As a recovering addict, recognizing that you’re potentially relapsing is one of the most important skills you can develop. Relapse can happen suddenly, as in the case of the dreaded slip, or it can come on over a long period of time. It can feel like an inevitable force. It can even feel like a tidal wave. But it doesn’t have to be that way. While you may be stuck with cravings—let’s not kid ourselves about that—you can learn strategies that can keep you out of the danger zone.
In this post, we’ll explore the phases of relapse so that you can recognize them in yourself. Then, we’ll give you a powerful toolbox with which you can course correct if you feel relapse coming on.
Ready? Let’s go.
Avoiding relapse starts with what you do right after leaving rehab. Hopefully, your treatment facility did more for you than get you clean and sober. With any luck, they also led you through some intensive therapy sessions. Therapy modalities such as CBT can help you recognize thought distortions that can drive you to make impulsive decisions. Common thought distortions include:
- All or nothing thinking
- FOMO—or fear of missing out
- Ignoring the positive
- Filtering the negative
It’s important to work on these thought distortions yourself every day. There are several free CBT apps that will allow you to conduct CBT sessions on the move. Be your own advocate.
Additionally, there are several things you should not do once you leave rehab. This includes visiting previous haunts where you got high, intentionally engaging in triggering activities and hanging out with toxic people. More on all these later.
For now, it’s enough to know that going to your old neighborhood when you first get out of rehab, hanging out with old friends who also use or even seeing family members may spark a desire to use again.
What is Relapse?
Sobriety is rarely a one and done affair. You may slip several times. Most people do. In fact, most addicts will relapse more than once. Stressors in the form of work, family, friends and the environment can trigger a relapse crisis.
It’s important to note that while detox gets the drug out of your system, your cravings may never completely go away. What’s more, during periods of acute stress, cravings may return with a vengeance. The good news is that while relapse is common, it’s not guaranteed to occur. Nor is it an automatic process that ‘just happens’ from time to time.
There are, in general, two types of relapse.
A slip occurs when you partake in a small amount of your drug of choice after having been through the rehab process at least once. For an alcoholic, for instance, a slip would be a few beers after work with the guys. You may be able to function normally, and you’re still in control for the most part, but you know that things could get out of hand. The slip zone, so to speak, is an uncomfortable place for most recovering addicts to be in, even if it provides short-term pleasure.
Many recovering addicts respond to a slip by course correcting right away. Others, however, feel guilty and allow this guilt to lull them into a what’s the point? attitude. This is how a slip can become a full relapse.
Slips are often spur of the moment. They’re rarely planned events.
If you’re working with a sponsor, it’s very important to report any slips promptly. Hiding the fact that you slipped from your sponsor hurts only you.
The Full Relapse
If you seek your drug of choice ahead of time, with premeditation, then you’re headed for full relapse territory. That’s the main difference between a slip and a full relapse. Slips, as stated, are often spur of the moment lapses in control. But a relapse is a conscious choice to use, often after an unintentional slip.
A relapse often starts as a slip. A slip is a spur of the moment, unplanned use of your problem substance. A relapse, which means ‘to fall again,’ signifies a return of the addiction unless you immediately seek treatment.
The Stages of Relapse
In order to reliably recognize that you’re relapsing, you’ll need to know the stages of relapse. There are generally three stages:
In the emotional relapse phase, the emotions associated with using resurface. This may involve longing to be high, or general nostalgia.
Signs to watch for:
- You show up late for support meetings or don’t show up at all
- You’re more irritable than usual
- You have unwanted, frequent thoughts about drugs
- You’re frequently told by others that you’re in denial about your ability to control your addiction
You may not yet be consciously thinking about using in this stage, but you may be engaging in adjacent behaviors. Let’s look at a quick example.
Steve is a recovering alcoholic. He got out of rehab recently, and he’s not thinking about using. Steve has two good friends. Both friends host poker games on alternating weeks. Steve chooses to go to these games most frequently when Friend A is hosting, and it just so happens that Friend A serves alcohol. Steve doesn’t partake, of course, but he enjoys watching others enjoy alcohol—or at least, that’s what Steve tells himself.
Symptoms to watch for:
- Mood swings
- Poor sleeping habits
- Jealousy or envy
- Poor diet
- Breaking commitments
- Befriending users of the problem drug or substance
- Engaging in risky behaviors or thrill seeking
In the mental relapse stage, the desire to use surfaces consciously, and you start thinking about using. You imagine what it would be like, and you engage in FOMO thinking—fear of missing out. You begin to picture what your life will be like without your drug of choice. You may feel bored with life, and you may feel bereft of passion.
In short, your mind is at war with itself. You’re fighting a battle of wills, with one part of your mind wanting to use, and another part wanting to remain sober.
Signs to watch for:
- Reminiscing about what it was like to get high
- Talking to other users about using
- Lying to sponsors and others about your thoughts about using
- Rekindling friendships with users you cut ties with
- Glamorizing your past drug use—or escapades—to others
- Thinking about relapse
- Gathering drug paraphernalia, such as needles, pipes and other items, even if you have no intention to use them.
