What Is A Relapse? How To Deal With Relapse In Recovery?

Last Updated: July 6, 2021

Authored by Dr. Ahmed Zayed

Reviewed by Michael Espelin APRN

Patients who have been treated with substance use disorder often fall back to their old addictive habits, which becomes a source of frustration for them and their families. Many think relapse means the failure of a patient to recover successfully. They’re mistaken.
This article will define relapse in light of perceiving addiction as a disease. Reasons will also be presented on why it should almost always be expected that a person recovering from addiction will experience it. While relapsing is common, it must be prevented at all costs because it can be fatal in many cases. Read further to find recommendations on how to define relapse, identify its warning signs and triggers, and how loved ones can help a recovering addict to prevent it?

The Definition Of Relapse

The Stages of Change or Transtheoretical Theory is often used to help explain why people suffering from substance use disorder typically undergo a relapse cycle before quitting for good. According to this model, people do not change addictive behavior following a unidirectional route. Proponents of this model define relapse as cycling through different stages that may be interrupted by recidivism from time-to-time.

Causes Of Addicts Relapse

According to NIDA, addiction relapse is a normal part of recovery. However, although relapse is part of recovery, the NIDA cautions that for some drugs, it can be extremely dangerous, sometimes even deadly. For the NIDA, relapse means the same way as when it occurs in other chronic medical illnesses. Relapse in addiction can result from triggers, ceasing medical treatment, or incompatible medications and treatment programs.

relapsed man with beer bottles
In a study published in the Journal of the American Medical Association, relapsation for substance use disorders were compared to relapsing among those suffering from hypertension and asthma. Study results showed that 40% to 60% of recovering addicts suffer from it at least once, whereas worsening occurs in as much as 50% to 70% of people with hypertension and asthma.
Preventing the worsening is a critical part of all drug treatment programs and involves identifying the warning signs and triggers. By improving awareness of the people, places, things, feelings, events that can catalyze drug cravings, the patient can better devise alternatives on how to identify the triggers, get relapse help immediately, and be able to determine when he is about to relapse.
Family and friends are encouraged to educate themselves on how to stop enabling an addict, and how to help them to stay clean.

The Stages Of Relapse

While experts agree that relapse is part of recovery and happens gradually, there are different explanations of the phases and warning signs of relapse.
In Relapse Prevention and the Five Rules of Recovery, dr. Steven Melemis presents a relapse prevention model that proposes 3 stages of relapse:

  • Phase 1: Emotional. This phase is highlighted by poor self-care. Some of the tell-tale signs include missing counseling sessions, not sharing, fault-finding, and unhealthy habits. Melemis offers the acronym, “HALT” which stands for hungry, angry, lonely, and tired, which summarizes the emotional triggers for relapse. Filling out Emotional Sobriety Worksheets can help a patient flesh out his reactions when subjected to different positive and negative feelings. This is why prevention training may include concepts on anger management and mind-body relaxation techniques to teach the patient how to better cope with negative emotions.
  • Phase 2: Mental. This phase can happen after or simultaneously with emotional phase. This next phase is what Melemis refers to as a bargaining stage where the patient is continuously weighing the pros and cons of using or drinking. Increased frequency of thoughts around this subject can trigger the third phase.
  • Phase 3: Physical. The last of the relapse phases and warning signs, this is the stage when a patient starts using again.

Relapse Warning Signs And Triggers

Apart from increasing a patient’s understanding of the correct drug relapse definition, it is also critical for them to become more aware of what may trigger them to recidivism.

Young relapsed man drinking alcohol
Some of the most common triggers of relapsing are as follows:

  • Stress and negative feelings. To overcome them, prevention worksheets often encourage patients to learn better management of time, stress, and health.
  • Sight, smell, and images of drugs and drug paraphernalia. Things like bongs, cigarettes, syringes, lighters, or empty drug bottles can trigger cravings. To help a patient resist these temptations, they should identify substitute behaviors to distract the mind.
  • Dealers or drug users in the patient’s surroundings. They can be directly or indirectly related to the patient, but all these people can trigger memories of drug abuse. Medical professionals highlight the avoidance of people who have substance misuse issues.
  • Familiar places. Substance abuse recovery programs encourage the patient to identify places where a patient used to do drugs and to consider relocation if necessary to avoid drug addiction relapse.
  • Celebrations, parties, and other social gatherings. In such functions, there is an even higher probability for the patient to become exposed to triggers, and the sight of people drinking or taking drugs can derail his substance abuse worsening prevention goals.

