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Drug and Alcohol Addiction Relapse: Stages, Prevention, and Treatment

Addiction is a brain disease that causes a person to compulsively use substances. They may continue to use even while knowing that doing so will have dire consequences.1 While addiction is a chronic disease (similar to high blood pressure or asthma), it is treatable.1

Addiction causes a disruption in brain functioning. Areas of the brain tied to reward, self-control, and pleasure are affected—and can continue to be affected for a long period of time after a person stops using drugs.1 These changes to brain functioning make it difficult for a person to stop using substances through sheer willpower alone, even when they want to.1

What Is a Drug/Alcohol Relapse?

According to the United States Department of Veterans Affairs, relapse is both a process and an event.2 A relapse is not a sudden event that occurs without warning, but it is often the final step in a progression of behaviors.2

When a person enters recovery, their treatment team develops a plan of various interventions, such as medication, therapy, and self-help groups.1 Relapse is less likely to occur if a person follows their treatment plan, has structure, and has a support system.1 Relapse is not a moral failing, but rather a sign that a person’s treatment plan is not fully compatible with recovery for their specific needs. For example, maybe their relapse plan does not address their underlying triggers that drove their addiction.1 No one treatment plan is right for everyone, and many treatment plans require modification.1

Relapse after rehab is common. However, when compared to other types of chronic illnesses—such as asthma and high blood pressure, where the relapse rates from a treatment plan are around 50%–70%—the relapse rates for substance use treatment are actually lower, with an average of about 40%–60%.1

Types of Addiction Relapse

As discussed above, relapse is a process.2 The immediate act of resuming substance use, or what is called a lapse, is a one-time event.2 However, if a person keeps using substances, the lapse is then a relapse.2

There are different models of recovery from addiction. While the abstinence-only model is common—where a person plans to abstain from using all substances—harm reduction is another type of recovery.3 For example, a person may decide to reduce their harmful behaviors involving alcohol.4

Warning Signs and Stages of a Relapse

Generally, relapse occurs after a series of various behaviors and warning signs occur.2 Some of these signs include:2

  • Thinking about drug use or about drugs.
  • Denying the need for support or refusing to reach out for support.
  • Going back to people and places associated with substance use.
  • Increased behaviors that were associated with past substance use.
  • Not taking prescribed medications that treat a substance use disorder.

Overall, there are 3 stages of relapse: emotional, mental, and physical.5

What Is an Emotional Relapse?

The emotional phase of relapse does not involve active thinking about using again.5 Typically, a person remembers the negatives associated with using and has no desire to use again, but their emotional state is setting the stage for a relapse.5 These signs of the emotional stage of relapse indicate poor self-care and include:5

  • Not talking about emotions.
  • Isolating from others.
  • Not attending support group meetings.
  • Going to meetings, but not really participating.
  • Focusing on the needs and issues of others.
  • Poor eating and sleeping habits.

Over time, this emotional stage of relapse leads to feelings of unhappiness, restlessness, and the mental stage of relapse.5

What Is a Mental Relapse?

A person’s mental relapse will involve a breakdown of cognitive processes that help a person to not use substances after they think about the consequences of such use.5 A person’s need for escaping their emotional and mental state increases, and signs of relapse will start to emerge, including:5

  • Cravings for substances.
  • Having thoughts of being with people, or going to places associated with drug and alcohol use.
  • Glamorizing past use or minimizing the negative consequences such use had on their lives.
  • Bargaining about using, such as thinking they can use other drugs, instead of the one that led to treatment. For example, thinking that they can smoke marijuana instead of drinking alcohol.
  • Lying about various things.
  • Thinking of ways to use that they think they can control, such as having substances only while on vacation.
  • Looking for opportunities to engage in relapse.
  • Planning opportunities to engage in a relapse.

What Is a Physical Relapse?

Physical relapse occurs when a person engages in ongoing use.5 Sometimes, just having 1 drink or using a substance only once leads to a full relapse.5 Many physical relapses result from a single opportunity—such as being offered a drink at a social event. If the individual hasn’t developed strong coping skills to manage such situations, it might cause them to use again.5

Causes and Risk Factors for Relapse

The brain undergoes functional changes during the course of addiction, impacting healthy brain functioning.1 Often, a person will experience cravings and substance use withdrawal symptoms for several months after they stop using, which can lead to relapse.5

The social factors that are frequently associated with relapse include:2,6 7  

  • Poor coping skills.
  • Symptoms of depression.
  • More severe levels of addiction.
  • Lack of social support.
  • Lower levels of belief in the ability to overcome the addiction.
  • Work stress.
  • Family problems.
  • Lack of motivation to change.

