What Is Relapse? Risk Factors, Treatment & How to Cope

What Is Relapse?

A relapse is a complete return to substance or alcohol use after maintaining periods of sobriety. Because addiction is a chronic illness that changes brain circuitry regulating reward, stress, and self-control, many individuals in recovery from substance use disorders (SUD) may experience a relapse.1,2,3

The DSM-5 recognizes the following substances as causes of SUD:

• Alcohol
• Caffeine
• Cannabis
• Hallucinogens
• Inhalants
• Opioids
• Sedative/hypnotic/anxiolytic
• Stimulants
• Tobacco/nicotine

How Common is Relapse in Addiction?

Relapse in addiction is common, and statistical data indicates that 40 to 60 percent of individuals in recovery would experience a relapse at some point.⁴ Individuals will likely relapse several times before maintaining sobriety. Even though this number may seem high and cause fear or doubt regarding addiction treatment, nearly half of those in recovery can establish sustainable sobriety.

Is Relapse a Sign of Failure in Recovery?

The Stages of Change model views relapse in drug or alcohol addiction recovery as normal.⁵ This philosophy emphasizes that recovery is a continuous process, and individuals should not be ashamed of relapsing.

Nonetheless, experiencing multiple relapses during treatment can be disheartening for individuals, possibly resulting in an abandonment of attempts to stay sober. In addiction treatment, providers often use the phrase, “Addiction is not a sprint but a marathon,” to stress that recovery is a long-term goal and process. A positive support system can help lessen the negative impact of relapse while keeping individuals motivated and committed to their recovery journey.

Signs of a Relapse

The signs of relapse vary depending on the individual but may include refusing to engage in treatment or revisiting past substance use triggers. Relapsing after years of sobriety is possible, so knowing these warning indications can help individuals take preventive actions.

The following are signs of relapse that can predict the occurrence of a relapse:⁶

• Increased thoughts about using or acting out
• Refusal to reach out for support
• Going back to people and/or places associated with substance use or addictive behaviors
• Increased behaviors associated with addiction in the past
• Not following professional advice
• Not taking prescribed medications that treat SUD

What Are the Stages of a Relapse?

Relapse is not a sudden event but a build-up that develops in stages. These stages differ from “traditional relapse,” where the individual consciously decides to use again, or “freelapse,” when someone accidentally relapses. 

The stages of relapse include:⁶

Emotional Relapse

An emotional relapse happens when an individual allows the negative consequences of their substance use to dull. Those in this stage may avoid discussing their feelings, isolate from others, exhibit appetite changes, or experience sleep disturbances. They may stop attending support meetings or refuse to participate when present.

Mental Relapse

A mental relapse occurs with the breakdown of cognitive processes. Coping skills enabling the management of symptoms and triggers are blocked or undermined by intrusive thoughts about using. Mental relapse in addiction may entail cravings, thoughts of addiction-related people or places, glamorizing or minimizing the consequences of past use, bargaining, or delusions about control over sobriety. Individuals may begin looking for excuses to relapse or planning relapse.

Physical Relapse

The final relapse phase includes the complete physical return to substance or alcohol use. This state manifests as actions directly leading to engagement with an addiction, such as driving to a bar or liquor store, contacting a dealer, and searching for drugs.

What Causes Relapse?

Risk factors for relapse usually become apparent days to months before the event. Relapse causes often come as physical and emotional triggers that lead to poor self-efficacy. Someone may turn to their addiction to alleviate negative feelings rather than enacting proper coping skills. However, individuals can take action to prevent relapses by being aware of triggers and developing a relapse prevention plan.

Risk factors and causes of relapse may include:

• Exposure to addictive triggers: Certain locations or people may trigger relapse in addiction. For instance, driving by areas of past drug use can lead to the person experiencing euphoric recall and a desire to use again.
• Stress: Acute or chronic stress can be an overwhelming experience for anyone but more devastating for those struggling with addiction. When an individual experiences stress, they might engage in addictive behaviors as a maladaptive coping skill.
• Interpersonal conflicts: Conflicts can lead to distressing feelings such as anger, pain, fear, or insecurity. Individuals may experience despair and use substances to numb the pain if they lack the skills to process emotions.
• Peer pressure: There is a strong correlation between negative peer pressure and addiction. Some individuals may feel pressured to return to use if peers or friends actively engage in substances.
• Lack of social support or isolation: Social support can help alleviate stress and provide comfort during challenging times. Without it, individuals become isolated and are left to struggle.
• Physical pain: Individuals in severe pain may view substances as pain management.
• Low self-efficacy: Some individuals experiencing relapse struggle with the thought of not being good enough, often leading to self-doubt about recovery and maintaining sobriety. Using substances might be the only way to soothe their low self-esteem and insecurities, even if the effects are short-lived.
• Positive moods or overconfidence: Individuals with overconfidence might believe everything is under their control. When things become unpredictable, they struggle with accepting a new reality and subsequently turn to substances.

