, it is important that you distance yourself for the sake of your own recovery. Remind yourself that your friend alone is ultimately in charge of their own life and choices. You cannot single-handedly save your friend, no matter how badly you may wish to do so.

Protecting Your Own Sobriety

Observing healthy boundaries is the first step to protecting your sobriety, but you may need to go further to ensure that you don’t go down the same path. Finding out about a friend’s relapse can bring up feelings, including the temptation to relapse yourself. Your friend may even pressure you to go back to using drugs or alcohol with them.

It is not wrong to distance yourself from your friend if you feel like being with them triggers your addiction and threatens to make you slip. Your friend may or may not understand your reasons for keeping them at arm’s length, but you should do whatever you need to keep yourself on the straight and narrow.

If you think you are still at risk of relapsing despite getting distance from your relapsing friend, you should get the help you need. This may include going back to treatment, counseling, or ongoing support programs that you thought you moved beyond. There is no such thing as a cure for addiction. Treatment only works as well as your efforts to make it work, including getting as much help as needed to stay sober.

Getting Help

If you or a loved one has relapsed or is displaying some of the warning signs, do not hesitate to take steps to get them help. Contact us today to understand your options for treating or preventing relapse. Our trained professionals are here to help get you or your loved one back on track.