The general meaning of relapse is a deterioration in health status after an improvement. In the realm of addiction, relapse has a more specific meaning—a return to substance use after a period of nonuse. Whether it lasts a week, a month, or years, relapse is common enough in addiction recovery that it is considered a natural part of the difficult process of change. Between 40 percent and 60 percent of individuals relapse within their first year of treatment, according to the National Institute on Drug Abuse . Relapse in addiction is of particular concern because it poses the risk of overdose if someone uses as much of the substance as they did before quitting.
How to Prevent Relapse
Research has found that getting help in the form of supportive therapy from qualified professionals, and social support from peers, can prevent or minimize relapse. In particular, cognitive behavioral therapy (CBT) can help people overcome the fears and negative thinking that can trigger relapse.
Experts in the recovery process believe that relapse is a process and that identifying its stages can help people take preventative action.
What Does a Relapse Mean?
Relapse is not a sign of failed recovery. It’s an acknowledgement that recovery takes lots of learning, especially about oneself. Recovery from addiction requires significant changes in lifestyle and behavior, ranging from changing friend circles to developing new coping mechanisms. It involves discovering emotional vulnerabilities and addressing them. By definition, those who want to leave drug addiction behind must navigate new and unfamiliar paths and, often, burnish work and other life skills. Recovery also requires discovery or rediscovery and development of interests that have the power to drive pursuit and deliver rewards, not only spurring the addicted brain to rewire itself but giving life real meaning—the ultimate goal of every person.
The risk of relapse is greatest in the first 90 days of recovery, a period when, as a result of adjustments the body is making, sensitivity to stress is particularly acute while sensitivity to reward is low. The risk decreases after the first 90 days. It is important to know that relapse does not represent a moral weakness. It reflects the difficulty of resisting a return to substance use in response to what may be intense cravings but before new coping strategies have been learned and new routines have been established. For that reason, some experts prefer not to use the term “relapse” but to use more morally neutral terms such as “resumed” use or a “recurrence” of symptoms.
What Defines a Relapse?
There is an important distinction to be made between a lapse, or slipup, and a relapse. The distinction is critical to make because it influences how people handle their behavior. A relapse is a sustained return to heavy and frequent substance use that existed prior to treatment or the commitment to change. A slipup is a short-lived lapse, often accidental, typically reflecting inadequacy of coping strategies in a high-risk situation.
No matter how much abstinence is the desired goal, viewing any substance use at all as a relapse can actually increase the likelihood of future substance use. It can engage what has been termed the Abstinence Violation Effect. It encourages people to see themselves as failures, attributing the cause of the lapse to enduring and uncontrollable internal factors, and feeling guilt and shame . Alternatively, seeing a binge or a slipup as a lapse encourages a person to minimize the size of the lapse, to quickly return to the recovery path, to direct attention to elements that can be controlled, which often means taking time to learn more about personal triggers, beefing up coping strategies, and bolstering a support network.
Why Does Relapse Happen?
Just as becoming addicted is a process that involves learning mechanisms in the brain, so is addiction recovery a learning process, and like most learning and growth, it does not occur overnight or in a strictly linear manner. Relapse frequently occurs in response to a trigger. A person on the road to recovery encounters a person or a place associated with addiction or some other reminder of the addictive life and the extreme highs it brought (however destructive they became), and that sets off a longing for the substance.
In the absence of an emergency plan for just such situations, or a new life with routines to jump into, or a strong social network to call upon, or enhanced coping skills, use looms as attractive. Alternatively, a person might encounter some life difficulties that make memories of drug use particularly alluring.
The majority of people who decide to end addiction have at least one lapse or relapse during the recovery process. Studies show that those who detour back to substance use are responding to drug-related cues in their surroundings—perhaps seeing a hypodermic needle or a whiskey bottle or a person or a place where they once obtained or used drugs. Such triggers are especially potent in the first 90 days of recovery, when most relapse occurs, before the brain has had time to relearn to respond to other rewards and rewire itself to do so.
