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

What Is Relapse?

Addiction is a chronic illness, and relapse is part of its symptoms. Addiction changes the brain circuitry that regulates reward, stress, and self-control.¹ The changes caused by substance usage can negatively impact the individual even after they stop using the substance. A relapse happens when the individual fully returns to using or engaging in addictive behaviors after a period of sobriety.² Conversely, a lapse is considered a slip where the person briefly resumes using or acting out but can stop shortly after.

The term “addiction” is typically used to describe Substance Use Disorders (SUD) when the condition meets the criteria outlined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.³

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

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

On the other hand, behavioral addiction refers to various compulsive and problematic behaviors, which ultimately can lead to significant impairments in the individual’s functioning.

Below are examples of behavioral addictions:

• Gambling addiction
• Sex addiction
• Porn addiction
• Masturbation addiction
• Video game addiction
• Social media addiction
• Shopping addiction
• Food addiction

It is worth mentioning that only gambling addiction is currently recognized by the DSM-5 as an official mental health diagnosis. Behavioral addiction is a relatively new field of study, and more research is being added to the body of knowledge.

How Common is Relapse in Addiction?

Relapse is common and occurs frequently as part of the recovery process. According to the Hazelden Betty Ford Foundation, statistical data indicatesd that 40 to 60 percent of individuals with addiction would experience a relapse at some point during their recovery journey.⁴ This means that individuals trying to overcome addiction will likely relapse several times before maintaining sobriety. Even though this number may seem high and can cause many to have fear and doubt regarding addiction treatment, it is important to recognize that nearly half of the individuals in recovery can establish sustainable sobriety.

Is it a Sign of Failure to Relapse?

The Stages of Change model actually views relapse as a normal part of the recovery process. This model views addiction recovery as a circular process where pre-contemplation immediately follows relapse.⁵ This philosophy emphasizes that recovery is a continuous process and that it is not a failure should the individual experience a relapse.

The six stages of recovery in the order are:

1. Pre-contemplation
2. Contemplation
3. Preparation
4. Action
5. Maintenance
6. Relapse

Nonetheless, it can be disheartening for those individuals who experience multiple relapses during their course of treatment. Repeated failures can often lead to individuals giving up on their attempts to stay sober. In addiction treatment, treatment providers often use the phrase “addiction is not a sprint but a marathon” to emphasize that recovery is a long-term goal instead of a short-term one. A good support system can help lessen the negative impact of relapse while keeping the individuals motivated and committed to their recovery journey.

What Are the Stages of a Relapse?

According to the United States Department of Veterans Affairs, relapse is not a sudden event; rather it is a build-up that happens in stages. These stages are different from “traditional relapse,” where the individual consciously decides to use again, or “freelapse” when someone accidentally relapses without intention. Additionally, relapse does not come without a warning but is often the final step in the progression of behaviors.

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

The three stages of relapse are:⁶

• Emotional Relapse: happens when the individual experiences emotional complacency during sobriety. The individual may recall some consequences of addiction in the past, but the negative impact of those events is beginning to dull out. The signs of emotional relapse include:not talking about emotions, isolation from others, not attending support meetings, attending meetings but not participating, focusing on the needs and issues of others, and poor eating and sleeping habits.
• Mental Relapse: occurs when there is a breakdown of the individual’s cognitive processes. Coping skills that enable the individual to manage their symptoms and triggers become blocked or undermined by the presence of intrusive thoughts about using or acting out. The warning signs for mental relapse include: cravings, thoughts of being with people or places associated with the addiction, glamorizing or minimizing the negative consequences of past use/acting out, bargaining, lying about various things, delusion about having control and ability to stop, looking for excuses to relapse and planning opportunities to relapse.
• Physical Relapse: the final stage of relapse where the individual returns to using. The manifestation of this state includes the act of using or acting out and all of the actions that lead directly to it. Some examples are: driving to a bar or liquor store, contacting the dealer, hunting/searching for drugs, etc.

Risk Factors Leading to Relapse

Risk factors will usually become prevalent from days to months before the actual relapse. These often come as physical and emotional triggers that lead to poor self-efficacy as someone turns to their addiction to alleviate negative feelings rather than using proper coping skills. An individual can take preventive actions to prevent relapses by being aware of the triggers. Having a relapse prevention plan in place can help.

Risk factors that can trigger a relapse include:

• Exposure to Addictive Triggers: certain locations or people may become a trigger for those with addiction. For instance, driving by a location where past drug use took place can lead to the person experiencing euphoric recall and having the desire to use again.
• Stress: can be an overwhelming experience for anyone but more devastating to those already struggling with addiction. When an individual experiences stress, he or she might engage in addictive behaviors as a maladaptive way of coping with it.
• Interpersonal Conflicts: an interpersonal conflict can lead to distressing feelings such as anger, pain, fear, insecurity, etc. If the individual does not possess skills that enable them to process their challenging emotions, it can lead to despair and the desire to be numbed through substances.
• Peer Pressure: causes individuals to act out in ways they would not otherwise do to fit in or be noticed. There is a strong correlation between negative peer pressure and addiction.
• Lack of Social Support/Isolation: when an individual has trouble in life, social support can help alleviate the stress and provide comfort. Without it, the individual becomes isolated and is left to struggle on his or her own.
• Physical Pain: can happen because of an injury or long-term illness. When the pain is severe, the individual might look to substances as a way to manage it. It is important to emphasize that licit medication can still lead to addiction and relapse.
• Low Self-Efficacy/Low Self-Esteem: these individuals frequently struggle with the thought of not being good enough, which often leads to self-doubt about recovery and maintaining sobriety. Using substances might be the only way for them to soothe their low self-esteem insecurities, even if the effects are short-lived.
• Positive Moods/Overconfidence: individuals with overconfidence might be under the delusion that everything is under their control. When things become unpredictable, they struggle with accepting this new reality and subsequently turn to substance.

