Identifying the Signs of Relapse And Preventing It
Relapse is a reality that many people face after leaving their rehab treatment facilities. Rehab programs typically do their best to prepare these people for handling a potential relapse, providing them with coping skills that can be used out in the world. But relapses can still happen, and it is important to identify the early warning signs so that a successful intervention can occur.
Studies show that 80% to 95% of those who stop using alcohol or tobacco relapse within a year. Definitions of “relapse” are varied, with some thinking of it as a dichotomous treatment outcome and others viewing it as an ongoing process that shifts over time.
The truth is that there are almost always signs that someone is relapsing or about to relapse. Paying close attention is important in preventing your loved one’s relapse. While relapse prevention (RP) is helpful as a higher-level intervention strategy for lessening the risk and severity of a relapse following reduced use or total abstinence, your loved one needs a solid support system in order to remain successful in their sobriety. Reaching out to First City Recovery Center can result in a more immediate intervention and a more functional return to sober living.
Relapse Happens in Stages
Let’s be honest — relapse doesn’t “just happen.” It is a gradual, stage-based process. The stages of relapse are:
Emotional relapse typically occurs first as someone in recovery starts to think about using again. Their emotional status might shift to more negative emotions, such as anger, anxiety, or feeling depressed. Their sleeping and eating habits might become more erratic, and they might showcase a dwindling interest and commitment to their sober living. At this point, the person is not truly aware that they are in danger of a relapse. This is the critical point for intervention since you can stop the relapse before it even happens and help your loved one identify what might be causing them to feel the need to use again.
After that comes mental relapse, which is characterized by a period of growing internal struggles for the person who is in recovery. They are caught up in a tug-of-war struggle in which part of them wants to remain on the sober pathway, but the other part wants to start using their preferred substance(s) again. As difficult as it may be to accept, you need to be aware that a part of this person might always want to use again. And they might be having a hard time accepting it, too. Just know that once a person decides that they are going to use again, it is just a matter of time before they act on this desire.
It is hard to come back from a mental relapse because of how quickly it turns physical. Once it becomes physical, once the person has gone back to substance use, is when we heard the term “relapse” used the most. This is because the relapse is now pretty obvious to those around the person. Even using just one time can result in the overpowering craving to use again, and this once again turns into cyclical behavior. At this point, it is critical that the person return to treatment as quickly as possible.
Signs of a Potential Relapse
Pay attention to the red flags. Any warning sign that your loved one might be using again necessitates intervention, as well as even more support from you and their other loved ones. The best way to keep someone close to you from relapsing is by paying attention to the warning signs.
Warning Sign: Romanticizing the Substance
One of the most common warning signs of an impending relapse is the person in recovery romanticizing the substance. They might start fondly reflecting on their days of using the substance and attribute a positive light to them that is unrealistic, ignoring the dangers that using the substance posed for them at the time. This can trigger the person to want to use again and might lead to a mental relapse, which can evolve rapidly into a physical relapse for the individual.
Warning Sign: Believing You Can Use Again Without Getting Addicted
One of the most common — but not often talked about — signs of an impending physical relapse is the person believing that they can use again without getting addicted. They might make what sounds like an off-hand comment about it, such as, “One more time wouldn’t hurt me.” They might even attribute their ability to casually use again to the skills they learned in rehab.
They also might not say anything directly about this belief. Some people know that saying such a thing could set off red flags for their loved ones. This means that you need to pay careful attention to both their language and behavior, not just one or the other.
Warning Sign: Behavioral Changes
Make sure you pay attention to common behaviors for people with substance use disorders. They might start to engage in other risky behaviors, show signs of social impairment (like not completing schoolwork or struggling to perform work tasks), lack self-control, and show signs of emotional distress.
Behavioral changes should set off alarms in your head because they often precede a physical relapse, and not by much. The individual might become more isolated and even stray away from their sober living support system. They might start skipping out on counseling appointments or 12-step recovery program meetings. The interests and skills they developed in recovery might be shoved to the wayside, too.
