What to Do After a Relapse
A ‘relapse’ is when someone stops working towards their goal of reducing or cutting out alcohol or drugs.
This is characterised by returning to alcohol use or drug use and can either be momentary or a prolonged period of use. For example, an alcoholic would relapse after a year of sobriety, by getting drunk at a party. [1]
Recovering from an alcohol use disorder or a substance use disorder takes both time and effort. A relapse is usually thought of in a negative light, as a moral failing or lack of strength. However, relapsing is a normal part of the recovery process. [2]
A ‘relapse’ is different to a ‘lapse’. A lapse is only temporary and less serious. If someone is trying to cut down on alcohol, they might lapse by momentarily departing from their goals, but will return to them quickly, and with ease, soon after.
For example, someone may lapse if they set a goal of not drinking alcohol for a couple of months, but end up having a couple of beers after a hard day at work. [3]
There is a strong correlation between alcohol and drug use, and personal stress and difficulties. Different things may lead someone to relapse, but there seems to be a trend of circumstances that predispose someone to relapse. Relapse is not failing, nor is it a dramatic end to your journey for a better life.
Relapse is merely a sign that you are using old and ill-fitting coping mechanisms, showing you that you need to create new and better coping mechanisms to help your journey of sobriety.
The common triggers of relapse:
- Stopping medication that helps curve cravings such as Librium
- Being under extreme stress and feeling overwhelmed
- Relationship conflict and arguments
- The death of a loved one
- Illness
- Major life changes
- Tempting situations, such as a party or place where you would have normally drunk or used drugs
- People you used to use drugs or drink alcohol with
- Professional or personal setbacks
- Social pressure
- Mental health issues
- Emotional struggles
- Physical health issues
- Guilt caused by a temporary lapse
The Phases of Relapse
Some relapse prevention programmes focus on the theory of three phases of relapse. Relapse usually starts with an emotional relapse, followed by a mental relapse.
If left untreated, the mental relapse will develop into a physical relapse. Examining relapse in parts allows for programmes to be able to establish their individual signs and symptoms, helping patients at different stages in order to intervene and prevent a full-blown relapse. [4]
The First Stage: Emotional Relapse
This first stage does not involve the thought of relapse; you will not think about drinking or using drugs. Instead, emotional relapse is about the take-over of negative emotions. These emotions almost force you into a pattern of self-destruction, undermining the mental work you have put in so far.
These emotions have consequences, the behaviours that follow negative emotions often form the foundations for a relapse.
Despite this, you may still be in denial about relapse or not be thinking about it at all. Denial can block and prevent effective coping mechanisms from being put in place at an early stage, leaving you vulnerable to mental relapse.
The signs and symptoms of an emotional relapse include the following:
- Isolation (emotional, mental, or physical)
- Anxiety and excessive worry
- Depression and overwhelming sadness
- Loss of appetite
- Lack of motivation
- Intolerance and lack of cooperation
- Focusing on other people’s problems
- Anger, hostility, and resentment
- Increasingly defensive
- Mood swings and mental fog
- The appearance of a lack of self-care
Patients also may avoid counselling or therapy that has been scheduled, as they sometimes believe they don’t need it anymore.
The Second Stage: Mental Relapse
This stage is where you will begin to think about using drugs or drinking alcohol again. There will be an evident mental struggle between the desire to remain sober and on track, and the cravings to use or self-medicate.
This is the antecedent to physical relapse; you will begin to think about whether recovery worth it, constantly trying to figure out if you could hide a relapse and keep it on the down low.
The signs of a mental relapse include:
- Substance cravings
- Romanticising or exaggerating the positives of past behaviour and use
- Ignoring the past negative effects substances have had on your life
- Lying and being secretive
- Bargaining with yourself or others
- Believing your goals are too high so believe you might as well give up
- Planning how to use whilst staying in control
- Looking for opportunities to relapse
- Planning a relapse
- Planning post-relapse programmes
The Final Stage: Physical Relapse
The final stage of relapse takes place as soon as you drink alcohol or use drugs. Despite users thinking they are in control, addiction is a chronic brain disease, and therefore they will never be in control of a relapse.
This is reinforced by the DSM criteria, stating that individuals will rarely have control over relapse or addiction in general.
Dysfunctional behaviours accompany a physical relapse, as patients tend to immediately drop out of treatment and back into old destructive habits. Leaving a relapse untreated can leave patients vulnerable to full-blown addiction.
The Stages of Recovery
Much like the stages of relapse, recovery is also made in stages to ensure that everyone has the best chance at getting back on track. Researchers and medical professionals have worked to identify the following stages of recovery.
These stages have no specific timeline, ranging from weeks to years as all patients have a different recovery process.
The first stage of recovery is abstinence. Professionals will work hard to help patients immediately stop their use following a relapse. The primary concerns at this stage are reducing the cravings and putting coping mechanisms back in place.
This is then followed by the repair stage, working on the damage caused by addiction and relapse. This will look at the emotional changes that have affected their lives and the root causes of the relapse itself.
This may involve patients feeling mentally worse than they did before, as professionals dig deeper into trauma and triggers to help reduce the chances of another relapse.
The final theoretical stage of recovery is called the growth stage. This stage starts after the damage from the relapse has been repaired, and it is expected to last for the rest of the patient’s life.
