Even after recovery, people can relapse for all kinds of reasons. Trigger avoidance is often a part of relapse prevention, but some triggers are difficult to avoid altogether. Sometimes it is something as simple as spending time with people with whom you used to use drugs. Major times of stress that are out of your control like job loss or natural disaster can also be triggers for substance abuse relapse. While it’s impossible to control every circumstance that can lead to relapse, there are some ways to mitigate the effect of these common relapse triggers.
What Qualifies As A Relapse?
Relapse is a return to drug and alcohol use after you had previously broken free of actively using. Even after a person stops using drugs or alcohol, they can make mistakes, experience feelings of guilt and failure, or experience stressful situations that lead them to begin using again. Along with relapse, the risk to health, personal relationships, and financial well-being will return as well.
Relapse can also be deadly. Many people who relapse will start using drugs in the same way they did prior to treatment. Without the same tolerance for the drug, overdose becomes a real danger.
Relapse is common in recovery, but developing and using a relapse prevention plan can prevent its frequency and mitigate its effects. It’s possible to achieve long-term sobriety, even in the face of triggers and severe stress.
How Common Is Relapse?
The nature of addiction is chronic, which means it cannot be cured, only managed throughout the course of one’s life. This means that the relapse rate for addiction is similar to that of other chronic physical illnesses like hypertension and asthma. According to data from the National Institute on Drug Abuse, up to 40 to 60 percent of addicts who have undergone treatment for substance abuse will relapse at some point.
This doesn’t mean that everyone will relapse; some people experience lifelong sobriety through continued involvement in their rehabilitation process. Relapse also doesn’t mean that treatment didn’t work; it’s merely a part of the process of recovery for many people. It can indicate that treatment must be modified to accommodate changing needs over the course of your life.
What Motivates Relapse?
Relapse is more likely when circumstances surrounding drug and alcohol use return after treatment. This may be related to stressful environments such as a troubled family life or a demanding job. Relapse can also be triggered by sudden unemployment or financial instability. Certain themes surrounding personal motivation suggest that negative emotions like self-pity and shame or guilt can motivate recovering addicts to relapse.
This likelihood is compounded when there is a lack of support from family and friends, especially when one is surrounded by negative influences. Successful continued sobriety hinges on the availability and support of people who want you to stay sober. That’s why it’s so important to cut ties with other users whenever possible. Relapse can indicate that further treatment may be necessary, and it can signal that you need to reach out to your sober support system.
External vs. Internal Triggers
Triggers are factors that can cause people to abuse substances again after getting sober. There are many common triggers for substance abuse relapse that include mental or physical illness, financial instability, relationships, and negative emotions to name a few. These triggers can generally be categorized in two ways: external and internal triggers.
External triggers are people, places, and activities that you associate with using drugs. It is critical to bear in mind that these triggers can precipitate the desire to use even before you are fully aware that you have developed a craving.
- People: Hanging around with friends and acquaintances you used to use drugs with will function as a trigger to use again. It is easy to fall into old behaviors when you are in the company of people who use drugs and alcohol. This could include friends, family members, coworkers, or drug dealers.
- Places: Often the places where we once spent time will become associated with drug use. These specific locations can produce what is called a cue-induced relapse in people who are recovering from substance abuse disorders. Locations can include hotels, certain friends’ houses, parks, bars and restaurants.
- Things: Certain objects can trigger the thought or desire to use, even subconsciously. These can include paraphernalia previously used in getting high or drunk such as bottles of alcohol, spoons, pipes, prescription bottles, or a belt.
- Situations: Situations, which can be out of our control, may also act as triggers. Examples include family gatherings, holidays, spending time with friends, losing your job, having a child, or getting divorced. Many negative and positive situations can trigger substance abuse relapse.
The cornerstone of external triggers is that they are largely out of our control. Since some of these situations cannot be completely avoided, you will need specific coping mechanisms for handling them. A relapse prevention plan can account for some external triggers in advance. By identifying these ahead of time, you will be better equipped to deal with them.
Internal triggers can be more difficult to identify. These involve thoughts, feelings, and emotions which precipitate the desire to use drugs or alcohol. Since these are internal, you will need to develop specific coping skills for how to handle them.
- Negative Feelings: Fear, anxiety, and guilt stand out as primary internal triggers. Research has also shown that depression, anger, loneliness, shame, and sadness are directly linked to cravings for drug use. Since people may have learned to deal with these negative feelings by self-medicating with drugs and alcohol, they need to find healthier mechanisms to cope with them.
- Neutral Feelings: This may seem counterintuitive, but “normal feelings” like boredom and tiredness can also be dangerous triggers for people recovering from substance abuse disorders. An emotion doesn’t have to be especially charged in order to trigger substance abuse relapse.
- Positive Feelings: Times of celebration and happiness typically represent moments when recovering people tended to use drugs in the past. As you move through recovery, these same positive times can become dangerous for relapse. Some examples of positive feelings include joy, excitement, confidence, sexual arousal, and passion.