Symptoms to watch for:
- Everything from the last section, but more intense
- Suicidal ideation
- Aggression towards sponsors, friends or family
Physical relapse is the final stage, and involves the actual consumption of the drug itself. Physical relapse does not always signify a return to uncontrolled usage, but it often does. A relapse may last several months. Some addicts, however, turn things around by seeking treatment right away.
If you can determine which stage you’re in at any given time, you stand a good chance of recognizing an impending relapse. Ideally, you want to become aware of the problem when you’re still in the emotional relapse phase.
When you find yourself in the emotional relapse phase, you can be sure that you have responded to one or more triggers. Triggers are events that cause nostalgia for your problem substance. Seeing drug paraphernalia is a common trigger. Another trigger reported by many recovering addicts is visiting with old friends who still use.
Common triggers include:
- As you may guess, hanging out with people who use is usually a red flag. Spending time with users can set off cravings that can be hard to ignore because of the social pressure to belong. You may feel as if you need to partake in order to fit in.
- Places. Any place that reminds you of your previous binges is a potential trigger. You should never ignore these triggers. If you’re unsure whether you can handle going to a given place, then don’t. Don’t worry about what others might think. Any place that makes you think about using is a high-risk location. Avoid it.
- Former heroin users often report that the humble spoon can trigger cravings. For this reason, some recovering heroin addicts use only plastic spoons or sporks. This eliminates one aspect of the trigger, the metal sheen of the spoon. Any sort of drug paraphernalia represents a threat to your sobriety, but as the above example illustrates, every day, hard-to-avoid items can be dangerous too.
Of the three, many addicts report that things are the hardest to avoid. Common thing triggers include:
- Pill bottles
- Credit cards
- Television shows
Tip: if you have clothes from before you first went into rehab, it may be a good idea to give them away, or, if they’re in no condition to give away, simply burn them.
Contact with drug-related objects can fuel cravings.
Now that you know how to recognize that you may be about to relapse, it’s time to learn some concrete counters. These counters are most effective in the mental relapse stage, when you become aware of a conscious desire to use.
#1 Reach Out
Call someone. Don’t wait. Do it now. Whether it’s a sponsor, a family member or a friend, reach out. Don’t worry about whether you’re being a burden, or whether the person is tired of hearing from you. Your sobriety is important. Feelings of loneliness can lead to cravings.
Talking through your cravings can help you recognize thought distortions that are fueling them. While experienced addicts can use CBT on their own, the newly recovered will likely need to verbalize their feelings to someone else. Getting out of your head can work wonders.
Voicing your thoughts to someone else can help those thoughts seem less intimidating, putting you back into control.
What’s more, admitting, out loud, that you want to use can help the urge subside. If you want to use, there’s nothing wrong with acknowledging that, as long as you understand that you don’t have to give in to that desire.
Denying that the desire exists can sublimate it. It will surely resurface, likely in response to stress, when you may not be as well equipped to deal with it.
# 2 Wait 30 Minutes
If you know you’re heading for a slip, and talking it out didn’t help, force yourself to wait for thirty minutes. Every time you curtail the impulse to use in this way, you gain more control. The brain is flexible . If you don’t give in to an impulse, that impulse becomes just a little bit weaker.
Often, addicts who can make themselves wait 30 minutes find that the craving subsides.
# 3 Imagine the Worst Case Scenario
Force yourself to imagine the absolute worst case scenario. You could overdose. Or, you could overdose, but not die, ending up a vegetable. Picturing as vividly as possible the worst possible consequence of using can help put things into perspective, which may make the craving subside faster.
# 4 Focus on Today
Don’t let FOMO—fear of missing out—make you picture going months or years without using. Focus on today. You just have to remain sober today. Tomorrow will take care of itself. Readjusting your perspective in this way can take a load off, which can make dealing with cravings much, much easier.
# 5 Think About Something Larger Than Yourself
If you feel like you’re going to use, think about a system that’s larger than yourself. For instance, the ecosystem on Earth is extremely complex. Animals range in size from microscopic—like the tardigrade—to 100 feet long—like the blue whale. Spend some time contemplating this complexity until your craving subsides. Every time your thoughts wander from this contemplation, gently force it to return.
With this exercise, you shift your focus away from yourself and onto many. This engages numerous brain regions and gives you some relief from dopamine-seeking.
Things to contemplate:
- The complexity of ant or termite colonies
- How killer whales work together to hunt
- The complex interactions of the microcosm, which includes bacteria, micro-animals fungi and more
#6 Replace Problematic Behaviors
You probably heard this one in rehab, but it bears repeating. If you can form new, more positive habits, you may have fewer cravings. Anything that gives your life meaning is a good place to start. Exercise can provide a natural high. Some people find that they enjoy cleaning, doing the dishes or ironing clothes. Others take up games, art, books or crafts.
At the end of the day, recognizing that you may be relapsing comes down to understanding the phases of relapse itself. Now that you’re familiar with these phases, put the above strategies to use for you the next time you find yourself thinking about using.
If you’re trying to get addiction treatment for yourself or for someone you love, reach out to The Hills for comprehensive and caring treatment that will help patients detox and learn the skills to cope with their triggers and their addiction. You have options, let The Hills be one of them.