Daily behaviors that can increase the risk of relapse include:2,5

  • Not attending support group meetings.
  • Associating with those who the individual previously used substances with.
  • Isolation.
  • Becoming hungry, angry, lonely, and/or tired (HALT).

In addition, health-related factors that increase the risk of relapse include:2,7

Environmental cues—such as walking past bars and liquor stores or smelling an odor that is associated with drug use—can also impact relapse.1,7 There is a multitude of risk factors for relapse, and each person may have specific signs that a relapse might be coming.2

Relapse Prevention Strategies

It is important to understand that recovery is a lifelong journey, and that relapse can occur even after years of being sober.2 In addition, a person needs a treatment plan that is individualized to their specific needs.7 It is critical that people go into recovery well prepared, as well as that their treatment plan utilizes numerous strategies, including:2,7

  • Medication for addiction treatment when appropriate.
  • Family therapy and support.
  • Behavioral therapies—such as cognitive behavioral therapy (CBT)—to help cope with cravings and triggers to use.
  • Support groups—such as 12-Step or other peer groups—for ongoing support.

Some of the critical components—or rules—for relapse prevention include:5

  • Change your life, including changing the people, places, and things associated with drug use, as well as changing negative thinking.
  • Be completely honest with yourself and others.
  • Ask for help, which includes getting formal substance abuse treatment, but also following up with self-help and peer support groups. These groups help people realise that they are not alone in their recovery.
  • Practice self-care, such as mind-body relaxation, which can help a person stay in recovery.
  • Don’t bend the rules, which involves looking for loopholes or exceptions to recovery processes.

What to Do After a Relapse

Relapse is not a failure, but part of the recovery process for many people.1 However, when someone relapses, it is important to return to a provider who can quickly adjust treatment to match the needs of the person and help them get back into recovery.2 These changes can include more intense treatment or adding additional support group meetings.2

If you need to return to treatment, there are several levels of treatment that can occur. Typically, you will undergo a thorough assessment to determine your treatment needs.8

Levels of treatment include:

  • Detoxification treatment—needed in some cases, depending on the types of substances involved. Detox is a series of interventions that helps to get a substance safely out of the body and stabilizes a person to get ready for further treatment.8
  • Inpatient treatment—you can stay 24 hours a day under medical supervision and receive behavioral therapy.
  • Outpatient treatment—you go home at night and on weekends but engage in services during the day. Some outpatient programs meet a few hours a week, while some may require up to 20 hours per week.

Regardless of whether you are in inpatient or outpatient rehab, there are various therapy approaches that can help a person overcome substance use disorders and sustain recovery. These include:1

Ongoing participation in mutual support groups—such as 12-Step groups like Narcotics Anonymous (NA) and Alcoholics Anonymous (AA)—is also helpful in getting people back into recovery and increasing abstinence.2

How to Help Someone Who Has Relapsed

Even if you feel discouraged by a relapse, it is important to remember that treatment does work. For example, studies show that around 1/3 of people who get treatment for an alcohol use disorder have no symptoms 1 year later.9 Furthermore, research shows that while many people do relapse, more people sustain recovery, even though it may take more than 1 treatment episode.2

When someone has a substance use disorder, it is important to help them, and it is better to get help sooner rather than later. With some substances—such as opioids—it is critical to get someone back into treatment to help avoid a potentially fatal overdose that can occur after a period of abstinence from the drugs.2

If you are concerned about a loved one who has relapsed, there are steps that you can take. For example, you can speak with a doctor about addiction treatment options.9 You can also research options for treatment and find out as much as you can.9

Ideally, when approaching your loved one about getting help, it is important to talk to them in a private setting and express your concerns in a direct way.10 Listen to what they have to say and offer to help, but concentrate on staying patient.10

It is important to understand that family support is a helpful component of recovery and treatment.11 Groups and treatment programs that provide family therapy can help increase the overall effectiveness of therapy by providing support to the whole family.11 A support group you can consider attending if your loved one is struggling with a substance use disorder is Al-Anon; a 12-Step program that helps you cope with your loved one’s substance use.12

If you a your loved one is in need of treatment, you can find a rehab center by using our online treatment directory. Remember that treatment works, and some people do relapse as part of their journey to sustained recovery.2

If you want to find out how your insurance coverage may be able to pay for part of the cost of rehab, you can check your health insurance benefits online. You can also call American Addiction Centers (AAC) free at .

Drug and Alcohol Addiction Treatment Levels of Care

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