What is a Relapse?
Relapse occurs when someone who has attained sobriety begins abusing drugs or alcohol again. It is a normal part of the recovery process that can occur at any point and can vary in severity, depending on how much of the substance you use and for how long you use it. In some instances, a relapse may pose particular health risks or could even be deadly; for example, if you were to resume using drugs or alcohol after losing a significant amount of tolerance during a period of sobriety, you could increase the likelihood of toxicity or overdose.1
According to the National Institute on Drug Abuse (NIDA), recovery can be seen in the same light as dieting in the sense that people struggling to successfully lose weight may need to build and adhere to entirely new routines, such as by eating nutritious foods and developing consistent exercise schedules.2 It may take several tries before they are successful in cultivating a healthier lifestyle. It takes time to learn new habits, and when you slip, you have to keep trying and avoid giving up hope.2
Various studies have shown that relapse rates can range anywhere from 20% to 80%.3 The rate can depend on different factors, such as the particular type of substance being used and individual circumstances/characteristics of the study participants.3 One study comparing people who sought help for alcohol use disorders (AUD) with those who did not showed that those who did not were more likely to relapse and less likely to achieve 3-year remission.
In this same group, short-term remission rates varied from 20% to 50% among those who received treatment, while only 5% to 45% of untreated individuals achieved some improvement or remission.3 An additional study showed that 85% of study participants who had recently undergone detox for alcohol experienced relapse.4
The Alcohol and Drug Foundation explains that some people may need to make 5 or 6 repeated attempts at recovery after experiencing a relapse to successfully maintain sobriety.1 It’s important to be patient and self-compassionate if you relapse. Try to view relapse as an opportunity to learn from the experience and become more aware of your relapse triggers, rather than to view it as a failure of treatment or recovery efforts.1
Relapse Warning Signs
Being aware of the red flags that may signal an impending relapse is crucial so that you can take precautionary measures. These include techniques such as avoiding situations that trigger cravings or implementing better stress management tools. However, remember that it’s not always possible to prevent relapse, so promise yourself that you’ll seek treatment as soon as possible at a rehab facility if it does occur.
One study explains that relapse warning signs occur in 3 broad phases. These include:5
- Emotional relapse: During this phase, people tend not to be thinking about using, but they experience negative or dysfunctional emotions that set the stage for relapse. Such emotions can include avoiding feelings, isolating from others, avoiding self-help meetings, going to self-help meetings but not sharing, and engaging in poor self-care (such as not getting enough sleep or eating an unhealthy diet).
- Mental relapse: You might experience a mental battle between wanting and not wanting to use. As this phase progresses, people may increasingly feel like they want to give up and escape from this battle by using. You may experience more cravings or begin thinking about where and with whom you used to use. You may lie to yourself or others, minimize the consequences of substance use, look for opportunities to use, and plan a relapse.
- Physical relapse: This is the phase where you start using again.
According to one study on the post-acute withdrawal syndrome model of relapse, individuals may experience 37 possible warning signs before a relapse.6,7 These warning signs are broken down into 10 overarching “phases” and include:6,7
- A return to denial. You may find that you have difficulty identifying your feelings, are unwilling to share them with others, and feel anxious and nervous that you won’t be able to stay sober, yet deny that these feelings are occurring.
- Avoidance and defensiveness. You start avoiding people or situations that force you to be honest with yourself. You might be afraid to share your feelings about potential relapse with therapists or members of your recovery group. You may become defensive when talking about your feelings or your recovery. You might start spending more time alone instead of reaching out for help.
- Crisis building. This means that you start to experience crises and consequences that are the result of the previous 2 phases. You might lose a sense of the “big picture” and develop tunnel vision. You might develop polarized thinking; you see either only the good or the bad parts of life instead of the integrated whole and start blowing those things out of proportion. You may start to feel depressed, stop making constructive life plans, or make plans that are not realistic, and then begin to experience increasing failure of your plans.
- Immobilization. You become unable to initiate action in your life. You feel that you’re just going through the motions and not really living. You may start to give up hope and feel like things are just spiraling out of your control. You might feel like you need someone to rescue you rather than feeling competent to handle things yourself.
- Confusion and overreaction. You find that you’re unable to think clearly and you start overreacting with family or friends, become easily angered, or feel irritable much of the time.
