When you stumble on the road to recovery from substance addiction, it is important that you pick yourself up and continue the journey. A relapse, although a critical sign that something is not right with your recovery process, is, in the cold light of day, just a stumble – it’s by no means a sign of failure or the end of your recovery journey.
Granted, it will feel like a serious setback to you, and it will undoubtedly raise internal questions, such as “What will happen if I can never conquer this?” or “Am I just not strong enough to see this through?” However, that is not the most productive way to view such an event.
Look at it this way.
A relapse provides a clear warning that either something is missing from your current process of recovery, or something that is part of that process is simply not working as it should do. You are not in error – your recovery program is. Either way, a relapse is the clearest sign you could possibly see that action needs to be taken, and changes need to be made.
Getting and staying sober is very challenging, but with the right support network and tools, it's completely attainable.
Furthermore, consider this.
Many people recovering from substance addiction, either drug, like opioid prescriptions, cocaine or methamphetamine, or plain old alcohol, will experience at least one relapse before they finally regain control of their lives. In fact, studies show that approximately 50% of people will have a setback during the first year of their recovery.
Obviously, a relapse may be a severely unwelcome occurrence during the recovery process, but it’s a common event. Although this statistic may seem daunting to you, it is vitally important to understand that recovery is a process – a process of learning new ways to live. Relapse, as it is for many others, may just be a part of your story, too.
However, there are those in addiction recovery that never get over the impact of their first (and only) relapse, and the plethora of intense emotions that come with it. At the time, they felt either overwhelmed, scared, disappointed, confused, or simply unsure of what to do next.
They responded to how they used to respond – they either used or they drank.
This article is written for those people – those in recovery from substance addiction who have relapsed (remember, it’s just a common stumble for many people like you), and, with a whirlwind of different emotions encompassing them, are unsure of how to react, what to do next, and how to move on in a positive way. Remember, a relapse is not the end of your recovery journey – it’s a well-lit road sign that says “TAKE ACTION NOW.” By doing so, and in the right way, you will prevent your substance use from escalating, and significantly increase your chances of overall recovery.
What is Relapse?
In clinical terms, relapse (or recidivism) is a recurrence of a past medical condition. In recovery from the disease of addiction, relapses occur when former addicts purposely seek out drug or alcohol use. It can present as either one standalone session of use or a full-on binge, but as long as treatment is resumed, it is considered a relapse.
Although relapses are a common part of many ultimately successful recoveries, they can be difficult to handle when the relapse happens to you. There is often a strong tendency to blame yourself, and feel that you should have been stronger. However, these negative feelings, such as anger, depression, negativity, and self-doubt are, ultimately, highly counterproductive, and, if they are allowed to fester because you have not made the necessary changes, they will not allow you to get successfully back on track.
Think of it this way. Relapse is part of the learning process of determining what will work for your particular situation. Addiction recoveries do not all follow the same clinical pattern, as a person’s circumstances, history, genetics, and so on, are always different.
When relapse does happen, you need to consider the following expert advice (and then put it into action) to ensure you get yourself straight back on the road to recovery.
Changing Your View of Addiction Relapse
Recovery from substance use disorder (SUD) – the medical name for the disease of substance addiction – is no easy process. The difficulty in finding a successful and sustainable recovery from addiction can be read between the lines of its clinical definition from the 5th edition of “The Diagnostic and Statistical Manual of Mental Disorders (DSM-5)” – the diagnostic manual that U.S. clinicians use to diagnose mental disorders.
The DSM-5 clinical definition reads:
“Addiction is defined as a chronic, relapsing disorder characterized by compulsive drug seeking, continued use despite harmful consequences, and long-lasting changes in the brain.”
However, the high number of people going through the addiction recovery process has never been successfully dealt with. According to the U.S. National Institute of Drug Abuse (NIDA), in 2017, an estimated 20.7 million people (aged 12 and older) needed treatment for a SUD. However, only 4 million people received treatment, or just 19% – less than a fifth.
