Some experts identify three stages of relapse. Here are the warning signs and some steps you can take to head them off.
Sometimes it seems like relapse is a boogeyman of recovery—the scary threat that’s always lurking just out of sight. But there are often warning signs and preventative measures that can be taken. We recently shared a post about how Suboxone (buprenorphine/naloxone) can help to prevent relapse for people recovering from opioid use disorder. Now I want to discuss some other steps we can take to safeguard against relapse, for all substance use disorders. They vary a bit based on which stage of relapse a person is in. That’s right—some experts recognize three stages of relapse, and two of them come before a person even picks up. Because these stages occur before someone drinks or uses, they provide the opportunity to stop the relapse in its tracks.
In this model, the stages are emotional relapse, mental relapse, and physical relapse.
Stage 1: Emotional Relapse
Emotional relapse can be tricky to spot because the person won’t actually be thinking about drinking or using during this stage. In fact, they may emphatically not want to pick up. But their thoughts, emotions, and behaviors begin to reflect unhealthy patterns, leading to a lack of self-care and a lowering of the protections they’d begun building around their recovery.
Warning signs of emotional relapse:
Many of the red flags for emotional relapse overlap with signs of depression, anxiety, or post-acute withdrawal syndrome. Fortunately, all of these situations can be improved with coping strategies and self-care. In emotional relapse, a person may:
- Isolate themselves (pulling back from friends, family, recovery community, sponsors, etc.).
- Skip recovery group meetings and therapy appointments, or no longer participate if they do attend.
- Keep their feelings bottled up.
- Focus on other people’s problems instead of caring for their own.
- Practice less physical self-care (hygiene, appearance, taking care of health concerns).
- Vent resentment and frustration about others.
- Have less healthy sleeping habits (sleeping much more or much less).
- Develop poor eating habits (not eating or hydrating enough, eating foods that make them feel bad, eating in excess to comfort themselves, etc.).
I want to emphasize again that these behaviors can accompany a lot of possible causes. They’re not a reason for shame, but they are a sign that a person may need more support.
What can someone do if they experience these signs?
- Lean on their support network—even if their brain is saying they don’t need or deserve the help.
- Go to recovery meetings, and try to set a small participation goal. If a full share is too difficult, they could still connect with another attendee for a few minutes, make a comment in the chat, or admit that they’re not feeling great emotionally.
- Pick a tool from their recovery toolkit (like journaling, gratitude exercises, breathwork, etc.) and use it.
- If eating well is hard, try adding Ensure or another nutrition drink. Cooking and eating with friends or family can also be helpful.
- Try to move their bodies gently, like taking a walk, playing with a pet, or doing stretches.
- If hygiene seems overwhelming, they can try to commit to brushing their teeth every day.
- Focus on sober fun they can have, and then do one of those fun things.
When an emotional relapse is headed off, it may be indistinguishable from any other low point in recovery. But if it’s not, it may lead into the next stage: mental relapse.
Stage 2: Mental Relapse
In recovery circles, I often hear this stage referred to as “the relapse before the relapse.” It still doesn’t involve actually drinking or using, but it is more recognizable as part of the relapse process. This is a slip back into old coping behaviors rather than the new, healthier ones we learn in recovery.
Warning signs of mental relapse:
In a mental relapse, a person may:
- Have increased cravings for drugs or alcohol.
- Reminisce about people or places they drank or used with (and possibly come up with excuses to visit them).
- Bargain with themselves, the universe, or their Higher Power. (“If I can make it through six months sober, I can reward myself with a drink.” “If XYZ bad thing happens in my life, of course, I’ll have to use.” “I can get a little buzzed on Christmas.” etc.)
- Mentally rewrite the past to minimize the past consequences of substance use or glamorize what it used to be like. I hear people call this “romancing the drink” sometimes.
- Think of ways they could better control their substance use. (“This time it will be different.”)
- Look for relapse opportunities, like looking up their old dealer’s phone number, reconnecting with using friends, or scoping out liquor stores nearby.
- Plan a relapse.
What can someone do if they experience these signs?
It’s common to have cravings sometimes or to experience thoughts about using. But if these signs are popping up as more than fleeting thoughts, it’s smart to take them seriously. A person in this stage can:
- Be honest with their support team about what they’re thinking and feeling, even if that feels scary. Sometimes just saying them out loud can be enough to reduce the power of these thoughts and feelings. If the individual is in medication-assisted treatment, they should tell their provider about any increase in cravings.
- Use a craving-fighting strategy like the ones we discuss in our popular online addiction course, Chill My Cravings Blizzard.
- Look at old journal entries or make a timeline of their substance use. This can provide a reality check about what it was like and what the consequences were.
- Consider any internal and external triggers that might be contributing to these thoughts. Act on the strategies for avoiding or navigating these triggers.
Stage 3: Physical Relapse
Physical relapse is the part that most of us recognize as a relapse: the resumption of substance use. Because the drinking or drug use is readily identified, there isn’t a list of warning signs for this one.
What can someone do if they experience a physical relapse?
We have several posts about this specific topic, so I’m going to link them here. I hope one of these will resonate and prove helpful.
- Tips on How to Handle a Relapse and Resume Your Recovery
- Relapse & Recovery: Addiction Recovery Is A Marathon, Not A Sprint
- Relapse is Not the End
- Recently Relapsed? You STILL Deserve a Life You Love
Physical relapse isn’t a goal of recovery, but neither is it the end of your journey. You can reach your goal of long-term recovery, even after a setback.