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How to Deal with Relapse

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Relapse is common for people recovering from a substance use disorder (SUD). But relapsing doesn’t mean you failed. Your recovery efforts can always start again. This article will help you understand more about relapse, including tips to prevent it, how to deal with it if and when it happens, and how to find help.

What is Relapse?

bar graph comparing SUD relapse rates to relapse rates for Type 1 diabetes, high blood pressure, and asthma
Source: National Institute on Drug Abuse.

For people with substance use disorders (SUDs), a relapse is defined as a return to drug use after a period of not using (abstinence). Many people think of SUDs when they hear the word “relapse.” But relapse (in this case, meaning that certain signs and symptoms of disease have returned) can also happen with other chronic (long-lasting) but manageable health issues. For example, high blood pressure and asthma have relapse rates of between 5 and 7 in 10 people (50 to 70%).1 In contrast, between 4 and 6 in 10 (40 to 60%) people in SUD recovery relapse at some point.1

Relapse is not a failure, but rather a clue that your current treatment plan is not working.1 It could mean you need to change your treatment or try a different one.1 Your doctor can help you decide the best way to move forward.

Relapse Isn't Failure
woman staring at prescription pills on table Think of relapse as not only being about substance use, but in terms of any disease. For example, when a doctor tells someone to exercise, stop eating certain foods, and take medicine to control high blood pressure, not everyone follows through. Sometimes people stop taking blood pressure medicine because they don’t like the side effects and need a different medicine. We don’t call people failures for not following blood pressure treatment plans. Instead, doctors encourage people in this situation to start over and follow suggestions to change their lifestyle.

Substance use disorders are also chronic diseases that should be viewed in the same non-judgmental way.

Treatment Helps Prevent Relapse

There are a number of reasons people relapse. Some common relapse risk factors include:7,9,11

  • Not being fully aware of or prepared for the recovery process. Many people think that when they stop using a substance and get through detox, their work is done. But recovery is a lifelong process.
  • Being around triggers—the people, places, and things that make you want to use drugs and alcohol.
  • Feeling lonely or sad.
  • Not having enough social support.
  • Having other physical or mental health issues.
  • Not staying in treatment long enough. Studies show that to greatly reduce or stop substance use, many people need to stay in some form of treatment for at least 90 days.

Guy talking to psychologist, concept of education for relapse preventionThe good news is that treatment can address all of these risk factors to help you avoid a relapse. An effective treatment plan considers all of your personal risk factors and recovery needs.11 Behavioral therapies can help you learn how to change your unhealthy thoughts and behaviors. One common therapy type is cognitive-behavioral therapy (CBT). CBT teaches you how to recognize and cope with your triggers and other situations that may put you at risk for relapse. For example, you might learn: 2

  • How to refuse an offer of drugs or alcohol. You won’t always be able to avoid this possible trigger. But a counselor can explain and practice these skills with you so that you feel ready to handle these situations before they happen.
  • How to build your interpersonal skills to communicate better, repair relationships, and increase your ability to tap into social supports.
  • How to manage your emotions to improve coping skills. Some people with SUDs may turn to drugs and alcohol to deal with negative moods and other sources of distress. Your therapist can work with you to develop better, non-drug responses to such situations, such as reaching out to your support network or taking part in rewarding sober activities.

Medicine can be another helpful tool to prevent relapse. Some medicines used in treatment are designed to help alter the usual effects of a substance. For example, naltrexone blocks some of the rewarding or pleasurable effects of alcohol and opioids.3,4 The theory behind this treatment is that drug cravings will decrease if you no longer feel pleasure from taking substances.3 In turn, fewer cravings can help reduce relapse risk.

Peer support groups such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) can also help reduce relapse. These groups offer a supportive and encouraging community of people with similar issues. Studies show that being a member of a peer support group can indeed reduce relapse.5

If you’ve relapsed, don’t lose hope. You can always start again.

I Relapsed—Do I Need to Go Back to Treatment?

Opioid Overdose Warning12

If you relapse while using opioid maintenance medicines, talk to your doctor right away. Opioid overdose can be life-threatening. When you don’t use opioids for a period of time, your tolerance to the drug decreases. This means that taking the same dose you took before could more easily result in an overdose.

Remember that a relapse does not mean you have failed at recovery. Many people restart their recovery a few times before they find the right combination of treatments to meet their needs. It’s never too late to get help after a relapse. Reach out to your support system as soon as possible, including your doctor. They can help guide and support you while you decide what to do after a relapse. Some factors to think about together include:6–9,11

  • What substances do you use? Relapse can sometimes be dangerous, especially if you were using opioids. Returning to your usual dose of opioids can lead to an overdose after a period of abstinence, because your body will have lost its tolerance to the substance over time. Going back to treatment can help keep you safer and more comfortable while you go through withdrawal.
  • Would you benefit from extra treatment? Sticking with some form of rehab program for the right amount of time (3 months or more) can be really helpful for people who want to stop drinking or using drugs for good.
  • Do you have a safe and supportive home environment? Social support can help you feel less alone and thus less likely to relapse. Inpatient treatment may be especially helpful for those who don’t have strong social support or a safe home.
  • How many times have you relapsed? Multiple relapses may mean you need to change your treatment plan. For example, if you relapse after outpatient treatment, you may want to try inpatient treatment.
  • Do you have any untreated physical or mental health issues? This can increase your chances of relapse. Treatment that addresses these issues as well as your SUD can reduce your risk of relapse.

