Relapse in Addiction Recovery: Risk Factors and Prevention

October 10, 2022

Table of Contents

Addiction is a chronic disease with relapse rates similar to other chronic diseases at between 40% and 60%.[1] A relapse is a return to using drugs or alcohol after a period of abstinence. 

Relapses often happen gradually in stages. 

Risk factors for relapse are many: from untreated withdrawal symptoms to difficulties managing stress, to untreated pain. 

Preventive measures against relapse include social support, group meetings, treatment of other underlying medical and mental health conditions, and adequate treatment of pain/withdrawal symptoms. 

Asking for help after a relapse, and even going back to treatment when necessary, can help you to achieve a lasting and healthy recovery.

Stages of Relapse

A relapse usually happens in three main stages:[2]

1. Emotional Trigger

During an emotional relapse, something triggers an individual to have less emotional stability. A break up with a partner, a falling out with a friend, loss of a job, etc. Signs of an emotional relapse include the following:

  • Isolation
  • Bottling emotions up
  • No longer going to meetings or going to meetings but refusing to share
  • Poor eating and sleeping habits
  • Focusing on other people’s issues instead of your own

Without addressing or acknowledging the emotional trigger, the more at risk you are of relapse.

2. Mental Relapse

A mental relapse involves the re-development of thoughts to use a substance again. Signs of a mental relapse include starting to think about using the substance or making plan for where and when to use the substance, or coming up with rationalizations about why it would be ok to use the substance. 

Thinking about using drugs or alcohol again during treatment and recovery is normal and does not necessarily indicate a mental relapse. When these thoughts become more frequent and insistent, this can mean you are having a mental relapse, which can progress to a physical relapse.

3. Physical Relapse

A physical relapse is when you start drinking or using drugs again. After a brief lapse, such as having one drink one time, it can be easy to slide back into uncontrolled use and a full-blown relapse. 

What Are “Triggers” For Relapse?

There are a variety of reasons that a relapse can happen, and each person’s potential triggers are different. 

A trigger is any stimulus that increases your desire to use a substance. Common triggers include: 

  • seeing individuals with whom you used to use substances
  • attending gatherings or events where substances are being used
  • having physical symptoms like untreated pain
  • having social or psychological stressors such as the loss of a job or a break up with a friend or partner. 
  • Boredom or too much free time itself can be a trigger. 

The National Institute on Drug Abuse (NIDA) recommends that you spend at least 90 days in an addiction treatment to learn how to identify triggers and prevent relapse. [3]

It is important to understand your personal triggers and to practice methods of minimizing or avoiding and working through them. 

Risk Factors/Triggers for Relapse

There are several risk factors that commonly lead to relapse: 

Withdrawal Symptoms/Untreated pain 

Withdrawal symptoms themselves are one of the most common triggers for relapse. Physical dependence on substances leads to withdrawal symptoms when use is discontinued. Many of these withdrawal symptoms will dissipate or at least lessen in severity after the first week or so after stopping alcohol or drug use, but their acute nature during this first bit of recovery can be cause for relapse. Some of the side effects can continue for weeks or even months. It can seem easier to return to drug or alcohol use to make them stop, leading to a relapse. One of the best ways to address physical withdrawal symptoms is with use of Medication for Addiction Treatment (MAT). MAT treats withdrawal symptoms and prevents relapse. 

Mental Health Issues

Untreated Mental health disorders can lead to relapse. Mental health disorders and addiction co-occur with each other around half of the time, and each can contribute to and exacerbate the other.[4] “Just stopping” drug or alcohol use does not deal with the root causes that led to the substance misuse in the first place, including an untreated mental health disorders such as depression or anxiety. 

Poor Self-Care: Diet and Sleep 

Not taking proper care of yourself can be a risk factor for addiction. This can include unhealthy eating habits and not getting the right nutrition. When you eat a diet that is high in sugar and low in necessary nutrients, you can experience mood swings and low energy that may also cause cravings for drugs or alcohol. Not getting enough sleep can leave you fatigued, irritable, and anxious and more likely to return to substance use. 

Relationship/Social Stress

Relationship problems - either Intimate relationships or family/friends - may involve a roller coaster of emotions that can be difficult to manage when you are not also trying to sustain addiction recovery. Unstable social relationships can be a trigger for relapse. 

People, Places & Things Associated With Using

Anything that reminds you of drinking or using drugs can be risk factors for relapse. Hanging out with the same people you used to get high with, who are still engaging in drug misuse, can be a trigger for relapse.

What to Do After a Relapse?

Relapse is common in recovery and does not mean that you have “failed”. Try to let go of shame and guilt and instead focus on reaching out for help as soon as possible. 

If you have discontinued formal behavioral therapy, it can be beneficial to go back . This can mean re-starting support groups, individual therapy, or other peer programs or day programs. 

You may need professional services for detox after a relapse. This can give you the right support and medical help you will need to manage cravings and withdrawal symptoms.

Lastly, starting or restarting medications for addiction treatment (MAT) can help address physical withdrawal symptoms and get you back on track. 

Give yourself some grace. Remember that you stopped drinking or using drugs before and you can do it again. Reflect on what caused this relapse and create a relapse prevention plan to avoid future backsliding. 

Use your support system and lean on them for help and encouragement. Your network may include family and friends, a support or self-help group, and other sober individuals. 

How to Prevent Relapse 

Here are some tips for preventing relapse and achieving long-term recovery:

  • Stay in treatment long enough to learn effective coping strategies and tools for managing triggers. Only discontinue treatment once you and your loved ones agree that you are very stable. It's better to be in treatment too long than not long enough!
  • Create a relapse prevention plan and consider how to deal with scenarios that might be triggering in advance. If you know you will be at an event where a substance will be used, for example, plan in advance how you will handle it. 
  • Continue going to outpatient therapy or counseling sessions to sustain recovery
  • Involve your family members and close circle in your treatment and recovery planning.
  • Ask for help when you need it and be honest about your feelings.
  • Ensure that your home environment is supportive and low stress.
  • Practice self-care, including caring for your emotional, physical, and psychological states.
  • Set healthy boundaries and stick to them.
  • Avoid triggers when possible.
  • Receive treatment for any underlying medical or mental health conditions.
  • Understand what your triggers are and learn how to effectively manage them.

Remember that relapse is often part of recovery. Part of the work of recovery is to identify and avoid triggers before they lead to relapse.

Medically Reviewed 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.

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  1. Drugs, Brains, and Behavior: The Science of Addiction Treatment and Recovery. National Institute on Drug Abuse. July 2020. Accessed June 2022.
  2. Relapse Prevention and the Five Rules of Recovery. Yale Journal of Biology and Medicine. September 2015. Accessed June 2022.
  3. Principles of Effective Treatment. National Institute on Drug Abuse. January 2018. Accessed June 2022.
  4. Substance Use and Co-Occurring Mental Disorders. National Institute of Mental Health (NIMH). March 2021. Accessed June 2022.

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