Warning Signs and Relapse Prevention Questions

Drug relapse is a common part of many people’s recoveries, but it can be disheartening to both the recovering person and those who love them and are invested in their sobriety. The questions below will help you to understand more about relapse, including the difference between a relapse and a lapse, common warning signs, and what to do if you’ve had a relapse. 

What does it mean to relapse?

In terms of drug abuse, a relapse refers to the return to substance use after a period of sobriety. For example, if you have been abstinent from alcohol for several months and then you end up going out and drinking with your friends some might say you have relapsed. On the other hand, some addiction and relapse prevention professionals have distinguished a relapse from a lapse and, in fact, place a lot of emphasis on this distinction. So, if you returned to using your drug of choice one time it would be considered a lapse, but if you returned to repeated use and your previous addictive behaviors, it would be considered a relapse.¹

For many people who have struggled with addiction, it is impossible to return to their drug of choice just once, which is why staying completely abstinent is most often advocated by addiction treatment professionals and recovery groups.

What are some relapse warning signs?

Luckily, as with most conditions or problems, there are some warning signs you can look out for that may be indicators of an impending lapse or relapse:

• You have started isolating yourself and withdrawing from family and friends or your support network. This may include missing your AA or NA meetings.
• You stop taking good care of yourself and notice that you are not sleeping or eating well or are neglecting your personal hygiene.
• You start thinking more and more about using, or that you’ve been sober long enough and can probably handle it this time.
• You are experiencing overwhelming negative emotions such as depression, anger, stress, or loneliness.
• You begin to find yourself feeling triggered more than normal.

What are triggers?

Triggers are people, places, objects, situations, emotions, or thoughts that spark a desire to use drugs. A trigger might be something that was previously associated with your substance use (such as the person you used to use with) and so it has the potential to produce strong memories of using and bring about cravings. A trigger might also be something that creates an urge to use as a maladaptive way of coping, such as feelings of rejection or inadequacy. Either way, knowing what your triggers are and making a plan for how to deal with them is an extremely important part of relapse prevention.

For many people who have struggled with addiction, it is impossible to return to their drug of choice just once.

Are there things I can do to prevent myself from relapsing?

If you have already been through a treatment program, it is likely that you worked on a relapse prevention plan prior to discharge. If not, the first thing you will want to do is work on developing a strategy to help you stay on track that includes viable actions you can take if you notice you are at risk for relapse.

Good relapse prevention can be summed up by 2 basic steps: awareness and action. In order to take effective action toward preventing relapse, you must be aware that you are at risk. This is likely one of the reasons relapse prevention programs that incorporate mindfulness have been shown to be so effective.^1,2,3 Mindfulness is a practice geared towards helping you be more connected to and aware of the present moment. Thus, the more mindful you are, the better you will be about noticing and managing your response to a triggering situation.

While the safest course of action is to stay away from high-risk situations where you’re likely to feel triggered, it isn’t always possible to avoid situations like these. In this case, there are several actions you might consider taking:

• Talk to someone about your feelings and/or your urge to use, such as a sponsor or a trusted family member or friend.
• Distract yourself with something until the urge passes. For example, you could step outside, engage in your favorite hobby, or exercise.
• Engage in an alternative activity that matches what you are trying to achieve from your substance use. For example, if you are feeling like you want to use out of boredom, try to find something else fun that you can do. It might help to make a list of things to do so you are not trying to come up with something in the moment.
• Practice any coping skills you have learned, such as relaxation exercises or journaling.
• Challenge any beliefs you have that using again will bring positive outcomes.¹ For example, is it really true that you can have just one? There is a common tendency to romanticize some parts of past substance use, but if you look more closely you will realize that it wasn’t all fun and games, you experienced numerous negative consequences, and you weren’t able to moderate your use like you thought.

Steven Melmis, a professional who has worked in the field of addiction for 30 years, also offers 5 rules of recovery that you may want to consider:⁴

1. Change your life: Recovery involves more than just not using—it requires a lifestyle change.
2. Be completely honest: Lying and denial support addiction, and your secrets keep you sick. Make a commitment to be truthful, at least within your recovery circle (family, doctors, counselors, close friends, 12-step groups).
3. Ask for help: Don’t wait or try to do it all on your own. Use support groups that are available to you (such as AA or SMART Recovery).
4. Practice self-care: Do what you can to relax, set healthy boundaries, and treat yourself with care and respect.
5. Don’t bend the rules: Don’t ignore the advice that professionals have been giving you or try to find loopholes in the strategy for recovery.

What do I do if I relapsed?

If you slipped up and used just once, remind yourself that you have had a lapse, not a relapse, and that the earlier you take action, the better. Judging yourself is not going to help, so try acknowledging that you are not perfect and you made a mistake—what’s important now is that you take whatever action is necessary to prevent yourself from fully relapsing. That might include calling your sponsor, going to meetings, making an appointment with your counselor, and talking to family and friends.
Try acknowledging that you are not perfect and you made a mistake.

If you feel your existing support structure is not enough, and especially if you’ve begun using in a compulsive manner again, consider returning to a treatment program.

If I relapsed, does it mean I’m completely starting over?

Common feelings after a relapse may be a sense of failure and disappointment, worry, or feeling like you are back to square one and have to begin recovery all over again. It’s important to understand, however, that relapse is a common part of a long journey of recovery for many people. In fact, the National Institute on Drug Abuse describes relapse as “likely,” and The Journal of the American Medical Association states that “among individuals with substance abuse disorders who get treatment, 40% to 60% will relapse within 1 year.” ^4,5

A slip is an isolated incident, and it doesn’t have to mean you haven’t made any progress or that you’ll never recover. Instead of focusing on the mistake or worrying that it means you won’t get better, focus on all of the gains and successes you have already had and use that to propel you forward. Also consider the fact that, even if you have had a full relapse, you are still ahead of where you were before since you have a set of tools to draw from as you work to make a new foothold in your path toward sobriety.

Do I need to return to treatment if I have relapsed?

Returning to treatment might be a necessary course of action for you. Remember that the longer you wait to reach out for help after a relapse, the harder it is going to be to stop. If you realize what led to your relapse, know what actions to take, and feel you can follow your relapse action plan, then you may find success in attending regular meetings and counseling appointments.

However, be honest about where you are and know that it is okay to go back to a full treatment program if you need to. If you are unsure, talk with your counselor or sponsor or do a consultation with a treatment center to help you decide what is best for you at this time. Again, a relapse is not a failure—it is only one part of your journey to a life free from addiction. With that said, don’t wait to ask for help if you think you might relapse or if you have already done so. You don’t have to be ashamed—it is better to be honest and address the problem right away than try to keep it a secret and allow yourself to slip back into the unrelenting grip of addiction.

References:

1. Marlatt, G. A., & Witkiewitz, K. (2007).Therapist’s Guide to Evidence-Based Relapse Prevention. Amsterdam: Academic Press.
2. Slomski A. (2014). Mindfulness-Based Intervention and Substance Abuse Relapse. Journal of the American Medical Association. 311(24):2472.
3. Grow, J.C., Collins, S.E., Harrop, E.N., & Marlatt, A.G. (2015). Enactment of home practice following mindfulness-based relapseprevention and its association with substance-use outcomes.  Addictive Behaviors, 40:16-20.
4. Melemis, S. M. (2015). Relapse Prevention and the Five Rules of Recovery. The Yale Journal of Biology and Medicine, 88(3), 325–332.
5. National Institute on Drug Abuse. (2014). Drugs, Brains, and Behavior: The Science of Addiction.