There’s no denying it: Relapse — returning to drugs, alcohol or other addictive behaviors after a period of non-use —happens. And it happens often. Recovery is rarely a straight line. Like relapse rates for people with other chronic diseases like diabetes, hypertension and asthma, relapse in people with substance use disorders (SUD) happen at a rate of 40-60%.
And yet if we normalize it or act like relapse is inevitable, people who struggle with addiction are tempted to think that getting help isn’t urgent, even when all indicators point to the opposite. Consider the following:
- A significant portion of relapses occur early in recovery, with over 85% of relapse happening within one year post-treatment.
- Individuals with a history of alcohol addiction will encounter at least one relapse in their lifetime.
- Opioid use disorder (OUD) has particularly high relapse rates, with some estimates ranging from 65-70%, often in the 80-95% range within the first year.
In other words, how soon a person gets the addiction help they need, and the longer they stay in treatment and addiction recovery groups, diminishes the likelihood of relapse. Relapse costs people their families, their jobs, their freedom and even their lives. And contrary to many people’s understanding of the process, relapse doesn’t begin when you first use or drink after being sober. By the time that happens, the relapse has already begun.
What are the Three Stages of Relapse?
That’s why it’s important to understand that relapse happens in stages, not as a singular choice, event or action. It is a process, and there are definitive signs along the way. By recognizing the signs and stages of addiction relapse, we can be prepared to meet each phase, and hopefully, prevent it from happening.
Stage One: Emotional – This stage is characterized by emotional and behavioral changes that increase the risk of relapse. This stage happens at the intersection of vulnerability and discomfort, when stress and negative emotions go unregulated, leading the individual to try to numb them through self-medication. Potential signs in stage one, include:
- Changes in mood, increased anxiety, irritability, anger or depression
- Isolation, withdrawing from support systems and social activities
- Attending meetings but not engaging
- Poor self-care, neglecting healthy habits like eating, sleeping, bathing, etc.
- Avoiding expressing feelings or seeking help
- Focusing on others’ problems as a distraction from their own
- Denial, minimizing or ignoring emotional distress
Stage Two: Mental – This stage involves the mental battle between the desire to use and the desire or commitment to sobriety, during which physical cravings and obsessive thoughts of using become more frequent. Here, the lack of coping skills and disconnection from ongoing recovery activities create a destructive void. This stage is often characterized by:
- Fantasizing about or glamorizing past drug experiences
- Downplaying the negative consequence of using
- Lying to others about thoughts, feelings or behaviors
- Seeking out people and environments associated with past use
External factors like negative influences, socializing in triggering environments, boredom, loneliness, relational conflict and financial stress can all impact someone’s intellectual and mental capacity for ongoing sobriety. And ultimately, the curtain closes on this stage with actively thinking and planning how to obtain substances and use again.
Stage Three: Physical – The final stage of relapse where the individual acts on their emotions, feelings and cravings, and returns to the use of the previously abused substance. Feelings of guilt, shame and hopelessness often accompany the return. But it’s important to remember that a singular, one-time use, or lapse, does not have to turn into a full relapse. A hiccup is not full-blown asphyxiation. You can still course correct. Reaching out for help immediately after a lapse may well prevent full relapse and interrupt the rapid return to previous levels of substance misuse.
These stages and the addiction symptoms associated with each are indicators that your recovery is at risk. Other psychosocial risk factors include:
- The person’s belief in their ability to control their substance use
- The person’s belief that substance use brings positive effects
- Lack of motivation or ambivalence toward positive change
- Lack of adaptive coping skills, especially in high-risk situations
- Inadequate social and emotional support
And while the risk of relapse diminishes over time and with ongoing addiction treatment and support, there is always a risk, no matter how long you are sober. That’s why it’s important to stay active and grow in your recovery. Every day.
