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The 3 Stages of Relapse

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By: Renaissance Recovery

Medically Reviewed by: Diana Vo, LMFT

Last Updated: 7/1/2021

A person contemplating on the stages of relapse

Authored By: Joe Gilmore

Table of Contents

While many people believe relapse is a brief, single occurrence, there are actually three stages of relapse – emotional relapse, mental relapse, and physical relapse.

Addiction recovery is an ongoing process rather than a time-limited event like detox or withdrawal. Unfortunately, data shows that between 40% and 60% of those in recovery will relapse at least once. While this relapse rate might seem unusually high, this is comparable to the rates of recovery for other chronic diseases.

Addiction is a chronic and relapsing disease, and how you handle any setbacks on your recovery journey could mean the difference between sustained sobriety and repeated relapse.

The most effective way to minimize your chances of slipping up before your recovery gets traction is to engage with professional treatment. When you are comparing rehab facilities, ensure that those on your shortlist focus on relapse management and prevention, in addition to providing robust aftercare.

What Are the Stages of Relapse?

Relapse is broadly defined as follows: “to slip or fall back into a former state or practice”.

In terms of addiction, NIDA (the National Institute on Drug Abuse) defines a relapse as a return to substance use. NIDA adds that many people in recovery will relapse, some more than once. As such, relapse should not be viewed as a failure, but as a learning opportunity. Relapse can also indicate that the treatment plan needs switching up.

Research shows that there are different stages of relapse. Just like addiction doesn’t just occur overnight, so relapse typically unfolds more gradually. The more aware you become of the warning signs, the more chance you have of remaining abstinent rather than succumbing to cravings for alcohol or drugs.

1) Emotional Relapse

During the first of the three stages of relapse – emotional relapse – you may not be thinking of substance use.

While thoughts of active substance use may not be uppermost in your mind, your emotions and behaviors during emotional relapse are leading you to the point where relapse becomes a real possibility.

Denial is a common marker of emotional relapse. You should also look out for any of the following red flags for emotional relapse:

  • Not enjoying sober life
  • Bottling up your emotions
  • Isolating yourself socially      
  • Failing to attend support group meetings
  • Mood swings
  • Intolerance

As tension builds, this phase of relapse can easily move into the second phase of relapse, mental relapse.

2) Mental Relapse

The second of the three stages of relapse is mental relapse. If you refuse to acknowledge the symptoms of emotional relapse, this can lead to the development of mental relapse, the second stage of addiction relapse.

Mental relapse is characterized by an inner battle. Part of you wants to use substances, while the other part wants to remain sober. Fantasizing about substance use is a common motif during mental relapse.

As this phase of relapse deepens, so your cognitive resistance is liable to weaken.

Look out for any of the following signs indicating the possibility of mental relapse:

  • Cravings
  • Fantasizing about substance use
  • Planning your relapse
  • Minimizing past consequences of substance use
  • Thinking about substance use
  • Imagining how you will control substance use
  • Spending times with people who are using substances

Using relaxation techniques can help you to resist cravings for substances.

Beyond this, try simply waiting for 30 minutes before taking action on any thoughts of substance use. Take a walk and clear your head. Examine the bigger picture and double down on your sobriety before mental relapse becomes physical relapse.

3) Physical Relapse

If you experience the symptoms of emotional and mental relapse without taking any affirmative action, it is only a matter of time before you physically relapse. This is the third stage of the three stages of relapse. The only question remaining at this stage is whether you will reverse this slip-up and re-engage with recovery or slide into a full relapse.

Learn to Avoid Relapse

Once you understand the stages of relapse, you can begin to learn how to avoid them. Anything the brain associates with the high delivered by substance abuse is considered an addiction trigger.

Triggers can be physical, such as the intensely uncomfortable feelings you experience during withdrawal. Even if you’re determined to clean up and stay sober, your brain is telling you that using drugs or alcohol will reduce or eliminate this discomfort.

Psychological triggers also occur, often as a result of depression, anxiety, or toxic stress.

Whether physical or psychological, triggers cause the brain to respond by craving the substance in question. Your brain is telling you that a beer, a joint, or a line of coke would ease this feeling. This happens due to the way addiction wires your brain to associate drinking or using drugs with positive feelings or happiness.