These internal triggers may be more difficult to handle, because unlike external ones, they cannot simply be avoided. In a moment of celebratory joy or after a heated argument with your spouse, your emotions may overcome you and lead you to relapse.
Can Stress Lead To Relapse?
Even without a specific situation or intense emotion fueling substance abuse relapse, everyday stress can be a major motivating factor in substance use. Stress is associated with addiction initiation, maintenance, and relapse. This is made worse by having poor learned coping skills that lead to drug and alcohol use as a way of self-medicating.
The link between stress and relapse can be explained through the pathway of the stress response in the body. Stress creates an increase in hormones associated with the fight-or-flight response. This response can become chronic with exposure to prolonged stressors like toxic relationships or a high-risk job. While the stressful event may not itself cause any harm, the response to it can lead to relapse. Maladaptive ways of coping make it more likely that substance use will be used to cope with stressors rather than healthier mechanisms like reframing the problem to make it more manageable.
Chronic stress poses an additional danger because it can reduce gray matter in the part of the brain that regulates stress and cognitive control. In other words, chronic stress erodes your ability to make deliberate and informed decisions and increases impulsivity. This makes it more likely that a person will give in to their cravings and use substances in order to cope.
Most Common Triggers Of Substance Abuse Relapse
While rehab programs aim to identify specific triggers in order to help you avoid them, it may be impossible to predict every trigger you’ll encounter. Nonetheless, there are several triggers that commonly lead to relapse for a variety of different people.
For many, stress is the top trigger of substance abuse relapse. There is an increased desire to use when faced with stressful situations, particularly if the substance was the primary method of coping with stress before sobriety. Managing this trigger requires establishing healthier and more adaptive ways of coping to turn to in times of stress. These can include mindfulness, relaxation, time management, or other life skills.
2. Exposure to drugs or alcohol
Simply being around substances can be problematic for many recovering addicts. The smell of alcohol or cigarettes at a bar may trigger a craving for it. Seeing other people around you partake in substance use can also commonly trigger relapse, because it motivates you to join in. For these reasons, the best way to avoid this trigger is to limit your exposure to these situations.
3. People associated with drug use
Even if they are no longer using drugs or alcohol, people you associate with addiction may still trigger relapse. People may also temp you to use if they elicit a strong emotional response that makes you feel vulnerable or volatile. For instance, your mother-in-law may make you feel ashamed or angry and inspire you to begin using drugs again as a coping mechanism.
4. Places associated with drug use
Like people, locations can be a powerful trigger for substance abuse relapse. Places where you might see people drink or use drugs or locations where you yourself spent time abusing drugs can be triggering. These can include certain friends’ or family members’ homes, hotel rooms, bars, or bathrooms.
5. Negative emotions
Emotion can be a trigger because drugs and alcohol usually provide temporary relief from negative feelings. People may seek out substances in times of sadness, anger, anxiety, guilt, or shame in order to deal with those emotions. Finding constructive ways to manage emotion is key to avoiding substance abuse relapse.
6. Celebration or joy
Like negative emotions, positive emotions can also trigger relapse. Times of celebration like holidays, birthdays, or weddings are common situations where drug and alcohol use may be present. For instance, you may be happy and relaxed at a restaurant with friends, giving you a false sense of confidence that you can handle one drink. In these situations, it’s helpful to have a supportive friend to stop you if you’re getting caught up in the excitement of the moment.
What Are The Stages Of Relapse?
Relapse occurs gradually and it happens in three distinct stages. Triggers generally initiate the stages of substance abuse relapse, which can lead to renewed regular substance use. If you can identify these stages, you will be able to recognize what is happening and potentially stop the progression of a relapse.
Unhealthy emotional responses and poor coping skills are the first harbingers of relapse. At this stage, you may not even be thinking about using drugs. What is happening is that your emotions are setting the stage for the relapse. Crucial signs of emotional relapse are anger, anxiety, defensiveness, and mood swings. Neglecting self-care, proper sleep, and eating habits are also signs of emotional relapse.
During the stage of emotional relapse, people will also begin to isolate themselves. They will refuse help from others and stop engaging in their recovery plans. They might start skipping 12-step meetings or stop sharing when they do attend. This stage can be easily recognized by using the acronym, HALT: hungry, angry, lonely and tired.
This is the stage in which the tension begins to mount in your mind between using and not using. Even if you’re not consciously thinking about using, you may be contemplating engaging in riskier behaviors like going to places where people are using. You may have active fantasies about using or you may begin to think fondly of using. At this stage of substance abuse relapse, it’s common to start rationalizing or justifying substance use and minimizing its risks and consequences.
Though these thoughts are fairly common while recovering, dwelling on these thoughts is a mark of mental relapse. This internal bargaining may lead you to use drugs or alcohol only sometimes, rationalizing that you are responsible enough to control occasional use. Recognizing these types of thoughts is essential to avoid acting on them.
Physical relapse is what most people consider to be relapse, the use of the substance. It might begin in a moment of high stress or at a time when you believe you won’t be caught. It’s not uncommon for one-time use to return to being a regular pattern of drug use in which you actively seek and use drugs.
