Drug Relapse: Warning Signs and Prevention
Drug relapse is common, especially in the first year of recovery from a substance use disorder. Importantly, relapse does not mean recovery has failed or is impossible. Understanding the stages of relapse, relapse warning signs and how to manage relapse can be the difference between being able to use a relapse event as a valuable learning experience or giving up on recovery and slipping back into substance use.
The Definition of Relapse
According to the Merriam-Webster dictionary, relapse is defined as:
- The act or an instance of backsliding, worsening or subsiding
- A recurrence of symptoms of a disease after a period of improvement
When applied to recovery from a substance use disorder, relapse means that someone who had successfully managed to abstain from their drug of choice backslides into substance use. Relapse may be a one-time event, or it may lead to regular and worsening substance use.
How Common is Relapse?
According to the National Institute on Drug Abuse (NIDA), between 40% and 60% of people with a substance use disorder will have a relapse event. Although this statistic is daunting, it is important for people in recovery to understand that relapse does not equal failure. In fact, many people who have had long term success in recovery look back on their relapses as valuable learning experiences.
Statistics on drug relapse show that relapse rates without professional treatment vary by drug type:
- Opioids (heroin, oxycodone) are associated with the highest relapse rates. More than 90% of people who quit using opioids will relapse.
- Nicotine has relapse rates that are estimated to be between 80% and 90%.
- Alcohol is associated with relapse rates between 50% and 80%.
- Cocaine relapse rates are estimated to be between 40% and 80%.
Relapse rates are lower for people who have completed professional rehab programs, but even then relapse rates can approach 50%. Rather than letting this be a discouraging statistic, it should help people understand that relapse is frequently a normal part of a successful recovery and many people who have enjoyed long-term sobriety experienced frustrating setbacks in the form of relapse.
Studies have shown that relapse vulnerability for cocaine is at its highest in the first 1-6 months after quitting, and relapse for most drugs typically occurs within the first year of sobriety.
Stages of Relapse
There are three stages of relapse:
- Emotional relapse: The first stage of relapse is generally not associated with thinking about using drugs. Many people in this early stage are determined to maintain sobriety. However, an emotional relapse often includes denial, self-isolation and overall poor self-care, which can increase the risk for depression and future relapse.
- Mental relapse: The second stage of relapse is characterized by a gradually increasing desire to use the drug of choice. Many people in mental relapse will bargain with themselves (“I will only use the drug at social events where it is acceptable”) or glamorize past use.
- Physical relapse: The final stage of relapse is the actual relapse event. The best way to prevent physical relapse is to understand the warning signs and symptoms associated with the first two stages.
Warning Signs and Symptoms of Relapse
While relapse may seem spontaneous, it is actually a gradual process that involves an “incubation of craving.” As the three stages of relapse progress, cravings often become stronger. If triggers or temptations are present, these cues will further drive the development of cravings.
Among the strongest relapse warning signs are reductions in self-care. Physical self-care involves proper diet, sleep and hygiene. Exercise is a valuable way to limit the risk for relapse. Emotional self-care involves making time for yourself, and therapies like cognitive behavioral therapy and motivational interviewing have been shown to be incredibly beneficial ways to help people understand their own motivations and learn how to manage emotions, control negative self-talk and improve outlook.
The acronym HALT has been used as a way to check on your level of self-care: Feeling like you are Hungry, Angry, Lonely and Tired is a major red flag that signals increased risk for relapse.
Triggers are things that remind you of your drug of choice and that promote cue-induced craving incubation. Common triggers are old friends who you used drugs with, places where you used drugs, drug paraphernalia and even songs that you listened to while using.
It will generally be impossible to completely avoid triggers, which is why making a relapse prevention plan is so important. When you can successfully face a trigger without succumbing to temptation, you will gain confidence in yourself and your ability to maintain long term sobriety.
How to Prevent Relapse
Relapse prevention is a crucial component in successfully managing short and long term recovery. Having a relapse prevention plan can be the difference between resisting or giving in to a temptation.
Relapse prevention can be substantially aided by having a solid network of supportive people in your life. Discussing your goals for sobriety and why recovery is important to you with someone you trust can be valuable if you start to question whether the challenges of recovery are worth it- having someone remind you of your goals and inspirations can be incredibly motivating. Aftercare or 12 step programs can be helpful ways to meet new people and develop a new, supportive network of friends.
Untreated co-occurring mental health disorders such as depression, anxiety and post-traumatic stress disorder are significantly associated with relapse. Conversely, a positive outlook and an ability to cope with stressors are significantly associated with successful recovery.
Other tips to prevent relapse include:
- Wait 30 minutes. Most urges will subside over the course of 15 to 30 minutes.
- Re-define “fun.” Find new hobbies or activities to replace your old ones. Exercise, arts & crafts and volunteering can be incredibly fulfilling and confidence-building.
- Learn from setbacks. If you relapse, make sure to take the time to understand which factors contributed to the relapse. Relapse is a learning experience, not a failure.
- Participate in cognitive behavioral therapy or another form of therapy that helps you become comfortable with your new sobriety.
If you are struggling to overcome a substance use disorder, you don’t have to do it alone. The experts at The Recovery Village Ridgefield understand the challenges of recovery and the risks that can lead to relapse, and we can help you make a relapse prevention plan that accounts for the triggers and temptations that are unique to your circumstance. Contact us today to learn more.
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National Institute on Drug Abuse. “How effective is drug addiction treatment?” Updated January 2018. Accessed October 24, 2019.
Velander, Jennifer R. “Suboxone: Rationale, Science, Misconceptions.” The Ochsner Journal, Spring 2018. Accessed October 23, 2019.
Hendershot, Christian S.; et al. “Relapse prevention for addictive behaviors.” Substance Abuse Treatment, Prevention, and Policy, July 2011. Accessed October 24, 2019.
Moos, Rudolf H.; Moos, Bernice S. “Rates and predictors of relapse after natural and treated remission from alcohol use disorders.” Addiction, September 2007. Accessed October 24, 2019.
National Institute on Drug Abuse. “Study Ranks Recovery Assets in Cocaine Addiction.” Updated July 2015. Accessed October 24, 2019.
National Institute on Drug Abuse. “EEG Indicates That Cocaine Relapse Vulnerability Peaks 1 to 6 Months Into Abstinence.” September 2017. Accessed October 24, 2019.
Melemis, Steven M. “Relapse Prevention and the Five Rules of Recovery.” The Yale Journal of Biology and Medicine, September 2015. Accessed October 23, 2019.
National Institute on Drug Abuse. “Cues give clues in relapse prevention.” April 2019. Accessed October 24, 2019.
Medical Disclaimer: The Recovery Village aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.