This is especially the case with relapse among addicted youth . They are particularly prone to relapse because they spent their formative years engaged with substances rather than developing a strong social support network, learning basic life skills, or gaining academic achievement—all positive predictors of success. Learning what one’s triggers are and acquiring an array of techniques for dealing with them should be essential components of any recovery program.
Relapse is most likely in the first 90 days after embarking on recovery, but in general it typically happens within the first year. Recovery is a developmental process and relapse is a risk before a person has acquired a suite of strategies for coping not just with cravings but life stresses and established new and rewarding daily routines.
Some evidence suggests that the risk for relapse is heightened just as people are leaving the full-time support of an inpatient treatment program—before they’ve had a chance to practice newly acquired skills and insights, set up their own social support system, or gained insight into their emotional vulnerabilities. They may not recognize that stopping use of a substance is only the first step in recovery—what must come after that is building or rebuilding a life, one that is not focused around use. They may falsely believe that their recovery is complete, or that cravings are a sign of failure, when in fact it takes time to rebuild a life and time for the brain to rewire itself and learn to respond to everyday pleasures. In general, the longer a person has not used a substance, the lower their desire to use.
What to Do If You Relapse
Relapse is emotionally painful for those in recovery and their families. Nevertheless, the first and most important thing to know is that all hope is not lost. Relapse triggers a sense of failure, shame, and a slew of other negative feelings. It’s fine to acknowledge them, but not to dwell on them, because they could hinder the most important action to take immediately—seeking help. Taking quick action can ensure that relapse is a part of recovery , not a detour from it.
• Ask for help . Many people seeking to recover from addiction are eager to prove they have control of their life and set off on their own. Studies show that social support boosts the chances of success. Help can come in an array of forms—asking for more support from family members and friends, from peers or from others who are further along in the recovery process. It might mean entering, or returning to, a treatment program; starting, or upping the intensity of, individual or group therapy; and/or joining a peer support group.
Some people arrange a tight network of friends to call on in an emergency, such as when they are experiencing cravings. Since cravings do not last forever, engaging in conversation about the feelings as they occur with someone who understands their nature can help a person ride out the craving. Others take advantage of the many types of peer support groups that provide, in addition to useful information, the wisdom and coping strategies of others who have faced the same hurdles; it is the ethos of such groups that members support their peers through crises without judgment.
Mutual support groups are usually structured so that each member has at least one experienced person to call on in an emergency, someone who has also undergone a relapse and knows exactly how to help. What’s more, attending or resuming group meetings immediately after a lapse or relapse and discussing the circumstances can yield good advice on how to continue recovery without succumbing to the counterproductive feelings of shame and self-pity. It can be a make-or-break source of hope.
• Reflect on the triggers . Reflect on what triggered the relapse—the emotional, physical, situational, or relational experiences that immediately preceded the lapse. Inventory not only the feelings you had just before it occurred but examine the environment you were in when you decided to use again. Sometimes nothing was going on— boredom can be a significant trigger of relapse. Such reflection helps you understand your vulnerabilities—different for every person. Armed with such knowledge, you can develop a contingency plan to help you avoid or cope with such situations in the future.
• Boost self-care. Engaging in self-care may sound like an indulgence, but it is crucial to recovery. For one, it bolsters self-respect, which usually comes under siege after a relapse but helps motivate and sustain recovery and the belief that one is worthy of good things. Too, maintaining healthy practices, especially getting abundant sleep, fortifies the ability to ride out cravings and summon coping skills in crisis situations, when they are needed most.
Learning from Relapse
How individuals deal with setbacks plays a major role in recovery—and influences the very prospects for full recovery. Many who embark on addiction recovery see it in black-and-white, all-or-nothing terms. They see setbacks as failures because the accompanying disappointment sets off cascades of negative thinking and feeling, on top of the guilt and shame that most already feel about having succumbed to addiction.
Setbacks can set in motion a vicious cycle, in which individuals see setbacks as confirming their negative view of themselves and see themselves as incapable and/or unworthy of living a substance-free life. Such a negative mindset can not just usher in a return to using but compound a sense of failure, which makes the journey of recovery appear even more daunting
The healthy alternative to seeing relapse as personal defeat is to regard it as a steppingstone, a marker of progress—a chance to learn more about one’s individual susceptibilities, about the kinds of situations that are problematic, and about the most workable means of support in a crisis.