- Depression. You feel depressed and sad; you may start sleeping more, eating more, and experience a loss of your daily structure.
- Behavioral loss of control. You might stop attending support group meetings or therapy sessions, reject outside help, and develop an “I don’t care” attitude. You start to feel powerless and helpless.
- Recognition of loss of control. You start feeling self-pity (the “poor me” attitude) and may have thoughts of using (“it’s OK if I just have one drink”) because you know it will help you temporarily feel better. You might try to rationalize that you’ll be able to keep things under control. Deep down, you know that things are getting out of control, but you may have become so socially isolated that you feel you don’t have anyone to turn to for help.
- Option reduction. You feel trapped by pain and resentment, and you no longer believe anyone can help you. You feel that aside from taking action to harm yourself, using is the only way to escape from your painful feelings.
- Acute relapse period. You experience an increased loss of control over your behaviors and emotions, which leads to using drugs or alcohol again.
Understanding Your Relapse
Everyone has different relapse triggers. For some, it might be seeing people with whom they previously used. For others, it might be a negative life event or stressor that seems too difficult to handle (such as divorce or loss of a loved one). Being aware of your triggers is the first step in understanding how to prevent relapse in the future. It can help you have insight so you’ll know how to best cope when things feel like they’re too much to handle.
Several predictors of relapse, as well as some common relapse triggers include:3,8,9,10
- Poor coping skills.
- Lack of self-efficacy (i.e., the belief that you can stick with sobriety).
- Stress, such as emotional stress from negative life events or physical stress from not sleeping or poor self-care.
- Exposure to drugs or drug-related stimuli (such as being in the environment where you used or seeing people drinking or using drugs on TV).
- Contact with people with whom you used drugs or alcohol in the past.
- A negative emotional state (such as fear, boredom, or anger).
- Co-occurring disorders (such as depression or anxiety).
- Feeling criticized or rejected by others.
- Social pressure, such as being at a party or restaurant where others are using or drinking.
If you experience relapse, don’t give up hope. Take action as soon as possible to get back on the path to recovery. Accept responsibility for what has happened, ask for help from a sponsor or other supportive and understanding friend or family member, and consider whether additional help from a professional treatment program is needed.
Adjusting Your Treatment Plan Post-Relapse
You may believe that rehab won’t work the second time if it didn’t work the first. However, NIDA states that relapse doesn’t mean that your previous treatment was a failure. It just means that you now need to make adjustments to get back on track with your recovery goals.11
It’s advisable to talk to your treatment team about what initially worked for you in rehab and what wasn’t so useful. Some people find it helpful to consider a longer treatment time, and indeed, some research indicates that a longer time in treatment is associated with relatively better treatment outcomes. However, in some cases, it could be the characteristics of or specific types of treatment offerings provided at longer- vs. shorter-term programs that can play a role in improved outcomes rather than the length of time in treatment itself. For example, one study found that people who had undergone treatment at a short-term clinic (between 2 and 4 months), as opposed to a long-term clinic (6 months or longer), were at increased risk of relapse regardless of the total length of treatment time received at either prior to discharge.12
While not everyone will have access to the types of programs offered at the 6-month or longer programs in this study, a short-term inpatient stay (between 3 and 6 weeks), followed by extended outpatient treatment and participation in a self-help group like Alcoholics Anonymous (AA) can also help reduce the risk of relapse.13
Aftercare is Essential
The hard work toward sustained recovery doesn’t end after you have completed treatment, though some people make the mistake of believing that they can “do it on their own” once they’ve finished their program.5 Many who have undergone treatment will attest to the fact that aftercare is a crucial part of the recovery process because it provides the necessary ongoing support and motivation that you’ll need to stay clean and sober.
There are many ways to engage in aftercare, such as:
- Residing in a sober living home. These are structured residential environments for people who have recently completed addiction treatment and feel that they need continued support. They provide a way to transition from the highly supervised setting of rehab to normal, mainstream life.
- Attending self-help support groups like AA. While 12-step groups like AA are based on the concept of submitting to a higher power, some people prefer secular support groups such as SMART Recovery or Secular Organizations for Sobriety.
- Engaging in individual or group therapy, which can help you uncover and work through the reasons you may have developed an addiction in the first place and offer additional help in maintaining your recovery trajectory.
