Addiction Relapse Prevention: Risk Factors, Signs & What to Do

One study reported that the five main reasons people reported for abstaining from illicit drugs were:

• Concerns about physical health
• Lack of interest
• Harmful psychological consequences
• Personal beliefs/morals
• Peer/family disapproval

To alleviate cravings

When someone abstains from a substance, especially in the first few weeks and months, they will likely experience cravings for it. These cravings can be intensified around certain people or places and require significant effort to overcome. They may also suffer from withdrawal symptoms that differ from drug to drug but can include nausea, insomnia, and mood swings. There can be a great temptation to alleviate these symptoms by taking the substance again.

When facing triggers

Addicts often face relapse triggers that encourage them to take the substance. Common triggers include people, places, or situations associated with their life using drugs. As part of addiction treatment, individuals are encouraged to avoid high-risk situations where they may face their triggers or, if this is not possible, develop new skills for dealing with times when they feel the urge to use drugs.

To deal with stress and emotional distress

For many people, using drugs or alcohol is a way to escape everyday life or relax when facing challenging, upsetting, or stressful situations. Exposure to stressors is a major risk factor for drug relapse after periods of recovery. To avoid old habits, those abstaining from drugs or alcohol need to develop new coping strategies for alleviating stress and helping them relax, such as meditation or exercise. Drug use can also alter a person’s brain and hamper their long-term ability to manage stress successfully. One study into cocaine use disorder found that cocaine causes neuroadaptations in the stress and reward circuits in the brain, which increase susceptibility to relapse.

The user believes they are in control

When someone has successfully abstained for a while, they may think they can control their substance use and not become addicted again. Testing this theory could result in a one-off minor lapse or the start of a full relapse into the same situation they were in previously, if not worse.

Feeling unsupported

When users feel like they are not being helped in their addiction recovery process or do not have social support, they are more likely to revert to old behaviors. As a supportive friend or family member, it can be essential to reassure the addicted person that they are making good progress and that their efforts are recognized.

When experiencing physical pain

For many addicts, especially those that have an addiction to prescription painkillers, physical pain can be particularly challenging. If someone has a painful condition, injury, or operation, the temptation to take painkillers can be overwhelming. A medical professional must manage this situation to avoid addiction relapse.

The substance has been replaced with another

People with a substance use disorder may believe using one substance is preferential to another. An example may be to swap taking opioids to drinking alcohol excessively as they have a similar effect. This behavior may cause a secondary addiction to the replacement substance or cause the person to lapse in judgment and give into temptation, leading to them retaking the original substance.

Mental health issues

Many studies identify a link between mental health conditions and substance use disorder (SUD). As many as one in four individuals with a serious mental health illness such as chronic depression, bipolar disorder, or schizophrenia also have a SUD. In line with the chance of developing a SUD in the first place, someone with a co-occurring mental health condition (either one that they had before or developed as a result of their substance abuse) is at a higher risk of relapse.

Past trauma

An individual with past trauma, especially trauma experienced as a child, such as abuse and neglect, is more prone to developing an addiction and relapsing. These experiences have a detrimental impact on the brain, contributing to a cycle of emotional and behavioral problems, and addiction.

Newly abstinent

People that have only recently stopped taking the substance are more prone to relapse. One reason is that the user may suffer from withdrawal symptoms, and the craving to take the substance to alleviate their symptoms is intense. Another reason, as identified by a study into recently abstinent cocaine users, is that the individual’s sensitivity to stress is more pronounced, making them susceptible to relapse.

Adrenal sensitivity

Those with autoimmune diseases and problems related to the adrenal gland can be more prone to relapse as they have a cortisol deficiency. This hormone regulates stress levels in the body. One study of those with alcohol addiction found a significant effect of high adrenal sensitivity and increased stress on subsequent alcohol relapse.

Not completing treatment

Individuals who do not complete their addiction treatment program or commit to an aftercare plan are at significantly higher risk of relapse. A study into opiate-addicted people showed that those who completed the entire six-week inpatient treatment program had a significantly delayed chance of relapse.