Triggers can strike at any time.

The cravings that follow can be fleeting, or they may linger for days, even weeks.

If you fail to address cravings, they can become almost impossible to shake. The good news, though, is that learning how to better manage these triggers will reduce the number of cravings you need to resist.

Here are some of the most commonly experienced addiction triggers:

  • People, places, and things: Running into friends who were alcohol or drug buddies is perhaps the most common and obvious trigger. Places associated with drinking or drug use can trigger the same cravings. Sometimes, even old drug paraphernalia might be enough to set off cravings. Make absolutely certain to throw away anything and everything that reminds you of your old ways.
  • Major, negative life events: Life has its ups and downs, but if one of these downs is a trauma or tragedy, from the death of a loved one through to divorce, this type of life event commonly triggers cravings if you’re suffering from addiction.
  • Withdrawal symptoms: Nausea, fatigue, exhaustion, and insomnia during the initial stages of detox are often enough to trigger severe cravings. This is one of the many reasons why medication-assisted detox in an inpatient setting is so effective.
  • PAWS (post-acute withdrawal syndrome): PAWS can endure for 18 months or more. This secondary withdrawal stage occurs as your brain chemistry normalizes. It’s commonplace to crave drink or drugs as a result.
  • Poor self-care: Too little sleep and exercise along with too much stress and a poor diet is a surefire invitation for cravings. These areas of life can cause you to feel depressed, irritable, or anxious, triggering cravings.
  • Toxic relationships: Any relationships triggering stress or emotional turmoil are also likely to trigger cravings when you’re in addiction recovery.
  • Prolonged social isolation: It’s not healthy to spend too much time socially isolated. This can easily trigger cravings.

More broadly, we can categorize triggers as follows:

  • Social triggers
  • Emotional triggers
  • Pattern triggers
  • Withdrawal triggers

Social triggers

Social triggers are people or groups of people you associate with drinking or drug use. These are frequently referred to as drink buddies or drug buddies. If you’re recovering from addiction and bump into these people, you’ll experience a social trigger and cravings to use alcohol or drugs.

Emotional triggers

Drug use and heavy drinking often has deep emotional roots. Whether you’re celebrating your abundant joy, or you’re self-medicating to numb pain or sadness, cravings typically follow these feelings. Emotional triggers can be hard to counter.

Pattern triggers

Times of the day, seasons, and any significant events or holidays can act as pattern triggers and cause cravings for drink or drugs.

Withdrawal triggers

Social, emotional, and pattern triggers are psychologically conditioned. A withdrawal trigger, on the other hand, is a simple biological response to the substance no longer in your body. Withdrawal triggers normally occur in the first few weeks of recovery as the substance leaves your body.

Although triggers can occur randomly, they are invariably linked to your previous drinking or drug abuse.

The most dangerous triggers span several categories. If you spent every Christmas drinking heavily with your family members, you’ll potentially be faced with triggers across all of the above categories. As you would expect, cravings will be correspondingly strong.

Now you have a clear overview of the many triggers that you’re liable to encounter on your road to recovery, how can you get to the bottom of them?

An image of a man in a tunnel | Stages of relapse

How To Identify Your Triggers

As we have established, anything can act as a trigger. Here are just a handful of examples, drawing from the above:

  • Bars
  • Restaurants
  • Sadness
  • Happiness
  • Anxiety
  • Friends you used with
  • Environmental clues
  • Weddings
  • Funerals
  • Parties
  • Holidays
  • Life events
  • Stress at work
  • Relationship turmoil
  • Trauma

While some people may suffer from a seemingly endless series of triggers, others get away with fewer triggers for cravings.

When you first embark on your recovery journey, you might find it hard to identify what is triggering you to crave alcohol or drugs. This is normal but don’t let it dissuade you from digging deep.

If you’re stuck, you could start by paying very close attention to yourself and the level of your cravings for alcohol or drugs right now. Write this down. Keep tracking cravings, and note the accompanying people, places, feelings, and things.

