How to Respond to a Relapse

What is a Relapse?

Relapse occurs when a person returns to substance use after abstaining for a certain period. The substance can be alcohol or drugs. 

The American Society of Addiction Medicine (ASAM) formally defines relapse as “the recurrence of behavioral or other substantive indicators of active disease after a period of remission.”¹

Relapse doesn’t happen suddenly. It’s a process that occurs over weeks or months. 

People are at risk of relapse if exposed to different risk factors. More risk factors means a higher relapse risk.

Relapse is considered a normal part of the recovery process. People might go through one or more relapses before they succeed. Those who accept this view tend to be more successful.

Some researchers usually distinguish relapse from lapse:²

• When people drink alcohol or use drugs but stop immediately, it’s considered a lapse or a brief slip.
• When people make a full return to alcohol or drug use, it’s regarded as a relapse.

This distinction may not be helpful, as it minimizes the ill effects of a lapse.

Does a Relapse Mean Failure?

No, relapse does not equate to failure. People can experience one or more relapses before they succeed. 

Many studies even suggest a 50% relapse rate among people who completed inpatient treatment programs.²

Viewing relapse as a failure promotes guilt and shame. As a result, people may stop trying to heal and never recover from a relapse. 

People should accept relapse as a normal part of recovery instead of failure. Those who have this perspective tend to be more successful.³

While relapse is sometimes expected, it should still be taken seriously. Good treatment programs have relapse prevention as part of their recovery process. 

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Stages of Relapse

Many health professionals view relapse as a process instead of a sudden event. 

Most treatment programs depict the relapse process as having three stages:^{2, 3}

1. Emotional
2. Mental
3. Physical

1. Emotional Relapse

At this stage, people don’t think about substance use. They may remember their last lapse and resolve not to repeat it.

However, emotions and resulting behaviors may already be laying the foundations for future relapse. 

Some signs of emotional relapse include: 

• Isolation
• Anxiety
• Not attending or sharing in meetings
• Poor sleeping or eating habits
• Denial of being at risk of relapse
• Focusing on other people’s problems

Health professionals should help people in this stage to: 

• Understand the importance of self-care
• Recognize denial to prevent relapse progression

2. Mental Relapse

At this stage, people experience an internal struggle to resume substance use and the desire to remain sober. 

Some signs of mental relapse include: 

• Intense cravings
• Missing people or places associated with past substance use
• Minimizing the negative consequences of past substance use
• Lying
• Bargaining
• Planning substance use while maintaining control

People in this stage should learn to recognize and avoid high-risk situations. This includes birthdays and holidays when many people justify their substance use through mental bargaining. 

People must also recognize that it’s okay to feel occasional cravings. Once they experience cravings, they’ll be ready to use the necessary coping skills.

3. Physical Relapse

People return to using alcohol or drugs in this final stage.

Health professionals should help people in this stage acquire critical coping skills. This includes the ability to recognize high-risk situations and avoid substance use.

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What Causes a Relapse? Who is at Risk?

People are at risk of relapse if exposed to risk factors. The risk is higher if more risk factors are present. 

Risk factors include:^{4, 5, 6, 7, 8}

• Triggers: Events, places, or things that remind the person of substance use. For example, seeing a friend who uses drugs or visiting clubs and bars.
• Negative emotions: Anger, anxiety, and depression sometimes increase the risk of relapse. Stress may also push people to turn to alcohol or drugs for relief. 
• Positive emotions: These can also lead to relapse. For example, a happy person may want to enhance their feelings by using drugs and alcohol.
• Interpersonal problems: Marital conflict and family dysfunction can lead to anger and other negative emotions. These emotions, in turn, increase the risk of relapse.
• Peer pressure: Family or friends who use drugs or alcohol may influence people to relapse. 
• Lack of social support: People may find it hard to cope without drugs or alcohol if they don’t have a social support system.
• Using drugs for managing pain: Some people self-medicate with opioids to relieve pain related to chronic illnesses. Others who use opioids as prescribed may still have a hard time due to opioids’ high addiction potential.
• Discontinuing 12-step programs: These include Alcohol Anonymous (AA), Narcotics (NA), and Cocaine Anonymous (CA). The longer people are in these programs, the higher the chances of remaining sober.

