Addiction to alcohol or drugs impacts millions of Americans every day. And while many find addiction treatment facilities, receive treatment, and go on to live substance-free, happy lives, there are those too who find recovery for a time and eventually go back to using alcohol or drugs—or relapse. Knowing the warning signs of a relapse and what to do can be important in preventing potentially deadly relapses.
According to the 2018 National Survey on Drug Use and Health (NSDUH), in 2018 about 21.2 million Americans over the age of 12 years needed treatment for a substance use disorder. And sadly, of these 21.2 million, only 3.7 million received treatment. But, treatment is only the first step in long-term recovery.
For those with an alcohol use disorder (AUD) or substance use disorder (SUD), it may seem like clinical treatment is completed, life in recovery begins and is easy. However, for many who have walked this road, leaving clinical treatment is when the real work begins.
Long-term, sustainable recovery doesn’t just happen. It takes work, perseverance, willingness, and commitment. Some have found this out the hard way. For those who have loved ones with an AUD or SUD, they too think that after clinical treatment all will be good. And while for some, this is the case, the majority of those with an AUD or SUD will need to make recovery their priority for years to come.
The National Institute on Drug Abuse (NIDA), reports that more than 85% of people relapse within one year. This is a lot of people relapsing. Initially, this number may seem alarming, however, many of these individuals who relapse will find recovery again and go on to long-term recovery.
What is a Relapse?
Relapse is defined as the deterioration of health after a period of improvement. A relapse, as it is used in relation to an AUD or SUD, is when a person stops drinking alcohol and/or using drugs for a period of time but then returns to using either or both.
Relapse can be a scary thing not only for the individual with the addiction but also for loved ones who watch. At one time, addiction treatment focused on the time the individual was in treatment and not once they left. However, today, a reputable addiction treatment center will have specific relapse prevention strategies for each of their patients. This is essential.
According to recent research, knowing the warning signs and stages of relapse can help to prevent an individual from relapsing as well as help loved ones to support them.
Many in the recovery community refer to two ‘kinds’ of relapse. One, referred to as a ‘slip’, and the other a full relapse. So what’s the difference and how does this impact one’s recovery?
A ‘slip’ is when an individual who has stopped using alcohol and/or drugs picks up a drink and takes a sip or takes a small hit of marijuana, etc. A slip usually ends quickly and the individual returns to abstinence quickly afterward. To many on the outside of the recovery community, this may seem minor, however, just this small ‘slip’ can lead to a full relapse down the road and should not be ignored.
A ‘full relapse’ is when an individual decides to use alcohol or drugs again. They may seek the substance or they may be somewhere it is and decide to use it again. For some, this results in a binge and for others, they are fast-tracked back to life in addiction to either alcohol or drugs or both.
Many times people who relapse report that they simply wanted to drink one more time or use the drug once more. What often happens is that once they have started to use again, they find it very difficult to stop on their own again. This is why relapse prevention strategies and plans for sustaining recovery after rehab are vital.
For some, relapse will be quick and they return to their support groups and get back on track. For others, the road will be long and they may never return to recovery. Still, for others, their first relapse will end in death. It’s essential to know the warning signs of relapse and what to do.
Whether you use the term ‘slip’ or ‘full relapse’, any return to the use of alcohol or drugs after a period of abstinence is a relapse. And both situations can be prevented and helped with the same tools. The first step is to understand how relapse happens and what warning signs of relapse to look for in both yourself and your loved ones.
Three Stages of Relapse
Previously, relapse was thought of as detrimental and sudden. Loved ones of those who have relapsed may have ‘never seen it coming’ or thought ‘everything seemed fine’, etc. However, more recent research into relapse reveals there are actually precursors to relapse which can often occur in three different stages.
It’s crucial to understand that relapse is a gradual process that happens over time. For some, the first stages of relapse begin months or weeks before they actually pick up a drink or drug. Let’s explore the three stages of relapse and how you can use this information to prevent relapse or be aware of early warning signs of relapse and take action.
Stage One: Emotional Relapse
During this first stage of relapse, the individual is most likely not thinking consciously about using alcohol or drugs again. The memory of the pain of their addiction is still strong enough to deter them from this thought. However, the issue is that they are beginning to experience difficult or challenging parts of life and their emotional well-being is not healthy. Resorting to previously relied-upon coping skills they begin to go back to habits that aren’t healthy and don’t support recovery.
These difficult emotions and associated behaviors begin to unknowingly set them up for a relapse. Denial may be part of this stage. The person with the AUD or SUD isn’t actively thinking about using alcohol or another substance at this point so they may deny that they are struggling with staying in recovery.
One of the overall biggest signs of an emotional relapse is lacking self-care or decreasing self-care. This can be seen in how they are engaging with others, their outer appearance, and overall ways they are tending to their needs.
Here are some specific emotional relapse signs:
- Stopping attendance at support groups out of rehab like Alcoholics Anonymous, etc.
