10 Relapse Signs & Symptoms to Be Aware Of

What Is a Relapse?

A relapse can be challenging to pin down as there are varying opinions on what constitutes a relapse. It has been contextualized as a “discrete outcome” and “a process,” and definitions range from returning to any use or the original problematic use before treatment.¹ However, the one piece these definitions have in common is a discontinuation of abstinence and a return to or re-engagement with a substance or particular behavior. Relapse rates may vary due to these definitions, the type of study populations, and the time since treatment.²

A lapse is not as severe as a relapse and is the initial transgression of problem behavior after a quit attempt.³ A lapse is simply ingesting a substance or diving into the behavior after an individual has attempted to quit, and a distinct behavior that does not indicate a relapse.

Relapse is not sudden and plays out in stages over time rather than as one discrete event. Each phase builds upon the last and increases the likelihood of a full-blown relapse. Recognizing these early signs of relapse can be paramount in seeking appropriate and beneficial treatment.

The stages of relapse include:

Emotional Relapse

The emotional stage is the first stage of the relapse process, and individuals may begin to feel anxious, stressed, or overwhelmed and lapse in self-care. Emotions become overwhelming, difficult to control, and hard to manage. As a result, individuals can even experience impaired ability to function at the same high level they did previously. Negative emotions can result from internal or external stressors that are not appropriately managed, resulting in impulsive behaviors that are difficult to manage.

Characteristics of the emotional stage of relapse include:

• Mood swings
• Isolation
• Poor self-care
• Internalizing feelings
• Increased cravings
• Loss of interest
• Increased stress and anxiety
• Feelings of shame or guilt

Mental Relapse

In the mental stage of relapse, individuals may begin to entertain thoughts of using again or plan for a relapse. They may start to reminisce about past substance use or glamorize it, leading to feelings of nostalgia and longing. Individuals may feel ambivalent about their desire to use drugs or alcohol, contributing to internal conflict as part of them wants to remain sober rather than use again.

Characteristics of the mental stage of relapse include:

• Planning to relapse
• Minimizing the possible consequences
• Experiencing cravings
• Romanticizing the substance
• Over-thinking and rumination
• Loss of control

Physical Relapse

The physical stage is the third and final stage of the relapse process. People will begin using and may return to their prior level of use before abstinence. They may feel they can escape their traumas and issues by using substances again or engaging in risky addictive behaviors. Negative thoughts and cravings will become too much for the person to manage, and they will act on these thoughts despite knowing the consequences.

In this stage, signs of drug or alcohol relapse may include physical withdrawal symptoms as the body readjusts to the presence of a substance. Withdrawal symptoms can be uncomfortable and dangerous in some cases.

Possible signs and symptoms of relapse during the physical stage include:

• Tremors
• Sweating
• Nausea
• Seizures

10 Relapse Signs & Symptoms

Although not always apparent, signs of relapse include changes in behavior or mood, physical indications of substance use, increased financial issues, and work or social problems. It is best to approach the concern non-judgmentally, allowing the person to feel they can express themselves honestly with you.

The individual may be adept at hiding their substance use or addictive behaviors after years of shame and embarrassment from others. They may be reluctant to admit they have started again because they feel like a failure, believe no one will understand, or think they will lose support. The individual may also not display overt signs and symptoms indicating anything new or concerning has arisen.

Here are 10 common signs of relapse:

1. Stealing or Asking to Borrow Money

Acute financial hardship can be a sign of relapse in addiction as the person may lack funds to support their habit and rely on others to enable their behavior. The amount of money, the speed at which it is needed, and the frequency of requests may indicate addictive behaviors might have resumed.

2. Defensiveness

Someone may display defensiveness if they feel attacked simply because they do not appreciate being questioned or not trusted. However, defensiveness may also be a sign they have something to hide and hope anger and aggressive outbursts will make the other person feel bad for asking or back away.

3. Contacting Negative Influences

When giving up an addiction, it is best to distance yourself from people who can trigger and pull you into using again. If a person is in contact with previous relationships related to their addiction, they may re-engage with their substance of choice again. These relationships may act as pleasant reminders of when they felt good, and seeking these people again may allow them to recapture those experiences.

4. Impulsiveness

Impulsivity can act as an early sign of relapse. As cravings and urges increase, individuals may use poor judgment and begin using substances again to find peace. They are not accounting for how their behavior can hurt themselves or others.

5. Missing Work

Responsibilities, such as work, can be eschewed if someone has relapsed. Missing work is easy if someone is experiencing a hangover or oversleeps because they are actively using and high. They may continue working to receive money, but the importance and significance of employment will likely drop due to relapse.

6. Changes in Physical Appearance

Another warning sign of relapse is poor self-care. Their main goal may be using the substance or engaging in addictive behavior, meaning their hygiene can suffer. They may look sleep deprived and malnourished, which may be an overt indication of substance use. Their image may be a stark contrast to what they previously looked like.

7. Isolation & Withdrawal

A relapse can cause a person to pull away from friends and family. They may fear judgment or shame for their behavior or that no one will understand. It is difficult to maintain reciprocal relationships if individuals are in the active stage of addiction.

8. Unrealistic Expectations About Addictive Behavior

Moderation can be a realistic goal for individuals with addiction issues, but some need to set an abstinence goal. A person who needs an abstinence goal but believes they can manage their addiction by moderating may be at risk of relapse. Thinking they “got it” may be a sign that a relapse is happening.

9. Changes in Mood

Mood swings, including increased irritability, anxiety, or depression, can be a common sign of relapse. Drugs and alcohol impair emotional brain functioning and the ability to regulate emotions. Individuals are more likely to be moody or nervous if they feel others are checking up on them and instructing them on how to live.