Sobriety is a life choice, and patients never stop working towards their goals. This stage includes working on relapse prevention skills, new coping mechanisms, and experiences that have been missed because of addiction.
Relapse is a Learning Curve
Those that relapse and really struggle with addiction may find themselves thinking that nobody understands them or what they are going through. The first stage to getting back on track after relapse is being kind to yourself.
However, you must face your issues and aim to work through them but include the possibility of setbacks – relapsing is real and quite likely if the addiction has been severe. Avoid shaming and blaming yourself if you do relapse, instead, think about the causes and triggers, using it as a learning curve rather than a wall in front of success.
Recovery plans last years or even a lifetime, people are mistaken if they think they are ‘cured’ and stop using coping mechanisms or attending treatment.
This has long been a cause of relapse, patients who believe they have overcome addiction feel like they may be able to use substances casually again like others, but this is not the case.
Even if things are going well, 1 month in or 30 years in, it is always best to consider relapse prevention. Relapse might not be the same source of substance, sometimes it might be the start of other addictive behaviour. However, getting help is the most reliable way to recover from a relapse.
The first step is admitting you need help – this is the most important step, if you stay in denial, you are at risk of further relapse. You have not let anyone down by making a mistake and taking a step back.
The best way to make others and yourself proud is by admitting you need to go back to treatment and working hard on correcting past mistakes.
Depending on what stage of relapse you are in, you or others will be able to intervene if you speak out and seek the help you need.
Your First Step: Detoxing
You will already have detoxed before if you have experienced a relapse. This relapse detox will be easier to cope with as you now know what to expect.
This can be both positive and negative; if you had trouble detoxing the first time, you may want to avoid all treatments to avoid withdrawal symptoms. At the same time, consider the fact that withdrawal symptoms might be easier to cope with now you have mechanisms and strategies put in place.
The withdrawal symptoms of a relapse detox will depend on the relapse itself. It will depend on how long the relapse lasted, how intense it was (how much of a substance was consumed), and how you are feeling mentally after the relapse occurred.
Think to yourself:
- What helped me in my last detox?
- What made things easier?
- What am I most scared of and how can I help myself?
- Is it safe for me to detox at home?
- Am I being honest about all aspects of this relapse?
- I have done it before, I can do it again
If your relapse was severe or you are mentally struggling, you may be referred to a specialist centre to carry out your detox and receive further treatment. Detoxing at home is not suggested nor recommended for those who have suffered or are suffering from substance use disorders or alcohol use disorders.
The best chance you can give yourself for recovery is to look at detoxing at an inpatient facility. Here, medical staff are on hand to provide 24/7 medical treatment and help.
This will help curve your withdrawal symptoms, easing your anxiety about how they might be affecting your overall health.
This provides a strong support network to help you through, with therapists helping you identify what coping mechanisms haven’t worked well and which ones you should try next.
You have been through recovery once before, so you know it is possible and you know you can find the right path for you.
After you relapse, you will be able to put in place more effective, tried and tested coping mechanisms. This will help you create a more effective relapse prevention plan; this is also an opportunity for you to grow and develop as an individual.
What Should I Consider in my Relapse Prevention Plan?
- Continuing outpatient therapy
- Trying new therapy sessions such as different group therapy sessions
- Treating underlying mental health conditions
- Consider medication for cravings and mental health issues
- Consider family therapy and behavioural therapy
- Involve family and friends in treatment
- Try local support groups such as SMART Recovery and Alcoholics Anonymous or Narcotics Anonymous
- Put realistic goals in place
- Plan for future relapse
- Learn your warning signs and relapse triggers
- Make your home a supportive environment to reduce future temptations and risks
The risk of relapse can be minimised by proper and suitable treatment programmes. Relapse rates are currently over 50%, proving how normal it is to relapse during recovery.
The road to recovery is long, but the range of treatment options available such as 12-step meetings and behavioural therapies offer everyone the chance to succeed at sobriety.
Drug and alcohol addiction differs from person to person, and so does addiction treatment. This means that rules of recovery must cater to different personal needs as it is a long-term process. Successful recoveries are rare without a relapse or at least signs and risks of relapse.
In order to prevent a full-blown relapse, you must assess recovery efforts, know the signs of relapse, and be conscious of high-risk situations. Relapse is a learning experience, where there will be emotional issues, environmental triggers, and personal triggers.
People believe these triggers and setbacks stop the addiction recovery process, but they are actually a part of the path to recovery.
Recovery plans will take into account the risk of relapse in everyday life, even during long-term sobriety. High-risk situations will rear their head more than you think, so be prepared for them as much as possible.
Addiction is a brain disease, and addictive substances are very controlling. You might have more than a couple of attempts at treatment, but this does not make you a failure.
Focus on mental well-being too, as the return to substance abuse is often a sign of co-occurring mental health issues and self-medicating. Treat this relapse as something to avoid in your next goal of therapy and seek help as soon as you recognise any stages of relapse.
References
[1] https://adf.org.au/reducing-risk/relapse/
[2] Sack D (2012) Why relapse isn’t a sign of failure. Psychology Today.
[3] Department of Health (2004) Relapse prevention and management. From Working with young people on AOD issues: learner’s workbook. Canberra: Australian Government Department of Health.
[4] Guenzel N, McChargue D. Addiction Relapse Prevention. [Updated 2022 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK551500/
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