Another approach is to reflect on your past drinking or drug use. Ask yourself the following questions:

  • Where was I?
  • Who was I with?
  • When did this happen?
  • How did I feel (before, during, and after)

As you answer these questions, you may find yourself uncovering more triggers. Jot these down and add to your record with as many concrete examples as possible.

It’s not always straightforward identifying triggers as they don’t always have a direct physical effect on the body.

Knowing about both physical and psychological triggers is key if you want to minimize your chances of relapse during recovery.

Addiction Triggers: Physical Symptoms

  • Feeling tightness in your stomach
  • Feeling nervous throughout your body

Addiction Triggers: Psychological Symptoms

  • Frequent thoughts of how good it would be to drink or use drugs
  • Planning how you would acquire substances
  • Remembering times in the past when you used substances
  • Feeling the need for substances

How to Overcome Triggers and Cravings

Different triggers call for different strategies, so you won’t be able to lash together a boilerplate solution for all eventualities.

The same applies to cravings. You may find that as cravings come and go, so different strategies for managing them become either more or less effective. Be flexible and adapt. You’ll need to be prepared to experiment, and you’ll need to pack plenty of patience, too.

Here are a handful of solutions to counter triggers and cravings:

  • Avoiding the people, places, or things responsible for triggering cravings is sometimes the best strategy. Avoidance might not always be possible, and it may not always be necessary or the best option. If the same triggers keep tripping you up, though, stay away.
  • Eating a balanced diet with plenty of whole, fresh foods rich in protein and complex carbs can strengthen your body and leave you better prepared to manage cravings.
  • Aim for at least 30 minutes of cardiovascular activity each day. This will give you a natural boost as your body releases endorphins and dopamine.
  • Attending support group meetings can be the only way some people find they are able to deal with cravings.
  • Meditating or relaxing can calm you naturally and prevent you craving drink or drugs.
  • Focusing fully on all the positive aspects of your life can be enough to drive away mild cravings.
  • Keeping yourself busy with healthy activities will stave off boredom and help you to avoid triggers.
  • Spend time around positive influences.
  • Immerse yourself in the things you love doing.
  • Disengage with some comedy movies or TV shows. Laughter is often the best medicine in the face of craving drink or drugs.
  • Rest well and try to get at least 7 hours of sleep each night. This may be tough in the early stages of recovery but rest as much as you can.
  • Listen to some relaxing or inspiring music, depending on your mood.
  • Make affirmative statements to yourself, like “I can do this. This will pass.”

Remember, however strong and unmanageable it might feel at the time, all cravings end.

To make things easier as you move forward, journal all your triggers and cravings so you can build a full arsenal of coping strategies to suit.

If you ever find yourself teetering on the brink of one of the stages of relapse, just hold on. Remind yourself of all the ways substance abuse has derailed your life, and simply hold on.

You might feel you can stay strong enough to manage triggers and the resultant cravings on your own, but going it alone is seldom the best option.

An image of the ocean near a drug rehab facility | Stages of relapse

Drug and Alcohol Treatment at Renaissance Recovery

Seeking professional treatment can help you to learn the skills you need to stay abstinent long-term. Part of the toolbox you need is an awareness of how to manage these triggers and cravings so you can avoid relapse.

Rehabilitation programs for alcohol or drug abuse – frequently abbreviated to rehabs – begin either immediately after detoxification, or with detox at the beginning of an inpatient program. During this initial period, your body will be purged of substances.

With an inpatient or residential program, you’ll be completely removed from your normal environment to kickstart your recovery without many social triggers and pattern triggers in place.

Whether you opt for an inpatient or outpatient rehab, you’ll learn:

  • How to build superior coping skills so you can better manage cravings
  • All about addiction and dependence
  • The dangers of sustained substance abuse
  • How to identify triggers and alternatives to drinking or using drugs to cope

Our compassionate team at Renaissance Recovery can help you or a loved one today. Call us at 866.330.9449 to learn more about the stages of relapse or our evidence-based treatment programs.

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Diana Vo, LMFT

Diana is an addiction expert and licensed marriage and family therapist who has been in the field of mental health for over 10 years.

Joseph Gilmore

Joseph Gilmore has been in the addiction industry for three years with experience working for facilities all across the country