What to Do After Relapse

Dealing with relapse can be challenging and discouraging. However, early action can help you stay on track to sobriety and prevent addiction from becoming ingrained. Recovering from relapse is always possible.

Below is helpful information on what to do when you relapse:

• Reach out for help: When life becomes overwhelming and unmanageable, reach out for help. Professional guidance can provide the necessary tools for recovery and help you see problems from a different perspective.
• Find a support group: Support groups allow individuals experiencing relapses to work together on achieving recovery and sobriety. Members openly discuss their struggles and get feedback from others.
• Avoid triggers: Individuals must avoid known triggers that led to past relapses. Knowledge and accountability are essential in understanding and planning for recovery.
• Set healthy boundaries: Individuals should set healthy boundaries that allow them to stick to recovery goals. Individuals may have to make short-term sacrifices for long-term gains.
• Practice self-care: Self-care can help with the recovery process. It ensures you are mentally and physically healthy to handle life stressors. You are more likely to relapse when depleted.
• Reflect on the relapse: Though dealing with relapse in recovery can be traumatic and disheartening, it can provide new insights and self-awareness. Reflecting on your experience can help you develop new self-management skills.
• Expect struggle and discomfort: Avoid believing you will never relapse, setting ultimatums, or expecting a smooth, linear recovery. Unrealistic expectations about recovery can set you up for failure.
• Develop a relapse prevention plan: Developing a relapse prevention plan is a productive way to prepare for a relapse. Having a well-thought-out plan provides concrete, actionable steps for early intervention.

Relapse Treatment Options

People relapse for many reasons, so treatment should be tailored for each individual, especially those experiencing multiple relapses. The prognosis or likelihood of recovery depends on the addiction’s severity and protective factors. Addiction requires a lifetime commitment to maintaining progress and sobriety.⁷

Choosing a therapist requires research, but using an online therapist directory can make the process easier. One particular modality or therapist is suitable for everyone experiencing a relapse. For optimal progress to occur, working with therapists or facilities specializing in addiction treatment is best.

Below are treatment options for managing and handling a relapse:

• Group therapy: Group therapy modalities are great for individuals experiencing relapse to discuss their struggles and get feedback from others.
• 12-step programs: Research shows that peer support and accountability reduce the chances of a relapse. 12-step programs, such as Alcoholics Anonymous (AA), connect the individual to peers who have or are experiencing similar issues.
• Cognitive behavioral therapy (CBT): CBT assists individuals in exploring their inner thought processes and the underlining negative core beliefs that led to unhealthy behaviors and emotions in the past. CBT can help the individual identify the thoughts that led to relapse.
• Rehab: Rehab treatment is for individuals with severe symptoms and high relapse risk. Individuals stay for an extended time while receiving 24-hour care and support. Rehab is the most restrictive treatment method because individuals suspend routine responsibilities throughout their stay.
• Intensive outpatient therapy: Individuals typically visit facilities for intensive outpatient therapy but can return home after sessions end. This modality is appropriate for individuals with mild to moderate symptoms and low relapse risk.

What to Consider in Relapse Treatment

Because addiction is a chronic disease, relapse is an expected outcome in recovery and treatment. However, multiple relapses mean that the treatment plan or modality is not assisting the individual with reaching their recovery goals. In these cases, the individuals must explore other treatment options. Discussing this with the previous treatment providers or social support can provide additional insights into the next steps.

Here are a few things to consider before starting or returning to treatment:

• The type of drug: Some drugs have a more addictive quality than others and may require more intensive treatments (e.g., residential, detox, rehab).
• Level of social support: A good support network can help you feel comfortable and cared for. If there are relationship ruptures, take time to repair them. Making amends is one of the most powerful steps in the recovery journey.
• Housing options: Asses if your living situation is conducive to recovery. If past usage consistently occurred at home, being in the same environment can trigger the euphoric recall.
• Access to transportation: Reliable transportation is another element to consider before returning to treatment. Long commutes or lack of adequate transportation can become barriers to recovery.
• Physical or mental health conditions: Being physically or mentally unwell can exacerbate symptoms and complicate recovery. Make sure to treat any co-occurring conditions while receiving addiction or relapse treatment.
• Past treatment efficacy: If past treatments did not produce desirable results, making a new plan and setting new goals is essential. Recovery is a matter of learning what does and what does not work.
• Proximity to triggers: External triggers are substance-related people, places, or activities. Putting distance between you and these elements helps to minimize cravings.

Final Thoughts

Relapsing in drug or alcohol recovery is hard to overcome, but therapy and support can help. Having realistic expectations about relapse and addiction treatment instills knowledge and prepares you to cope with this chronic illness.