Additionally, the relapse rate for SUDs is estimated to be between 40%-60%, which mirrors the rates of relapse for other chronic diseases, such as hypertension or asthma. Addiction is still considered a highly treatable disease, though, and recovery is clearly attainable. In recent years, around 10% of U.S. adults who are at least 18 years old say they are in recovery from either a SUD or, more specifically, an alcohol use disorder (AUD).
Viewed at with reference to our topic of addiction relapse, that’s a huge number of people potentially going through this same event as you. When such a significant event occurs, it is not just the event itself that directly impacts us. It is also how we react to that event. When we are talking about relapse, our reaction can make a world of difference.
Marlatt’s Relapse Prevention Model: A Mistake, Not Failure
Marlatt’s cognitive-behavioral model of relapse, developed in 1985, and known as “Marlatt’s Relapse Prevention Model,” looks upon relapse as a “transitional process, a series of events that unfold over time.” Alternative models have always viewed relapse as a failure of treatment, and an end-point – the point at which the patient needs to begin the treatment process again.
Marlatt, of Stanford University, presented a model that is far more flexible in its approach than these others, as it provides both guidance and opportunities for intervening at multiple stages in the relapse process in order to either prevent or reduce future episodes of relapse.
In fact, Marlatt’s model is designed to view a relapse – the initial return to substance use – as a slip-up or a mistake, rather than as a “personal failure.” Viewing such an event in this way significantly increases your chances of getting back on track, as compared to abandoning the idea of recovery altogether.
It’s that vital difference between thinking “Ok, I made a mistake – I’m human, it happens; I can learn from this, and then move on,” as opposed to “Clearly I can’t do this, so why not carry on using and getting high?”
Absolutely no-one finds recovery from substance addiction thinking the latter.
From the model depicted above, you can see that everything relates back to the “high-risk situation” (where relapse triggers are at their most prominent). People with effective coping responses to high-risk situations (i.e., they have increased “self-efficacy” – see below), are at a decreased probability of a relapse.
Conversely, people with ineffective or poor coping responses (with decreased self-efficacy) can result in an initial lapse, particularly when there is the expectation that drug use will have a positive effect. This lapse, in turn, can result in feelings of guilt and failure, i.e., the “abstinence violation effect. This abstinence violation effect, along with a perceived positive outcome, can increase the probability of a relapse.
What is Self-Efficacy?
A term used within Marlatt’s model is “self-efficacy.” According to Albert Bandura, from Stanford University, who first used the term in his seminal 1977 paper, “Self-Efficacy: Toward a Unifying Theory of Behavioral Change,” self-efficacy is defined as:
“The belief in one’s capabilities to organize and execute the courses of action required to manage prospective situations.”
In other words, it is a person’s belief in his or her ability to succeed in a particular situation. As Bandura and other researchers have since demonstrated, self-efficacy can have an impact on everything from psychological states to behavior and motivation.
Marlatt’s model helps clinicians to develop individualized treatment plans for clients at risk of relapse. Once the characteristics of each individual’s high risk situations have been assessed, the clinician can then:
- Analyzing their client’s response to these situations, and
- Examine factors that increase the individual’s exposure to high risk situations
Note: While the model was initially designed for working with clients struggling with alcohol problems, it has been applied successfully to addictive and impulsive behaviors more broadly, such as problematic eating behaviors.
The Damaging Emotional Impact of Relapse
The emotional impact of relapse will obviously vary from person to person, but it will feature negative emotions such as sadness and disappointment, as well as feelings of decreased self-worth, motivation (particularly when it comes to recovery) and disillusionment. These feelings, quite normal in themselves, will mirror the same or similar feelings felt when the individual was actively abusing substances, and will promptly return them to the same mindset of addiction if no action is taken.
Reflect, Forgive Yourself & Act
Therein lies the key phrase that all relapsed addicts should understand completely – “if no action is taken.” The only clear and logical response to relapse is to take action to ensure the relapse does not reoccur or, worse, spiral back into the cycle of addictive substance use.
However, we are not all robots where we can simply hit the “reset” button. Therefore, there needs to be a short period of reflection to understand exactly why the relapse happened in the first place. Then, there is the process of forgiveness – forgiving yourself this error of judgment, bearing in mind all the has been written above about such an event being a slip-up, a mistake, as opposed to any kind of personal failure.