Regarding setbacks as a normal part of progress enables individuals to broaden their array of coping skills, to engage in planning for problematic situations, and to devise strategies in advance for dealing with predictable difficulties. Among the most important coping skills needed are strategies of distraction that can be quickly engaged when cravings occur. Mindfulness training , for example, can modify the neural mechanisms of craving and open pathways for executive control over them.
Also critical is building a support network that understands the importance of responsiveness. Not least is developing adaptive ways for dealing with negative feelings and uncertainty. Those ways are essential skills for everyone, whether recovering from addiction or not—it’s just that the stakes are usually more immediate for those in recovery. Many experts believe that people turn to substance use—then get trapped in addiction—in an attempt to escape from uncomfortable feelings.
The causes of substance dependence are rarely obvious to users themselves. Addiction recovery is most of all a process of learning about oneself. A better understanding of one’s motives, one’s vulnerabilities, and one’s strengths helps to overcome addiction.
Overcoming Hopelessness and Shame
Typically, those recovering from addiction are filled with feelings of guilt and shame, two powerful negative emotions. Guilt reflects feelings of responsibility or remorse for actions that negatively affect others; shame reflects deeply painful feelings of self-unworthiness, arising from the belief that one is inherently flawed in some way. As a result, those recovering from addiction can be harsh inner critics of themselves and believe they do not deserve to be healthy or happy.
Such feelings sabotage recovery in other ways as well—negative feelings are disquieting and are often what drive people to seek relief or escape in substances to begin with. In addition, feelings of guilt and shame are isolating and discourage people from getting the support that that could be of critical help.
What is more, negative feelings can create a negative mindset that erodes resolve and motivation for change and casts the challenge of recovery as overwhelming, inducing hopelessness. A relapse or even a lapse might be interpreted as proof that a person doesn’t have what it takes to leave addiction behind.
Therapy is extremely helpful; CBT (cognitive behavioral therapy) is very specifically designed to uncover and challenge the kinds of negative feelings and beliefs that can undermine recovery. By providing the company of others and flesh-and-blood examples of those who have recovered despite relapsing, support groups also help diminish negative self-feelings, which tend to fester in isolation.
It is possible to overcome shame —by releasing it. Shame diminishes as recovery proceeds. Neuroscientist Adi Jaffe, who himself overcame severe addiction, identifies five steps for doing so:
- Identify important past events that gave rise to negative beliefs about yourself.
Maintaining Recovery/Preventing Relapse
Experts agree that the best way of maintaining recovery is to engage all the positive recovery practices—seeking the input of others, reflecting on triggers of desire to use, acquiring skills to tolerate discomfort, hewing to a program of self-care, building new interests, finding new sources of meaning in life, polishing a relapse prevention plan—and to avoid overconfidence about one’s ability to withstand high-risk situations. It’s also necessary to schedule regular opportunities for fun.
Equally important is to learn to identify situations that carry high risk of relapse and to develop very specific strategies for dealing with each of them. High-risk situations include both internal experiences—positive memories of using or negative thoughts about the difficulty of resisting impulses—and situational cues. And the approaches can encompass both behavioral strategies—it is sometimes wisest to just walk away from a challenging situation or to call on one’s support network—and cognitive ones, such as distancing oneself from one’s thoughts unil h dure to use dissipates.
Some situations are predictably problematic.
The following situations are among the most common causes of relapse:
• exposure to environmental cue related to drug use
• interpersonal difficulties
Frequently Asked Questions
What exactly is relapse?
The general meaning of relapse is a deterioration in health status after an improvement. In the realm of addiction, relapse has a more specific meaning—a return to substance use after a period of nonuse. Whether it lasts a week, a month, or years, relapse is common enough in addiction recovery that it is considered a natural part of the difficult process of change. Between 40 percent and 60 percen
Is relapse a serious condition?
Relapse exists on a spectrum. While mild forms are a normal part of life, persistent or severe relapse can significantly impact daily functioning and quality of life. It's important to seek professional support if relapse is interfering with work, relationships, or wellbeing.
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