Emotional Relapse

At this stage, individuals are not thinking about relapsing and are still committed to sobriety. They are, however, starting to experience negative thoughts and feelings, which may lead them to forget their resolve to remain sober. They may begin to act in self-destructive ways. The denial can make it particularly challenging to address the risk of relapse at this stage as the person may not see that there even is a risk.

Mental Relapse

During a mental relapse, the individual starts to think about using the substance again. They are torn between feelings of wanting to use the substance and not wanting to use the substance. They begin to struggle to cope with everyday situations and have the potential to start using the drug again if the opportunity arises.

Physical Relapse

Physical relapse is when a person starts using the substance or substances again. There are two different types of physical relapse – lapse and relapse. A lapse is a one-off, short-lived or accidental use of drugs or alcohol, whereas a relapse is a return to pre-abstinence levels of the substance to which they have an addiction. When they lapse, the addicted person can experience feelings of self-blame and uncontrollability, which can trigger another relapse unless dealt with appropriately.

Signs of Emotional Relapse

• Isolating themselves: Someone who is starting to struggle emotionally may distance themselves from friends and family.
• Not showing emotions: Although they may be experiencing some negative thoughts and feelings, they are reluctant to express them.
• Reduced involvement in treatment programs: At this stage, the individual is still committed to sobriety and will likely continue with treatment but may not contribute as actively as before.
• Projecting concern onto others: To distract themselves and other people from the negative feelings that they are experiencing, the individual may start putting the focus on other people’s problems instead.
• Poor self-care: This could be emotional or physical. A person at risk of relapse may start to not take care of their basic needs, such as sleeping, healthy eating, and hygiene. At this stage, they may benefit from a reminder of the HALT acronym used in many addiction treatment programs. Standing for hungry, angry, lonely, and tired, it asks a person to focus on their basic needs and address them before taking drugs or alcohol.
• In denial: During this stage, the individual may be in denial about what is happening. Or they may be unwilling to address the situation for fear of failing in their recovery.

Signs of Mental Relapse

• Looking for an escape: When someone has been experiencing the negative emotions associated with an emotional relapse for some time, they may start to feel disheartened and unmotivated in their recovery. They may be thinking about using drugs to escape these unwanted feelings.
• Thinking about the past: If someone is torn with feelings regarding whether to use the substance again or not, they may start to recall people, places, and situations associated with their past drug use. In doing so, they may try to glamorize this time in their life. They may underplay the risks they took previously.
• Devising strategies for use: A tell-tale sign that someone is considering using drugs again is when they start to create ways in which, this time, it will be different. They may have a strategy to manage the situation better to avoid repeating their former addictive behavior, such as only using the substance on special occasions.
• Becoming secretive: Lying and deceitful behavior goes hand in hand with substance abuse. Someone considering retaking drugs will likely return to some past secretive behaviors, such as not disclosing their whereabouts.

Signs of Physical Relapse

When someone physically relapses, the signs are similar to the development of the initial substance use disorder. The National Institutes of Health identifies some warning signs of addiction as follows:

• Insomnia
• Anxiety or depression
• Problems with memory
• Irritability and mood swings
• Frequently refilling prescriptions
• Increasing the amount of medication used
• Lack of interest in usual things
• Unexplained excessive energy

Examples of treatments that may be employed are:

• Cognitive behavioral therapy (CBT)
• Contingency management
• Motivational enhancement therapy
• Family therapy
• Twelve-step facilitation

SAMHSA’s National Helpline

SAMHSA’s National Helpline is free and confidential and available daily. You can get advice on treatment options for addiction relapse by calling: 1-800-662-HELP (1-800-662-4357).

Rehab.com

Rehab.com offers trustworthy online resources and a helpline. Call now at (833) 386-0206 to be connected to treatment providers that care.

Support Groups

Narcotics Anonymous, Alcoholics Anonymous, and other support groups are available across the U.S. As relapse is so common, you will likely meet with other people in the same situation and receive invaluable peer support to assist you with getting back on track.