Addiction is a chronic disease that can be successfully managed and long-term recovery is possible. For many, part of the recovery process will include relapse, which is a return to active substance use after a period of improvement or discontinuation of use. Relapse does not mean that treatment was ineffective or that recovery is unattainable, it is just an indication that that some modifications, additional treatment, or a new approach is needed1. 

While relapse is considered a “normal” part of the recovery process, it is not a necessity. Relapse is entirely preventable. Preventing relapse is vital in reducing many risks associated with substance use, including overdose. It is important to understand that relapse doesn’t happen in the blink of an eye – it is a process. A relapse usually begins long before the first drink or drug is picked up. Understanding the process involved in a relapse can provide those in recovery, and their loved ones, vital insight and hopefully prevent a relapse from occurring. 

The Stages of Relapse

Research has shown that the relapse process is progressive and is generally broken down into three different categories: Emotional Relapse, Mental Relapse, and Physical Relapse2.  

Emotional relapse is usually the first stage of the relapse process. During this time, the individual has become distinctly uncomfortable – this could include emotional, psychological, or physical discomfort. This phase of a relapse is also characterized by a lack of interest in recovery focused activities, mildly impulsive or erratic behaviors, and mood swings2. Generally, the individual is not actively considering a return to substance use and probably won’t be experiencing any using thoughts or cravings, but they are also disengaging from the recovery process2.  

Without appropriate intervention or a re-commitment to recovery, mental relapse will follow an emotional relapse. Thoughts of using, cravings, and romanticizing use may all occur during a mental relapse.   The individual may feel stuck and see themselves as a victim to life’s circumstances. This change in perspective can lead relying on unhealthy coping mechanisms to manage life’s stress. While the person in recovery may not be fully ready to return to active substance use, they are seeing a return to use as a solution to their on-going discomfort2.

Physical relapse is the final stage of the relapse process. As the name suggests, a physical relapse does include the decision to return to active substance use. While some people may experience a brief episode of physical substance use, the risk of falling into a long-term physical relapse is high1.  

Warning Signs

Research has shown that there are consistent and visible warning signs when a recovering person enters the relapse process2. Some warning signs will only be recognized by the recovering person, but others will be noticeable by those around them. Early identification of relapse warning signs, along with appropriate intervention, is one of the best ways to prevent a physical relapse. Below are some of the most common warning signs that a recovering person has entered the relapse process2:

  1. Change in attitude towards recovery

The recovering person may no longer feel that a recovering lifestyle is appropriate for them.  They may also begin prioritizing work or school over their recovery obligations.  This change in attitude indicates that their commitment to recovery is waning and is often one of the early predictors of relapse2. 

  1. Elevated stress

Fluctuations in stress levels happen to everyone – whether they are in recovery or not.  However, for a recovering person, an exaggerated response to stress is often an indication they have entered the relapse process2.

  1. Denial

The individual is not necessarily in denial that they have an issue with substances, but rather focuses on denying their emotional discomfort to themselves and others2.  They may also believe too strongly that they are at no risk for relapse, can handle life on their own, or that they no longer need recovery supports to maintain recovery. 

  1. Behavioral Changes

Behavioral changes can be as simple as changing a daily routine, such as neglecting morning meditation or skipping a regular recovery meeting.  These changes can also manifest in the form of neglecting proper hygiene or experiencing increased levels of depression, anxiety, or irritation, and defensiveness2. 

  1. Isolation

Isolation is dangerous for people in recovery. Pulling away from loved ones, finding reasons to break plans, and avoiding recovery supports are all predictors of relapse2.   

  1. Loss of Structure

People in recovery typically have routines in place that they developed early on.  These routines help to fill time and take the place of the lifestyle they had while actively using.  If someone is no longer waking up on time, skipping important obligations like work or school, or has stopped taking care of their mental health – there is a very strong likelihood they are stuck in the relapse process. 

  1. Decline in Decision Making Abilities

Impulsive or compulsive decision making, the inability to make a decision, or an “I don’t care attitude” are all indicators that relapse potential is high2.  Difficulty focusing, periods of confusion, or feeling y overwhelmed without reason have also been shown to occur prior to physical relapse2.

  1. Neglecting Responsibilities

Becoming unable to fulfill day-to-day responsibilities begins creating chaos within the individual’s life2.  They may experience financial or occupational distress.  Often, their interpersonal relationships become strained2.

  1. Loss of Options

The individual may begin to feel that they have limited options, outside of returning to active substance use2.  They feel backed into a corner and the only viable option to relieve their distress is to pick up a drink or drug.

  1. Loss of Control

The individual loses the ability to control their behavior.  They may be experiencing a return to dysfunctional behavioral patterns, such as lying or stealing, which served them during their active use.  This loss of full control over their thoughts, feelings, and actions often results in a return to physical use1.

What if a Relapse Occurs? 

Relapse is preventable. Understanding the warning signs and the relapse process can result in healthier decision making and the ability to intervene early. Staying connected to recovery supports is a great way to prevent a relapse from happening. Honestly discussing any cravings, urges, or struggles with a trusted individual can go a long way in preventing a slip.

If a relapse does occur, avoid falling victim to the shame and guilt that may arise. Relapse is a common part of recovery and there is no shame in reaching out for help. Just because someone makes the decision to use does not mean that recovery is unavailable to them. Promptly entering a treatment program or seeking professional care is vital in ensuring the safety and well-being of the person who relapsed.

If you or a loved one has experienced a relapse, Greenbriar Treatment Center is here to help. Greenbriar has vast experience in preventing relapse and in helping those who have gone through it. Don’t wait to get help, contact us today to learn about our comprehensive treatment options. 

Resources
  1. https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery(opens in a new tab)
  2. Miller, W. R., & Harris, R. J. (2000). A simple scale of Gorski’s warning signs for relapse. Journal of studies on alcohol, 61(5), 759–765. https://doi.org/10.15288/jsa.2000.61.759