10. Disruptions in Sleep & Appetite

Substances affect the ability to regulate sleep and hunger cues, which may result in increased or decreased appetite and changes in eating patterns. Individuals in relapse may skip meals, forget to eat, or engage in binge eating behavior. Sleep can also become a low priority or decrease in frequency. Drugs and alcohol also prevent a person from having restful sleep, even if they sleep for hours.

Why Do People Relapse?

As motivated and engaged as individuals may be to remain abstinent, they must always remain vigilant of risk factors that can pull them back to their addiction. Relapse triggers can be external, such as people, places, events, and attitudes, or overwhelming internal states and emotions. For example, falling back into depression or situations involving negative mood have been associated with poorer prognosis and are among the most frequently cited precipitants of relapse across several substances.⁴

Risk factors may pop up depending on where the person is in treatment, or they may be in the background and in need of consistent management. For instance, acute and chronic stress may significantly impact motivation to abuse addictive substances.⁵ Risk factors usually become prevalent days to months before relapse occurs. Although it can look like it came out of nowhere, there are potential signs that a return to addiction is highly probable.

Triggers for relapse may include:

• Negative mood states: Depression and anxiety can cause an individual to return to addiction because these can bring about hopelessness and cognitive distortions. Seeking treatment for underlying affective states can be a protective factor for addiction.
• Stress: Different types of stress can be overwhelming and have long been known to increase vulnerability to addiction.⁵ Reducing stress by using coping skills will be necessary to decrease the chances of relapse.
• Interpersonal conflicts: Interpersonal conflict can drive a person away from their support system, increasing the chances they won’t have others to lean on. Communication skills, boundary setting, and ensuring you have a robust system can improve these conflicts.
• Peer pressure: Individuals may feel peer pressure to engage in substance use or other risky behaviors to fit in or avoid social rejection from others. It is important to identify your values and personal goals, communicate assertively and respectfully with peers, seek positive social support and relationships, and practice refusal skills.
• Lack of social support or isolation: Not feeling supported can increase the chances of relapse. Individuals can prioritize building and maintaining supportive relationships, participate in social activities and groups, reach out to loved ones, and engage in hobbies or activities that bring them joy and a sense of purpose.
• Physical pain: Substances can be a great way to avoid and escape pain because they can make living with acute or chronic pain tolerable. Pain should be managed, and it is best to consult your doctor about potential non-narcotic treatment options.
• Low self-efficacy or low self-esteem: Not believing in yourself to weather life stressors without substance use can be overwhelming. Low self-esteem can be addressed by practicing self-compassion and positive self-talk, setting achievable goals, and engaging in activities that promote feelings of competence and accomplishment.
• Positive moods or overconfidence: Individuals may feel a false sense of security and underestimate the power of relapse triggers or stressors. Practicing mindfulness and self-awareness, recognizing and preparing for potential triggers or stressors, and developing coping strategies and a relapse prevention plan can all be helpful in alleviating any overconfidence.

Responding to Signs of a Relapse

Intervention is best when initiated at the first sign of relapse. The sooner action is taken, the better chance to reduce physical relapse. Having several lapses or relapses is not uncommon throughout and during treatment. Thus, multiple interventions may be necessary before a lasting change is achieved. Family and friends can provide a safe and supportive space for individuals to talk about their struggles and concerns, which can help them feel less isolated and more motivated to seek help. Addiction treatment providers can offer support through therapy or counseling. Responding to the warning signs of relapse requires a collaborative effort.

Below are steps you can take at the first signs of and after relapse:

• Find them a support group: Support groups can provide a safe environment to share experiences, gain encouragement and accountability, and receive guidance and advice from peers. It is best to research a group that meets your specifications.
• Provide a safe place to avoid triggers: Staying away from relapse triggers is one of the easiest ways to discourage relapsing. An environment free from stressors can reduce risky behaviors and substance use.
• Help them maintain healthy boundaries: Individuals can better prioritize their own needs, values, and goals by maintaining healthy boundaries. To create boundaries, they can identify their personal beliefs, communicate assertively with others, and say “no” to requests or situations that may be harmful.
• Develop a relapse prevention plan: A relapse prevention plan can help reduce the risk of relapse by providing a structured approach to identifying potential triggers and stressors, developing coping strategies, and taking preventive steps.
• Suggest intensive outpatient therapy: Intensive outpatient therapy can act as a structured and supportive environment to address underlying issues and develop coping strategies to manage triggers and stressors. Find a program that meets your needs and goals and where you feel comfortable spending many hours and days.
• Avoid enabling behaviors: Avoid giving your loved one money or covering up for them. This can prevent them from facing the consequences of their actions and hinder recovery. Draw strict boundaries and set expectations of how you will and will not help.
• Be patient: Recovery is a process that takes time. Avoid placing undue pressure on the person in recovery to bounce back quickly, and don’t make them feel like they are doing something wrong.
• Offer hope and encouragement: Encouragement is essential when preventing relapse. Hope allows a person to stay positive and maintain motivation for success. Believing in them may dramatically increase their ability to believe in themselves.

Final Thoughts

Relapse can sometimes seem unexpected, but with proper knowledge of warning signs of relapse, you can help your loved one maintain their abstinence and support them if lapses arise. The signs of relapse are not always obvious, but educating yourself about the risk factors will better prepare you for the unknown. Not everyone may want or appreciate your help. Offer a safe, nonjudgmental space and allow them to come to you when ready.