After these have fully happened, there is only one thing left to do – act.
If you have relapsed, there will have been a number of factors that influenced or triggered your return to drug or alcohol use. Obviously, you will want to understand these as much as you can to enable you to understand why the relapse occurred.
Potential relapse triggers can range from being around people, places or objects that remind you of using, to underlying emotional issues or stressful relationships or events – we discuss the 5 most common relapse triggers further on in this article.
Therefore, for you to refocus on your recovery, and, importantly, prevent another relapse, it’s essential to spend some time reflecting on what really led to you using or drinking again. Here are some example questions for yourself:
- Have I been spending time with the wrong people?
- Have I been putting off responsibilities, like paying bills, subsequently feeling overwhelmed by mounting tasks or debts?
- Am I negative in my approach or outlook, particularly in not believing I could actually be successful in your recovery?
- Have I been getting lax with my recovery efforts, e.g., not attending 12-Step or group meetings?
Take time to identify exactly what led you back to drugs or alcohol, so that you can make positive and appropriate adjustments in your recovery process. If you are having difficulty working this out for yourself, you may need the help of a professional substance abuse counselor- in fact, a counselor can be extremely beneficial even if you do understand the reasons behind your relapse, as they can help you to find new and positive ways of managing your relapse triggers and stressors.
2. Forgive Yourself
It is common and perfectly understandable to experience guilt and shame after a relapse – it shows how important recovery is to you. However, as you are undoubtedly aware, these feelings will not help you in the long run. Remember, both of these feelings can also be a trigger for relapse in and of themselves. Instead, use this 3-stepped approach:
- Acknowledge the relapse
- Make changes
- Let go of your negative emotions about the mistake
If you could summarize all the advice of this article into one word, it would be this – ACT. Without taking action to resolve what’s wrong in your recovery plan, you will go on to relapse again and again, until you are firmly back in the clutches of active addiction. When it comes to it, if you want to live a safe and sober life, you must act, and act now. Further advice on what actions you may need to take is described in detail later in this article.
The “High-Risk Situation”: Relapse Triggers
Extensive medical research has pinpointed several factors that are associated with an increased risk for relapse for those in substance addiction recovery, such as:
- Financial stress
- Negative feelings, emotions, or mood, primarily:
- Depression, and
- Loneliness or isolation
- Interpersonal (relationship) conflict
- Exposure to drugs and/or drug paraphernalia
- Poor coping skills
- Poor lifestyle choices, and
- Social bonding
The 5 Most Common Relapse Triggers
All of the above can prove highly dangerous for recovering addicts, and they should be actively avoided, particularly in the early stages of recovery.
- Stress: Whether it is financial stress, relationship stress caused by conflict, or stress from outside pressures that are beyond your control, unresolved stress in any form is regarded as the most dangerous of triggers for the recovering addict. Many people simply return to their substance of choice as a form of either “self-medication” or an effect of poor coping mechanisms.
- People or Places Associated with Addictive Behavior: People associated with your past substance abuse are potential triggers, and that includes your family members.
- Difficult / Negative Emotions: Emotions that you have trouble dealing with effectively can be triggers to relapse, as they may have been your initial triggers to addiction in the first place, including anger, anxiety*, boredom, depression*, and loneliness.
Note: Untreated anxiety or depression can potentially lead to a number of mental health disorders, which need to be resolved as part of your addiction treatment and recovery
- Sensing Your Substance of Choice: Our senses can evoke strong emotional responses in all of us. For example, seeing or smelling that substance can prompt strong cravings, and should be regarded as a relapse trigger.
Times of Happiness or Celebration: Strong emotions such as happiness or times of celebration, eg. Thanksgiving, Christmas, Independence Day, family or friends’ birthdays, should also be seen as a potential trigger and a threat to your recovery.
Taking Action: Improving The Elements of Your Recovery
You must respond to your relapse, as soon as you can. Delays in doing so can compound the problem, and even prolong the relapse. While you may not have all the answers right now, retaining a strong desire to move past this is vitally important to your recovery.
