By: Elena Hill, MD, MPH -

3 Stages of Relapse: How to Spot Early Warning Signs

Mental Health Opioids Relapse

Relapse is a part of the recovery process.[1] If you slip, your treatment program hasn’t failed. Your relapse gives you information about what you should work on with your treatment team to better fortify your recovery going forward. 

But a relapse can be dangerous too. If you return to the same dose of drugs you took while your substance use disorder (SUD) was active, you could overdose. 

Visualizing relapse in three distinct stages helps some people to plan and prepare if they notice themselves starting down the path toward relapse. 

What Does It Mean to Relapse? 

Though relapse is often unplanned and impulsive, certain warning signs indicate the danger of a potential opioid relapse. 

Relapse happens when a person returns to old ways of thinking and behaving. Contrary to what most people believe, this doesn’t always happen overnight. 

The 3 Stages of Relapse Explained 

The Relapse process can be separated into three phases.[2] 

Stage 1: Emotional Relapse

Emotional relapse is when there is a trigger that can cause the individual to become emotionally less stable – a fight with a friend or loved one, the loss of a job, a financial hardship, etc. The individual may start to neglect the newfound coping techniques that have helped the individual maintain sobriety. 

Stage 2: Mental Relapse 

The mental relapse stage is when the person starts having active thoughts of using in order to deal with the emotions they start to experience in stage I. They may start thinking about how they could obtain their drug of choice again, or have thoughts about where and when they would use. 

Stage 3: Physical Relapse 

Physical relapse is the final stage of relapse when one actually starts using the substance again.

You have the power to stop a relapse in the first, second or third stages, although the sooner the better! Recognizing the emotional triggers in stage one, or the thoughts of returning to use in stage two is a key skill that will prevent you from reaching stage III where you start physically using substances again. 

Relapse Is Not Failure 

Be honest about relapse and open to learning new ways to cope. Never be afraid to ask for help. Remember that relapse is most preventable when you are in the earliest stage of relapse: the emotional stage or even the mental stage. 

When you start noticing warning signs of emotional relapse, speak up and get the help you need. 

If you’re enrolled in a Medication for Addiction Treatment (MAT) program, your doctor uses medications combined with therapy to help you manage an OUD. A relapse could mean that you need higher medication doses. You may also need a different type of therapy.

Cognitive behavioral therapy (CBT) is one of the most effective tools for managing warning signs and negative thinking patterns. It aims to help individuals recognize the early warning signs that may lead to relapse and develop coping skills to help prevent it. Research shows CBT can help people with substance use disorders get control.[3]

Like some other forms of therapy, CBT helps patients recognize, avoid, and cope with the situations where they are most likely to use drugs. The key to recovery is building a life that makes it easier not to use.

Tips to Help You Avoid Relapsing 

Preventing relapse is a critical part of any treatment program. The longer you stay away from drugs, the more your brain cells can heal and begin functioning normally. 

Experts recommend four broad strategies:[4]

1. Therapy

Keep your appointments with your therapy team, and be open and honest about your progress in each session. If you don’t think therapy is helping you, ask for a different type of treatment. Plenty of options exist if CBT isn’t right for you. Speak up about what you want and need.

2. Medications

Take your MAT medications per your doctor’s orders. If you don’t think your dose is strong enough, talk with your doctor and describe your symptoms. If you’re tempted to stop taking your medications so you can return to drug use, tell your doctor about that urge. 

3. Monitoring

Your doctor might check your urine or saliva for drugs to determine if you’re using again. Never try to cheat on your tests. Testing is used in order to help you to set treatment goals, not to punish you for relapses. 

4. Peer Support

Connect with a group like Alcoholics Anonymous and talk with others in recovery. Use these meetings when you’re in crisis, so you’ll have something to do instead of returning to drugs. 

Be honest with yourself and your treatment team about your thoughts, feelings, and cravings. Use techniques like meditation to help you get familiar with inner dialogue. And never be afraid to tell your doctor about your relapse risks. 

Worried About Relapsing on Opioids?

Bicycle Health uses Suboxone as part of a comprehensive MAT program for people with OUD. Our unique telemedicine approach means you get the help you need, no matter where you live. 
Schedule an enrollment call or contact us at (844) 943-2514 to learn more.

By: Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.


  1. Treatment and Recovery. National Institute on Drug Abuse. July 2020. Accessed January 2023.
  2. Relapse Prevention and the Five Rules of Recovery. Yale Journal of Biology and Medicine. September 2015. Accessed January 2023.
  3. A Meta-Analysis of Cognitive-Behavioral Therapy for Alcohol or Other Drug Use Disorders: Treatment Efficacy by Contrast Condition. Journal of Consulting and Clinical Psychology. 2019. Accessed January 2023.
  4. Addiction Relapse Prevention. StatPearls. May 2022. Accessed January 2023.

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