What to Do After a Relapse

The sooner action is made after a relapse, the better chance there is to get back on track to recovery, preventing addiction from becoming engrained again. Recovery from a relapse is always possible, regardless of how long someone has been in relapse.

Some steps to take after relapse include:

• Reach Out for Help: when life problems become overwhelming and unmanageable, the individual should reach out for help immediately. Professional guidance can provide individuals with tools and help them see their problems from a different perspective.
• Find a Support Group: support groups are resources for individuals working on their recovery and sobriety. This format allows individuals to openly discuss their struggles and get feedback from others.
• Avoid Triggers: it is highly critical that individuals avoid known triggers that led to past relapses. Knowledge and accountability are essential in understanding and planning for recovery.
• Set Healthy Boundaries: it is important for individuals to recognize what is and are not conducive to their recovery by setting healthy boundaries. This step may require the individuals to make short-term sacrifices for long-term gains.
• Practice Self-Care: self-care ensures the individual is mentally and physically healthy to handle life stressors. Depleted individuals are more like to relapse than those who are not.
• Reflect on the Relapse: though relapse can be traumatic and disheartening, it can provide new insights and self-awareness. Reflecting on relapse can help the individual develop new skills for self-management.
• Expect Struggle and Discomfort: unrealistic expectations about recovery (e.g. never relapsing, being able to have a full recovery in a short amount of time, having a smooth process of recovery, etc.) can actually set the individual up for failure.
• Develop a Relapse Prevention Plan: developing a relapse prevention plan is a good way for the individual to prepare for a relapse. Having a well-thought-out plan provides concrete, actionable steps for early intervention.

When to Consider Treatment

Because addiction is a chronic disease, relapse is very common and 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, it is crucial that the individuals 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 more addictive quality than others and may require more intensive treatments (e.g. residential, detox, rehab).
• Level of Social Support: having a good support network can help the individual feel comfortable and cared for. If there are relationship ruptures, it is important for the individuals to take time to repair them. Making amends is one of the most powerful steps in the recovery journey.
• Housing Options: the individual must assess if their living situation is conducive to their recovery. If past usage consistently took place at home, being in the same place can trigger the euphoric recall.
• Access to Transportation: this is another important element to consider before returning to treatment. Long commutes or lack of adequate transportation can become barriers for those working on their recovery.
• Physical or Mental Health Conditions: are greatly important in whether or not treatment can be successful. Being physically or mentally unwell can exacerbate symptoms and complicate recovery.
• Past Treatment Efficacy: if past treatment did not produce desirable results, making a new plan and setting new goals is important. Recovery is a matter of learning what works and what does not work.
• Proximity to Triggers: external triggers are people, places, or activities associated with substance use or acting out. Putting distance between the individuals and these elements helps to minimize cravings.

Treatment Options for Managing Relapse

Addiction is a complex illness requiring treatment to 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. It is important to emphasize that addiction is a chronic disease and, as such, requires a lifetime commitment to maintaining progress and sobriety.⁷

Here are some possible treatment options to pursue after relapsing include:

• Group Therapy: provides a safe space for individuals to come and share their struggles or progress and receive critical feedback from their peers. The group therapy modality is great for individuals with relapse to openly discuss their struggles and get feedback from others.
• 12-Step Programs: connect the individual to a group of peers who have or are experiencing the same issues. Research showed that peer support and accountability greatly reduce the chances of a relapse.
• CBT: Cognitive Behavioral Therapy 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 underlying core beliefs that led to the relapse.
• Rehab: are facilities where an individual checks in and stays for an extended amount of time while receiving 24-hour care and supportive treatment. This is the most restrictive treatment method as it requires the individual to suspend their normal responsibility for the duration of the stay. The rehab treatment modality is for individuals with severe symptoms and high relapse risk.
• Intensive Outpatient Therapy: provides a structure for individuals to continue working on their recovery with less restriction. The individual typically comes to the facilities for intensive outpatient therapy treatment but can return home after the session ends. This modality is appropriate for individuals with mild to moderate symptoms and low relapse risk.

Finding a therapist requires research and is possible through the online therapist directory. Because each individual has different needs and expectations, not one modality nor any therapist would be a good fit for everyone experiencing a relapse. For optimal progress to occur, working with therapists or facilities specializing in addiction treatment is best.

Final Thoughts

Relapsing with an addiction is hard to overcome, but therapy and contacting your support network can help. Having realistic expectations about relapse and addiction treatment instills knowledge and prepares the individual to cope with his chronic illness.