A relapse occurs when an individual abandons their goal of reducing or avoiding substance use and returns to previous levels of use. This differs from a lapse, which is a brief deviation from recovery goals, followed by a return to these goals. For example, a lapse might involve having a drink at a party but then resuming sobriety the next day.
Addiction has a profound impact on the brain, altering its function and structure. Normally, the brain releases pleasure chemicals during rewarding activities like exercise or socializing. However, drug use also triggers these chemicals. Over time, as addiction develops, the brain starts requiring increasing amounts of the substance to experience the same level of pleasure. Eventually, not using the substance can lead to feeling worse due to this dependency.
Brain scans reveal that addiction changes the brain in ways that diminish an individual’s capacity for self-control and sound judgment, making it more challenging to overcome addiction and maintain sobriety. These changes can be particularly severe in teenagers, whose brains are still in the developmental stage, making them more susceptible to these adverse effects. Every day that a person refrains from using substances is a significant achievement against these powerful changes in the brain.
Several factors can lead to a relapse, including:
- Challenging Personal Circumstances
Issues such as emotional and psychological struggles, work-related problems, financial hardship, social rejection, and difficulties in personal relationships can contribute to a relapse.
- Triggers and Temptations
Situations or environments associated with previous substance use can tempt an individual to use again.
- Coping Mechanisms
Using substances as a strategy to cope with stressors like insecure housing, professional setbacks, or social pressures.
- Mental and Physical Health Issues
Pre-existing mental health conditions and physical health problems, especially chronic pain, can lead to relapse, often through the misuse of pharmaceutical drugs.
- Guilt from Lapsing
Experiencing guilt after a lapse can lead to further substance use as a coping mechanism.
Relapse should not be seen as a sign of weakness or failure but as a continuation of past coping patterns that need to be replaced with new, healthier ones. Recovery and the reasons for relapse are highly personal, and it may take several attempts to find effective long-term management strategies for maintaining recovery goals. In the addiction recovery community, relapse is often seen as a part of the recovery process. It’s important to understand the warning signs and triggers that may lead to relapse, such as stress, social settings, or emotional instability. By recognising these risk factors, you can begin to develop strategies to avoid or manage them effectively.
Relapse in addiction recovery can be understood in terms of its types and stages:
Types of Relapse
- Traditional Relapse
This occurs when a person consciously decides to use drugs or alcohol. An example is someone who, after a period of sobriety, chooses to smoke marijuana to relieve stress or decides to drink wine with friends, believing they can control it.
This term refers to an accidental relapse. It happens when a person unknowingly consumes drugs or alcohol, such as accidentally drinking an alcoholic beverage at a party, thinking it was non-alcoholic.
Stages of Relapse
Relapse typically unfolds in three stages:
- Emotional Relapse Stage
This initial stage occurs well before actual substance use. It involves failing to cope with emotions healthily, bottling up feelings, isolating oneself, denying problems, and neglecting self-care. Although there’s no conscious thought of using substances at this stage, the groundwork for a future relapse may be laid.
- Mental Relapse Stage
At this stage, there’s an internal conflict about sobriety. Part of the person wants to stay sober, but another part battles cravings and considers ways to relapse. This stage may include glorifying past substance use, downplaying the consequences, and seeking opportunities to use.
- Physical Relapse Stage
This final stage is the act of using drugs or alcohol. What might start as a lapse, like having a single drink or drug use, can escalate into a full relapse, characterized by feeling out of control with substance use.
It’s worth mentioning that relapse is neither inevitable nor necessary for everyone. Many individuals successfully maintain long-term recovery without experiencing a relapse.
Why People Relapse
Here are key factors and scenarios that often contribute to relapse:
Individuals may relapse within the first week of cessation to avoid withdrawal symptoms, which can range from nausea to potentially deadly conditions, particularly with substances like alcohol and benzodiazepines. Medical detox is recommended for safety and comfort.
- Mental Health
Underlying mental health issues like anxiety, depression, or PTSD often accompany substance dependence. Addressing these issues is key in recovery, as they can trigger relapse if left untreated.
Associating with others who use substances can lead to relapse. Setting boundaries with such individuals and having a sober support network is vital.
Locations associated with past substance use can trigger cravings. Awareness and avoidance of these places, or redefining them in the context of sobriety, can be helpful.
Objects or sounds associated with substance use can unconsciously trigger a relapse. Mindfulness and awareness are key to managing these triggers.
- Poor Self-Care
Neglecting self-care, like poor diet or sleep, can lead to low mood and cravings. Healthy lifestyle practices are an essential part of recovery.
- Relationships and Intimacy
New relationships or existing ones can be challenging for individuals new to recovery. It’s often advised to avoid new intimate relationships in early recovery to focus on personal stability.
- Pride and Overconfidence
Being overly confident in one’s recovery can lead to risky situations and potential relapse. It’s important to remain vigilant and continue with recommended treatments and recovery activities.
- Boredom and Isolation
Excessive free time can lead to boredom and isolation, which are common relapse triggers. Engaging in recovery-related activities and developing new hobbies are beneficial.
- Uncomfortable Emotions
Previously masked by substance use, learning to accept and cope with uncomfortable emotions is a critical skill in recovery.
Understanding these triggers and stages can help individuals in recovery anticipate and prepare for challenges, increasing their chances of sustained recovery.
What to do After a Relapse
After a relapse, it’s essential to consult with a healthcare provider who can reassess and modify the treatment plan. This might involve intensifying the treatment or incorporating more support group meetings. Depending on the substances involved and the individual’s situation, treatment can vary. It may include detoxification to safely remove the substance from the body and prepare for further treatment. Treatment options range from inpatient treatment, which provides 24-hour medical supervision and behavioral therapy, to outpatient treatment, where individuals attend services during the day but return home at night. Therapy approaches in both inpatient and outpatient settings may include Cognitive Behavioral Therapy (CBT) to manage cravings and prevent relapse, Contingency Management (CM) using incentives for maintaining sobriety, and Motivation Enhancement Therapy (MET) to boost motivation and alter behaviors. Additionally, ongoing participation in mutual support groups like Narcotics Anonymous (NA) and Alcoholics Anonymous (AA) can be important for re-engaging in the recovery process and sustaining abstinence.
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