What to Do after a Relapse

Whether or not you go back to treatment, you can take some active steps to get back on the path to recovery. These steps include:6,9

people in embrace in group therapy session

  • Focus on the future and don’t dwell on the past. Every day is a new day to start over. Remember that relapse is common and does not mean that you are a failure or that you will never be able to sustain long-term recovery.
  • Seek help and support. Reach out to your doctor, family and friends, sponsors, and mutual support groups. A strong support community can help prevent relapse.
  • Set healthy boundaries. Avoid people who don’t support you or who use substances. Also avoid places where you used in the past.
  • Create a relapse prevention plan. Think about what led to your relapse, such as certain triggers or thoughts. Being aware of triggers and planning how you’ll cope with them when they happen can help prevent relapse.
  • Practice self-care. Physical or emotional stress can often trigger a relapse. Finding ways to ease this stress without drugs can be critical for long-term recovery. Self-care includes eating healthy foods and getting enough sleep. It also includes activities such as writing in a journal, spending time with family and friends, caring for a pet, reading, walks, yoga, meditation, or any other hobby you enjoy.

Relapse is an opportunity to learn and grow.

At American Addiction Centers, we understand how stressful a relapse can be. If you or your loved one have relapsed, call our free and confidential helpline at 1-888-509-8965 Who Answers? . Our caring and compassionate staff are ready to help you start again, any time of day or night.

Tips to Help Prevent Relapse

Relapse is more of a process than a one-time event.10 Knowing the warning signs of relapse and how to deal with them can help prevent relapse. These include:9,10

Starting over after relapse can be hard. Professional treatment can help you feel less alone and learn the skills you need to cope.

  • Not talking about your feelings and holding them in (sometimes called “bottling up”). Bottling up can be a major trigger for a relapse. Instead, be honest and open with yourself and others.
  • Trying to go through recovery alone. Pulling away from family and friends, skipping treatment or group meetings, and not talking to your sponsor can increase your relapse risk. Remember, a strong support network is important for long-term recovery. Talk to family and friends and attend support groups.
  • Being hungry, angry, lonely, and tired (HALT). When you do not meet your basic needs, you are following a pattern that often triggers relapse. Instead, practice good self-care and make sure you’re meeting these needs.
  • Focusing on other people’s issues instead of your own recovery. It may feel easier to deal with other people’s issues rather than your own. Instead, try to focus on the rules you set for yourself and work with your support network to help you stick to your plan.
  • Drug or alcohol cravings. If you have cravings, use your relapse prevention plan to cope, and talk to your support network.
  • Daydreaming or talking about your past use in a way that makes it seem glamorous or fun. Remember the not-so-fun things that happened during your substance use and that substance use harmed yourself and your family.
  • Thinking about people you used drugs or alcohol with or thinking about the places where you used, such as certain clubs or bars. To help avoid these triggers, delete the contact info for people you used with and don’t go to places where you used before.

Sources

  1. National Institute on Drug Abuse. (2020). Can addiction be treated successfully?
  2. McHugh, R. K., Hearon, B. A., & Otto, M. W. (2010). Cognitive behavioral therapy for substance use disorders.Psychiatric Clinics, 33(3), 511–525.
  3. National Institute on Drug Abuse. (2020). Principles of effective treatment. Opioid addiction.
  4. National Institute on Drug Abuse. (2020). Principles of effective treatment. Alcohol addiction.
  5. Kelly, J. F., & Yeterian, J. D. (2011). The role of mutual-help groups in extending the framework of treatment. Alcohol Research & Health: The Journal of the National Institute on Alcohol Abuse and Alcoholism, 33(4), 350–355.
  6. Government of British Columbia. (2019). What to do after a relapse.
  7. Alcohol and Drug Foundation. (2019). Relapse.
  8. Substance Abuse and Mental Health Services Administration. (2015). Tip 45: Detoxification and substance abuse treatment.
  9. U.S. Department of Veteran Affairs. (2020). Reducing relapse risk.
  10. Melemis S. M. (2015). Relapse prevention and the five rules of recovery. The Yale Journal of Biology and Medicine, 88(3), 325–332.
  11. National Institute on Drug Abuse. (2020). Principles of drug addiction treatment: A research-based guide (Third edition).
  12. Substance Abuse and Mental Health Services Administration. (2020). Opioid overdose.

 

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