- Attending family or couples therapy sessions. Addiction affects everyone, not just the person with the drug or alcohol problem. Family or couples therapy can help repair relationships, teach improved methods of communication, and help families and couples understand the challenges faced by a person in recovery.
Before treatment ends, you will learn a variety of relapse prevention strategies to help you stay on the path to recovery. Some strategies to keep in mind include:5,14,15
- Making changes to your environment, such as avoiding people and places where you formerly used, and cultivating healthier, positive relationships.
- Changing self-defeating or negative thought patterns, which you can learn to do in treatment or by engaging in cognitive-behavioral therapy as a part of your aftercare plan. It’s common for people in recovery to be too hard on themselves. Try to practice being kind to yourself and giving yourself a break.
- Engaging in alternative therapies like yoga or mindfulness meditation.
- Scheduling regular time for relaxation and stress relief.
- Developing a healthier lifestyle, such as eating a balanced diet and following a regular exercise routine.
- Reaching out for assistance when you feel cravings or experience relapse triggers. Don’t hesitate to ask for help; call a supportive friend or your sponsor.
Get Treatment For a Relapse
If you’ve experienced a relapse and are ready to seek treatment, American Addiction Centers’ (AAC) admissions navigators can discuss your treatment options with you. Alcohol.org is a subsidiary of AAC, a nationwide provider of addiction treatment services.
Remember, a relapse doesn’t mean you have failed; it simply means you need to adjust previous treatment plans. Don’t let it keep you from getting the help you need and deserve. Additionally, if you’ve successfully complete 90 consecutive days at an AAC facility and experience a relapse, you are welcome back for a complimentary 30 days of our treatment.*
Call our hotline 24/7 to speak with one of our admissions navigators and start your path toward recovery today. All calls are 100% confidential. Or, fill out the form below to see if your insurance covers treatment within an AAC facility.
*Terms and conditions may apply, and results may vary.
. Alcohol and Drug Foundation. (n.d.). Relapse.
. National Institute on Drug Abuse. (n.d.). What is a relapse?
. Moos, R. H., & Moos, B. S. (2006). Rates and predictors of relapse after natural and treated remission from alcohol use disorders. Addiction, 101(2), 212–222.
. Willinger, U., Lenzinger, E., Hornik, K., Fischer, G., Schönbeck, G…Meszaros, K. (2002). Anxiety as a predictor of relapse in detoxified alcohol-dependent patients. Alcohol and Alcoholism, 37(6), 609–612.
. Melemis, S. (2015). Relapse prevention and the five rules of recovery. The Yale Journal of Biology and Medicine, 88(3), 325–332.
. Miller, W. & Harris, R. (2000). A simple scale of Gorski’s warning signs for relapse. Journal of Studies on Alcohol 61(5), 759-65.
. Gorski, T. & Miller, M. (n.d.). The relapse syndrome: The phases and warning signs of relapse.
. Ramo, D., & Brown, S. (2008). Classes of substance abuse relapse situations: a comparison of adolescents and adults. Psychology of Addictive Behaviors, 22(3), 372–379.
. Sinha R. (2008). Chronic stress, drug use, and vulnerability to addiction. Annals of the New York Academy of Sciences, 1141, 105–130.
. National Institute on Drug Abuse. (2020). Drugs, brains, and behavior: The science of addiction: Treatment and recovery.
. National Institute on Drug Abuse. (2018). Principles of drug addiction treatment: A research-based guide (third edition): How effective is drug addiction treatment?
. Andersson, H. W., Wenaas, M., & Nordfjærn, T. (2019). Relapse after inpatient substance use treatment: A prospective cohort study among users of illicit substances. Addictive Behaviors, 90, 222–228.
. National Institute on Drug Abuse. (2018). Principles of drug addiction treatment: A research-based guide (third edition): Types of treatment programs.
. McHugh, R. K., Hearon, B. A., & Otto, M. W. (2010). Cognitive behavioral therapy for substance use disorders. Psychiatric Clinics of North America, 33(3), 511–525.
. Smith, M. A., & Lynch, W. J. (2012). Exercise as a potential treatment for drug abuse: evidence from preclinical studies. Frontiers in Psychiatry, 2, 82.