- Keeping feelings and emotions to oneself
- Attending support groups but not participating
- Focusing on other people and their problems
- Blaming other people for one’s own feelings and problems
- Engaging in poor self-care habits such as poor eating, sleeping, and hygiene habits
This lack of care for oneself can be emotional, physical, psychological, or all of them. While the specific signs may differ from one person to the other, the overarching theme of the emotional relapse is the lack of self-care in one or all of these areas.
During this stage of relapse, a return to therapy in which self-care is addressed can be helpful. Understanding oneself and one’s needs—physical, emotional, and psychological—is important if an individual is in this stage.
In clinical treatment, the need for self-care as well as recognizing when one’s self-care is lacking are often discussed. ‘How does that feel?’, ‘Are you pushing yourself too hard?’, ‘Are you feeling overwhelmed?’ are often-heard questions in rehab. These are essential to continue to ask once clinical treatment has ended.
This is also where honesty comes into play. Answering these questions honestly is vital in preventing relapse. Often, individuals in recovery just want to ‘be better’ and hesitate to talk about when they are struggling. For some, they are already experiencing guilt from active addiction, it’s difficult to admit they are struggling again. However, it is essential, to be honest with oneself and others, in order to stay in recovery.
Remember, everyone needs help at one time or another in life. It’s okay to struggle in recovery, it’s okay to ask for help. This is true whether you have one day sober, one month sober, or ten years sober.
When the emotional relapse stage continues untreated, it eventually leads into the next stage of relapse—mental relapse.
Stage Two: Mental Relapse
Often as individuals continue quietly without getting help in the emotional relapse stage they become more easily agitated, discontented with their lives, and generally restless. Once this takes hold and becomes a regular way of feeling, they may begin to think about using alcohol, drugs, or both again. This is a mental relapse.
During this time, they may fantasize more and more about using alcohol or drugs. At this point, individuals become more focused on escaping the uncomfortable feelings they are experiencing than on resisting relapse. For many, using alcohol or drugs is still their ‘go-to’ escape or solution to the pain they are experiencing. While they may have acquired new coping skills in recovery and rehab, they are either not solidified or they simply return to their old ways of thinking and coping.
Here are some signs of mental relapse to watch for:
- Romanticizing past alcohol or drug use
- Forgetting about the devastating consequences of alcohol or drug use
- Thinking about or associating with people and places previously associated with drug or alcohol use
- Starting to crave alcohol or drugs
- Looking for opportunities to drink or use again
- Considering returning to alcohol or drugs with a plan for how to keep it controlled
- Planning to drink or use drugs
It’s important to note that once a person has experienced addiction, to alcohol or drugs, that will never be forgotten. It is also vital to understand that thinking about using alcohol or drugs again is normal. The key is that if the thoughts come more often, are regular, or increase in intensity with changes in behaviors. These can differentiate between normal thoughts of drinking or using and a mental relapse.
Equally crucial is removing shame associated with these thoughts and feelings about alcohol or drugs. Most likely these thoughts will not ever completely leave, but can be recognized as acceptable on occasion and worked through with the right coping skills in place.
If an individual passes from the emotional relapse stage to the mental relapse stage and nothing is done, they will almost always move on to the next stage of relapse, the physical stage.
Stage Three: Physical Relapse
As the name clearly indicates this third and final stage of relapse is when the individual actually picks up and uses alcohol and/or drugs. Clinically speaking, relapse is defined as the uncontrolled use of drugs or alcohol. However, what many in recovery and their loved ones don’t understand is that even when a full return to alcohol or drugs hasn’t occurred, just one drink may be setting them up for a full-blown relapse down the road.
When someone who has an addiction to alcohol or drugs takes just even one drink or uses the drug just one time, it can start a mental obsession with using again. And, as discussed, once there is a mental relapse unless intervention occurs, it almost always leads to physical relapse. This stage of relapse is often the most difficult to stop once it’s begun.
Relapse prevention strategies and awareness are essential for anyone in recovery or if you have a loved one in recovery. These should be established while in treatment before getting back out into the ‘real world.’ Having solid, evidence-based plans in place if you or a loved one enters any one of the three stages of relapse is crucial to long-term, sustainable recovery.
What to Do
If you are in recovery and feel that you are in any one of these three relapse stages ask for help. This help can be from a friend also in recovery, a therapist or support group, reaching back out to the addiction treatment center you attended for aftercare support, a family member, etc. The most important part is that you reach out for help.
Many who have not yet had a physical relapse may be reluctant to do so, however, it’s vital for long-term recovery. It is easier to ward off the relapse the sooner you start experiencing these feelings and thoughts than after you have actually relapsed. However, it’s important to note that many people who now have years of life in recovery have relapsed. Some say it was essential for them to find long-term recovery.
Keep in mind that not all who relapse find recovery again. For this reason, avoiding relapse is important but it’s equally important not to beat yourself up (or your loved one) if there is a relapse.
Whether you are considering getting help for the first time, are in one of the stages of relapse, or have had a physical relapse Futures Recovery Healthcare can help. Offering evidence-based care through three comprehensive treatment programs (Core, Orenda, Rise), Futures is here for anyone looking for help for addiction issues.
Contact Futures today to get help for an AUD, SUD, or mental health issue.