For those suffering from a substance use disorder, the threat of relapse can feel omnipresent. Family and friends may worry that one wrong move will spell the end of their loved one’s sobriety. Relapse can hurt everyone involved and cause meaningful, long-term relationships to fall by the wayside. The tug of alcohol or drugs on your mind and body can feel impossible to avoid, even long after you have gone through detox and treatment.
Some continue to imagine what drinking and/or using felt like, admitting that if they were presented with the substance again, they may not resist the temptation. The subject of relapse is critical to address before a patient leaves treatment. Preparing for independent living with clinicians is key to a successful recovery.
Factors Influencing Relapse
Those trying to quit drinking and/or using may engage in the behavior once or twice during recovery or independent living. These lapses may lead to relapse or repeated engagement similar to levels before quitting. Relapse is not an event: it’s a stage of a substance use disorder where a person reverts to using. Some persons may lapse, but not relapse, by managing their intake of, for example, alcohol, drinking moderately to where it does not present a problem.
For some, though, this moderation is not possible, and relapse is a likely occurrence. In a study looking at 1-year outcomes for people with alcohol, nicotine, and illicit substance use disorders, over 85% of individuals relapsed and started using again within 1 year of treatment. Various factors have been found to help predict susceptibility to relapse:
- Depressive symptoms
- Cortisol and adrenal sensitivity
- Stress
- Drug craving
- Other neurobiological factors
For example, brain atrophy and hyperreactivity during withdrawal are important indicators of relapse risk. In addition, several studies found that individuals with substance use disorders tend to have lower gray matter volume in some brain regions.
Patients have reported their reasons for their relapse, including stress, temptation, poor mood, anxiety, drug-associated triggers, boredom, and a lack of support structures like family relationships or important responsibilities. Researchers are trying to understand neurobiological mechanisms to create a biological profile, or “endophenotype,” that could be used to assess a patient’s susceptibility to relapse. Knowing this risk could help guide patient-specific treatments.
Warning Signs of Relapse
There are warning signs of relapse that you and your loved ones should know. Being more of a process rather than a singular and distinctive event, relapse has three general stages: emotional, mental, and physical. The emotional stage can involve feelings of anger or anxiety, disrupted eating, or changes in sleep patterns. Interest in recovery may decrease, and a patient may not realize the reason for their new feelings.
A person going through the mental stage will start to consciously acknowledge their internal struggle to remain sober. While they may want to maintain sobriety, they may also flirt with the idea of using again. Romanticizing and reminiscing on past alcohol and/or drug use and failing to acknowledge the painful experiences is a common warning sign. These are risky thoughts: once a seed has been planted, it can be extremely challenging to stop it from growing. In other words, a person might rationalize why they should use and end up following through. The physical stage follows this, representing what most think of when they hear “relapse:” consuming the substance and breaking sobriety.
Other warning signs to be aware of are:
- Sudden and increased self-isolation
- Avoidance of loved ones or other support groups
- Sudden change in behavior, interests, or hobbies
- Expressing doubt about how effective their recovery process is
- Expressing the belief that they can moderately use their substance of choice or other drugs that they do not currently have a problem with
How to Avoid Relapse
Finding ways to avoid relapse and truly become confident with yourself is crucial for a successful and long-term recovery. Everyone is unique in what their recovery will look like, but some general tips have helped many.
For example, being able to talk to someone that understands where you are coming from (like a sponsor) can alleviate mental urges. Moving through an imagined scenario from start to finish, including all of the negative aspects of the experience, can allow a person to see the full picture and come to a more rational perspective. Family therapy and 12-step programs can be integral to this process. Developing social connections is important for making a person feel valued and heard, helping to build the necessary self-confidence. You might find that you need a little more assistance, which is okay. Some enter sober living homes or aftercare programs to help keep them on the right track.
Substance use disorders are hard to recover from, even after going through treatment. The risk of relapse can be long-lasting, and addressing it as soon as possible with the right approach can be critical to long-term success. Patients have expressed various reasons for relapse, such as stress, triggers, and a lack of support structures. Researchers are working to uncover biological profiles that can be used to assess a patient’s relapse risk. In the meantime, knowing the warning signs of an impending relapse can prevent it from happening. At Oceanfront Recovery, relapse prevention planning is a key focus in preparation for a patient’s move to independent living. We offer sober living homes where you will have access to work, meetings, and activities. Our aftercare programs connect patients to community resources and various therapy options. We know that transition from treatment to recovery can be filled with challenges but we believe those challenges can be overcome. Call (877) 279-1777 to find out more.