Your Game Plan for Ongoing Recovery
Relapse is common on the recovery path, so a relapse prevention plan is the best way to achieve success. Recovery requires developing new skills and learning to adapt when life comes at you with hard stuff. Here are five effective relapse prevention strategies that will equip you for long-term sobriety:
One: Success Is Asking for Help … Repeatedly
Since recovery is an ongoing, life-long process — and for most people, relapse is part of that process — it’s important to redefine success. Relapse may feel like a failure, but it doesn’t mean that everything you’ve learned, every effort you made before you took that step backward, is a complete loss. Just like completely abstaining from using alcohol or drugs while still engaging in behaviors or relationships that trigger you doesn’t mean your recovery is going great. An “all or nothing” mentality is detrimental to your growth. One step back doesn’t mean you can’t learn from it and grow forward. In fact, research indicates that ongoing participation in an addiction recovery group or 12-Step program results in higher rates of abstinence. “Success is asking for help,” according to Dr. Timothy B. Walsh, Vice President of Minnesota Adult and Teen Challenge. If you’re still showing up at meetings, if you’re still engaged in counseling, if you’re still reaching out to people you trust when you need support, that is the very definition of success.
Two: Keeping Score
To know better is to do better. To know better requires those of us in recovery to live with greater intention. To plan and learn and think and grow … and leave little to chance. That’s where daily journaling comes in. It helps you explore emotions, identify triggers, track progress and reflect on experiences. Use journaling to process difficult feelings, reinforce positive changes and gain self-awareness.
Dr. Timothy Walsh recommends keeping a daily recovery inventory, answering the following questions:
- What has been done to me?
- What have I done to myself and others?
- What are some good things I’ve done?
The goal of the inventory journal is to make a habit of writing in it every day, to track the things that are relapse risks and also what is helpful for sobriety, and to explore the deeper reasons underneath the person’s addiction.
Three: The New Social Strategy
Addiction recovery care depends on your willingness to build a whole new social scene for yourself that does not revolve around alcohol or substances. It’s not going to happen overnight, and it’s not going to happen without effort. You’re going to have to be intentional, to actively rebuild the good-for-you social connections you may have let drop off. You’re also going to need to be brave enough to step out of your comfort zone to participate in mental wellness activities like hiking, biking, reading, playing music, painting, spending time in nature or other hobby-based groups to put yourself in places where you can practice healthy communication skills and socialize with people who don’t drink or use.
Four: New Box of Coping Skills
One of the most critical predictors of relapse is a person’s ability to cope with triggers in high-risk situations. Managing stress, cravings and emotional triggers doesn’t just happen automatically. You have to build those skills. One of the best ways to do that is in group therapy, 12-Step programs or other support groups that help you identify the people, places, things and situations that lead to cravings. Then, when these triggers pop up (because it’s not a matter of if, but when), you pull out your arsenal of tools to stop these recovery killers in their tracks.
Tools you should have in your coping toolbox may include:
- Practicing mindfulness
- Practicing gratitude
- Prayer and/or meditation
- Regular physical exercise
- Listening to music
- Deep breathing exercises
- Practicing grounding techniques
- Structured daily routines/schedule
- Getting quality sleep nightly
- Healthy nutrition
Through creative expression and other stress-reduction techniques, you build emotional muscle memory. Over time, that means you get stronger and more resilient, diminishing the possibility of relapse.
Five: The Magic Bullet
Perhaps nothing is more powerful on the road to recovery from addiction than the support of people who know, understand and support you. As you begin to set boundaries with or disconnect from those who have played a role in your addiction, it’s crucial to form new relationships and build on previous relationships with people who love and support your new pursuit of sobriety. Doing so is the best predictor or long-term sobriety.
Support groups, group therapy, and 12-Step programs will help you begin addressing the root causes of your substance abuse. Building healthy relationships with friends and family will help you begin to replace negative thought patterns and emotional trauma with affirming, self-esteem building thoughts and feelings. When you have kind, compassionate people in your life, it rubs off on you, shifting your focus from the pain of the past to the positivity of the present and the possibility of the future.
Relapse in the Rearview
Here at Defining Wellness, we get that relapse happens, but we also wholeheartedly believe that relapse need not cripple your pursuit of lifelong recovery. We offer compassion, understanding, and the tools, skills and support to help you put relapse in the rearview. We help families and loved ones grow in their understanding of addiction and how to better communicate and support each other in recovery. Give us a call today to begin … or begin again.