Many drug rehabs in Arizona offer post-treatment therapy following an inpatient stay. Additionally, contacting your support system for help is another good place to start. However, only you can decide what to do after relapse, and whether you want to continue on the path of recovery.
Important: If You Need To, Return To Addiction Treatment
Fully recovering from your addiction can be a long-term process that often needs several attempts at treatment due to the high rate of relapse. In fact, to look at it practically, a relapse is a clear indication that something more needs to happen, maybe a return to drug rehab or that the treatment strategy needs to be fundamentally adjusted in some way.
1. Understand Your Relapse
It is important that you recognize the reason(s) for your relapse, and make the necessary changes. You need to make a list of the people, places, and things – your relapse triggers – that can undermine your recovery. This will enable you to avoid these high-risk situations in future that prompt or trigger you to engage in destructive and addictive behaviors.
2. Learn New Coping Skills
You need to learn new ways of coping to free yourself from these challenging situations if your old techniques are no longer working. It is important to remind yourself that addiction is a disease – not a character flaw. Coping skills you may not know, but can learn include:
- Stress management
- Mindfulness / meditation
- Grounding techniques
3. Attend Meetings & Build a Stronger Support Group
After a relapse, you should reach out to your sponsor, therapist or your support system. Being honest about your relapse among your peers is the best way to deal with it. Attending meetings and receiving help from your support network will facilitate getting you back on track.
4. Take Your Medication
Many people with substance use disorders can benefit from medication-assisted treatment (MAT), a treatment approach that encompasses the use of FDA-approved medications, in combination with counseling and behavioral therapy. You may have been prescribed certain medications upon leaving rehab, and it is vital you continue to take these as directed. In fact, clinical studies have shown that staying in recovery and avoiding relapse is much more likely with the use of medications than without.
5. Developing Healthier Habits
The more you take care of yourself, and work on being a healthy and whole individual, the less you will be tempted to use. The following are ideal ways to begin feeling far healthier and to reduce cravings:
- Daily exercise
- Eat well and nutritiously
- Make sleep a priority
- Learn how to develop a higher emotional quotient, eg. increasing your ability to manage emotions, and strengthening your social skills
All of these things may be important for you on your path to recovery following a relapse, but you know yourself best, and what you as an individual might need to focus on the most. Just remember that relapse can be just a stepping stone on your long-term road to recovery. In no way should relapse be considered a failure. Rather, it is another step on your continuing path to recovery and a sign that you need additional support and help.
Moving on from a relapse may seem overwhelming. The fact that you were clean and sober before you relapsed proves that it can be done. You just need to re-frame what relapse means, why it happened and ways to avoid another one in the future. Recovery happens one day at a time, and the journey can be challenging. Surrounding yourself with a strong support network and making the necessary changes can help you recover from a relapse and continue on the road to lifetime sobriety.
- National Institute on Drug Abuse: https://easyread.drugabuse.gov/content/what-relapse
- Verywell mind: https://www.verywellmind.com/the-four-stages-of-alcohol-and-drug-rehab-recovery-67869
- Harvard Health Publishing: https://www.health.harvard.edu/addiction/substance-addiction
- Google Books DSM-5: https://books.google.com.co/books?id=-JivBAAAQBAJ&printsec=frontcover&dq=the+diagnostic+and+statistical+manual+of+mental+disorders+(dsm-5)&hl=en&sa=X&ved=2ahUKEwisorn1h-LtAhWohOAKHRdPBwkQ6wEwAHoECAIQAQ#v=onepage&q=the%20diagnostic%20and%20statistical%20manual%20of%20mental%20disorders%20(dsm-5)&f=false
- National Institute on Drug Abuse: https://www.drugabuse.gov/publications/media-guide/science-drug-use-addiction-basics
- National Library of Medicine: https://pubmed.ncbi.nlm.nih.gov/10890810/
- Science Direct: https://www.sciencedirect.com/science/article/abs/pii/0146640278900024
- Verywell mind: https://www.verywellmind.com/why-did-i-relapse-21900