How to Respond to a Relapse 

Here is what you can do if you fall into a relapse:

Reflect

Think about triggers, emotions, or events that led you to relapse. 

Stress can trigger a relapse, especially if you use drugs or alcohol to cope. Birthdays and other social events can also be triggers for people who celebrate with alcohol. 

By knowing these cues, you’ll know what to avoid next time. 

Adjust

View relapse as a learning experience. It can show you what you need to change to recover successfully.

Adjustments include recognizing and avoiding triggers. This can help encourage you to develop coping strategies. 

You can also change your treatment plan if you discover a more suitable one. 

Change Perspective

Discard negative beliefs and acquire positive ones. 

Here are some perspectives that can help you deal with relapse:³

• Recovery is based on coping skills and not willpower.
• Recovery is sometimes hard. But, addiction is harder.
• Relapse is not a failure. It’s a normal part of the recovery process. 
• Insufficient coping skills and a lack of planning ahead lead to relapse. You can easily fix these issues. 
• Feel comfortable with being uncomfortable. This will reduce your urge to revert to addictive habits or behaviors.

Seek Support

Friends, family members, and other sober people can help you cope with relapse. They can act as a constant source of positive influences and guidance.

Join a 12-Step Program 

12-step mutual support programs help people achieve abstinence and prevent relapse. Examples include: 

• Alcoholics Anonymous (AA)
• Narcotics Anonymous (NA)
• Cocaine Anonymous (CA)

The 12-step philosophy emphasizes addiction as a disease that can be arrested but not eliminated. These self-help groups have 12 “steps” or activities that people must go through during recovery.⁹

In one study, people who didn’t attend AA or a similar 12-step program only had a 20 to 25% abstinence rate. This rate doubled for those who did attend. 

Moreover, the longer people are in the program, the higher the chances of abstinence.⁸

According to AA’s Big Book:¹⁰

• Fifty percent of participants successfully recovered
• Twenty-five percent went sober after relapses
• Twenty-five percent failed due to ineffective use of the program

Return to Treatment

Behavioral therapies and medications are common strategies for addiction treatment and relapse prevention.^{2, 11}

Approved medications for substance use disorders (SUDs) include:

• Bupropion and varenicline for nicotine use
• Disulfiram and acamprosate for alcohol use
• Methadone and buprenorphine for opioid use
• Naltrexone for alcohol and opioid use

Behavioral therapy options include:

• Motivational interviewing: An approach that seeks to increase people’s readiness to change behavior and seek addiction treatment.
• Cognitive-behavioral therapy (CBT): A treatment that helps people overcome challenges that sustain their alcohol or drug use. It also equips people with skills needed for recovery.
• Acceptance and commitment therapy (ACT): The health provider helps people change their relationship with addictive substances. 
• Contingency management: Participants who submit negative drug tests may receive motivational incentives like vouchers. These can be exchanged for various items like food, movie passes, or gym memberships.

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Relapse Prevention Tips

Here are some simple tips to prevent relapse: 

• Be honest with yourself. Self-denial makes you more prone to relapse.
• Recognize and avoid triggers. These include people, places, and things that remind you of substance use.
• Set boundaries to avoid negative feelings. Start by avoiding abusive people and harmful situations. 
• Surround yourself with positive influences and develop healthy relationships.
• Practice self-care. Take part in activities like exercise, yoga, and meditation.
• Manage stress to reduce tension in your life.
• Continue seeking counseling or treatment for the substance use disorder (SUD). 
• Join support groups or a 12-step program. 
• Develop a detailed relapse prevention plan. Include your triggers, coping skills, and a list of people or groups you can rely on for help.

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