Lapse Vs. Relapse Vs. Slip

These three terms are commonly misunderstood and are often used interchangeably. While each one can vary in terms of the extent by which a patient falls back to undesired behavior, all of which can easily open up the route to addiction.

Slip Vs. Relapse

It isn’t unusual for a patient’s loved one to suspect a patient may have “slipped” since just one use can affect outward behavior. There is general agreement that a slip is a one-time use of the substance of addiction.

Lapse Vs. Relapse

Compared to a slip, lapse indicates a relatively long period of use of an addictive substance. Despite use, however, a patient experiencing a lapse may still be complying with his recovery program or some components of it. Just like a slip, however, a lapse can also easily drag a patient to a full recidivism.

Relapse Vs. Slip and Lapse

In contrast to both slip and lapse, a relapse is a more sustained, more regular use of an addictive substance that happens over a more extended period. During a relapse, there is a complete abandonment of a patient’s recovery program. Treatment and detox may be necessary.
Using the 12-Step Model perspective of relapse, however, a slip or lapse can be immediately construed as a sign of relapse and necessitate restarting the process once again from Step 1.

Dealing With Relapse In Recovery

Other than avoiding triggers, listed below are different ways to help a patient recover more successfully and more sustainably.

people sitting in circle during therapy session

Live In A Sober Living House

Patients may elect to live in a sober living house, where they are compelled to abide by the rules and regulations and take on responsibilities. The patient’s progress may be more closely supervised to stay clean and sober.

Find A Sober Companion

The duty of a sober companion is that of a life coach and confidante of the patient. They provide the patient with one-on-one support to keep from relapsing or reduce harm related to addiction.

Sign Up For Family Therapy

When a relapse occurs, family members also suffer. To encourage positive communication and sustain optimism for the patient’s recovery, the patient and his family members may elect family therapy. It can help reduce blaming and working towards a sustainable solution to the patient’s addiction problem.

Getting Further Medical Treatment

There are new methods to treat addiction today that include the following:

  • Transcranial Magnetic Stimulation. TMS is a non-invasive procedure that involves stimulating the part of the patient’s brain involved in regulating mood and cravings. Although TMS is widely used to treat substance use disorder, more research is necessary, and, by far, it has only been found effective for the treatment of depression.
  • Nicotinamide Adenine Dinucleotide Therapy. NAD Plus is an intravenous procedure that replenishes a patient’s supply of this enzyme, which, in turn, improves his energy levels, facilitates natural detox, and decreases cravings.
  • EEG Neurofeedback is a therapy that involves observing brain wave activity using a computer program. Results show where a patient’s brain may have lost or decreased regulation so that proper interventions to restore brain balance may be introduced in his recovery program.

Page Sources

  1. Larimer M. E., Palmer R. S. & Marlatt A. Relapse Prevention: An Overview of Marlatt’s Cognitive-Behavioral Model. Alcohol Research & Health. 1999; 23(2): 151-160. https://pubs.niaaa.nih.gov/publications/arh23-2/151-160.pdf.
  2. Hendershot C. S., Witkiewitz K., George W. H., Marlatt G. A. Relapse prevention for addictive behaviors. Substance Abuse Treatment, Prevention, and Policy. 2011; 6: 17. doi:10.1186/1747-597X-6-17. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3163190/.
  3. Substance Abuse and Mental Health Services Administrtation. Substance Abuse and Mental Illness Prevention. 2019. https://www.samhsa.gov/find-treatment/prevention.

Published on: August 12th, 2016

Updated on: July 6th, 2021

About Author

Dr. Ahmed Zayed

Dr. Ahmed Zayed is a Bachelor of Medicine and Surgery. He is graduated from the University of Alexandria, Egypt. Dr. Ahmed Zayed has a passion for writing medical and health care articles and focuses on providing engaging and trustworthy information to readers.

Medically Reviewed by

Michael Espelin APRN

8 years of nursing experience in wide variety of behavioral and addition settings that include adult inpatient and outpatient mental health services with substance use disorders, and geriatric long-term care and hospice care.  He has a particular interest in psychopharmacology, nutritional psychiatry, and alternative treatment options involving particular vitamins, dietary supplements, and administering auricular acupuncture.