Once drug use is uncontrolled at the physical relapse stage, it is most difficult to reverse the pattern of addiction. Without an intervention of some kind, the addiction will return in full force.
Since each stage has distinct features, it makes substance abuse relapse easier to identify at every stage and therefore easier to stop. With a sound relapse prevention plan, you will have coping mechanisms and contingency plans for triggers and for relapse warning signs.
Managing Triggers In Recovery
Learning to manage triggers is a skill that is taught throughout the course of rehabilitation and is honed over time with continued practice. It is an ongoing process that must be updated and adapted to changing conditions in your life. Triggers may change and require new strategies as you continue your recovery journey. There is no simple exhaustive list of ways to avoid and manage triggers, but there are some common ways to reduce your risk of substance abuse relapse.
- Eliminate access to problematic substances by getting rid of alcohol, drugs, or paraphernalia from your home
- Reduce or eliminate contact with people who trigger your substance abuse
- Avoid places that are high-risk like bars or locations you associate with drug use
- Limit your time with people who are drinking or using drugs
- Learn to manage your emotional responses so that substance use isn’t your default coping mechanism
- Surround yourself with positive influences and supportive people
- Emphasize self-care, focusing on your general wellness through good sleep and eating habits
- Take up hobbies or activities that will make you social in order to avoid isolation
- Attend regular recovery meetings
- Be honest and open when you need help
- Contact a sponsor, therapist, or supportive friend if you relapse or are thinking of relapsing
Signs And Symptoms Of Relapse
Some warning signs can help identify an impending relapse. Recognizing these signs and symptoms is the first step in reversing these dangerous patterns to avoid relapse.
- Romanticizing drug use while minimizing its dangers and consequences
- Increased confidence that you can safely use drugs sometimes without falling back into old patterns
- Becoming isolated from sober peers or your sponsor
- Losing interest in activities like exercise and hobbies that supported recovery
- Avoiding recovery meetings or becoming less engaged during meetings
- Spending more time with friends and family who use substances
- Growing belief that treatment is not effective or that recovery is unsustainable
These thoughts and behaviors are clear signs that relapse may follow. It is best to intervene or ask for help if one more of these signs emerge during recovery.
How Treatment And Support Groups Reduce Relapse Rates
Research supports the idea that substance abuse treatment effectively reduces substance abuse relapse rates. According to the National Institute on Drug Abuse, treatment longer than 90 days is more effective for maintaining long-term sobriety. During treatment, you’ll learn the skills you need to address the reasons for your addiction and to identify triggers and healthy coping mechanisms that can help you navigate these circumstances after treatment. A relapse prevention plan developed during treatment acts as a roadmap so you know how to respond in situations where relapse is likely.
In addition, a variety of therapeutic interventions like cognitive behavioral therapy (CBT) can teach you how to reverse problematic ways of thinking and behaving that lead to substance use. It can also improve how your brain functions and regulates emotional and behavioral responses. As a result of these mechanisms, CBT has been shown to support longer recovery by limiting instances of substance abuse relapse.
Though individual treatment outcomes vary according to the severity of the addiction and the appropriateness of treatment, research has shown that substance abuse treatment leads to reduced drug use and criminal activity and improved occupational, social, and psychological functioning. A rehabilitation program and accompanying therapy can teach you effective management strategies to help regulate your moods and cognitions in order to help you transition more effectively into sober living.
Holistic Treatment For Addiction
There is a growing trend that encourages a holistic or “whole person” approach to addiction treatment. This helps address individuals’ physical and psychological needs during the course of treatment. Several types of holistic treatments like yoga, meditation, acupuncture, or massage therapy can help recovering addicts see improved wellbeing and overall functioning.
A holistic approach to relapse prevention may include:
- Maintaining healthy and regular eating patterns
- Getting enough sleep
- Practicing mindfulness and meditation
- Doing yoga
- Getting regular exercise
Though relapse can be a normal part of the recovery process, the goal of treatment is always to prevent it whenever possible. Effective relapse prevention is an individualized process that depends on your specific set of triggers and established coping mechanisms. Regardless of the unique situation, one of the most research-supported ways to prevent substance abuse relapse is to stay in treatment for the recommended time.
Taking accountability for your sobriety after treatment is another key component of preventing relapse. This involves actively participating in your established relapse prevention plan, which includes maintaining supportive relationships that you can turn to if relapse becomes a danger. By employing the skills learned in treatment, you can learn to navigate the stresses of regular life without turning to substance use to cope.
To facilitate your recovery, you may consider a sober living facility to help you stay surrounded by sober peers. This can provide regular drug and alcohol testing, a tiered recovery structure to suit your needs, employment assistance, and access to clinical therapy as needed.
In some cases, regular attendance to recovery groups like Alcoholics Anonymous or other 12-step peer groups can help you remain involved and motivated in your recovery. Remember, sobriety is an ongoing process, evolving as you do and requiring continued practice and attention.