Finally, a key indicator is the person expressing any doubt in the recovery process. They might say that it is not working quickly enough, or working at all, and doubt its efficacy. It might seem like they have just given up on the idea of recovery being a lifelong process. They might also doubt their own ability to maintain sober living, using negative self-talk like, “I can’t do this,” or “I’m just a failure anyway, so what does it matter?” If you hear anything like this, consider it a signal that a physical relapse is close on the horizon.
What Triggers a Relapse?
There is a common misconception that a relapse occurs because a person in recovery simply decides to use again. The process is never that simple or cut-and-dried. Instead, there are likely a number of triggers that are leading the individual to doubt the recovery process and the efficacy of the skills they learned in treatment.
Depression is a common co-occurring disorder for people who have substance use disorder. Family relationships, peer environments such as school and social settings, and other co-occurring problems can trigger depressive episodes, which can prompt someone in recovery to start using again. The person could be suicidal and might even consider intentionally overdosing as a final way to escape their problems.
Many who have depression will try to mask their symptoms out of shame and fear of the stigma attached to mental health conditions. The most common depression symptoms are:
• A sense of hopelessness
• Exhibiting low energy
• Lacking interest in usual activities
• Major fluctuations in appetite
• Feeling worthless
• Feeling irritable or easily agitated
• Difficulty concentrating
• Changes in sleep habits
Stress and anxiety tend to trigger returns to substance use as well. Stress is both a physical and mental condition characterized by high blood pressure, bodily aches and pains, muscle tension, and a weakened immune system. And it can certainly act as a precursor to anxiety.
People with stress and anxiety disorders sometimes use substances as a way to self-medicate. They might drink too much, too often. They might also engage in risky, addictive behaviors such as gambling, compulsive shopping, or compulsive sexual activity.
Exhaustion is another factor that could trigger a relapse. When a person overexerts, they allow themselves to become too tired to be able to rationalize and utilize the coping skills they learned in rehab. They might not be following through on their self-care routine of regular exercise, healthy nutrition, and getting the right amount of sleep each night.
They might also start to expect too much from you and other people who are closest to them. They might take the approach of “Hey, I have changed — why haven’t you?” They lose track of the fact that they can only control themselves and ultimately lose the self-control they worked so hard to build up while in rehab. When you cannot control yourself, you start to control others, and that is something a person in recovery might do when they are thinking about using again. This type of behavior should not be brushed off since it often serves as a precursor to a physical relapse.
If your loved one is expressing any self-pity, this could be a sign that they are on the verge of using again. They might be struggling to admit that the choices they made got them to the unfortunate place where they are, and that could be a sign that they are struggling with the recovery process itself.
Prevention and Recovery From a Relapse
Relapse is preventable. It is important to address those mental urges to use again. Continuing counseling and 12-step programs are critical in this regard. It is important to have someone to speak with when those urges come up, and they will come up.
It can be helpful to hit replay when a person is romanticizing their substance use. Sure, that initial use might feel good, but what happens next doesn’t feel good at all. Hearing this is important, as it reminds the person in recovery of why they sought help in the first place.
In some cases, it is necessary for a person who contemplates using again to re-enter rehab. When the urge to use again is overwhelming, another stay in a rehab facility could be truly beneficial. This gives the person a chance to separate themselves from their surroundings but also address their problems in a safe, welcoming, and open environment. And, if they do need to detox again, they can do so in a location where they are being monitored and medically assisted 24/7. First City Recovery Center is equipped to help those who have relapsed.
Relapse doesn’t make someone a failure. It makes them human. The fact of the matter is that there will always likely be an urge to use when something negative acts as a trigger. The recovery process is lifelong, and relapse can occur at some point. When it does, recovering from that relapse is going to require a lot of support. It also provides the individual with a chance to learn more about their triggers, why they are occurring, and how to cope with them in a safer and healthier manner. Getting help now is important since a full, physical relapse can be dangerous. You can get back on track with help from First City Recovery Center, so
Dr. Vahid Osman, MD is a psychiatry specialist in Indianapolis, IN.
Dr. Osman completed a residency at Austin State Hospital. He has over 32 years of experience in Psychiatry & Behavioral Health. He is board certified by the American Board of Psychiatry and Neurology.