Recognize Relapse Triggers

Many may think of relapse as an event, a quick decision during a stressful moment of an already bad day. This is not true, however. Relapse is a process that takes place over time and at different stages.¹ When relapse triggers go unrecognized and unprocessed, you become more vulnerable to relapse. This is true for anyone in recovery from a substance use disorder.

No one maintains sobriety on willpower alone. Nor do they stop using alcohol and drugs and immediately have a distaste for them. Because so many parts of the mind and body are involved in developing a substance use disorder, it takes time and skills to avoid relapsing. One necessary skill is to recognize addiction relapse triggers.¹

In this article:

• What is a Drug or Alcohol Relapse?
• Common Relapse Triggers
• What to Do If You Are Experiencing Relapse Triggers
• What to Do If You Relapse
• Find a Treatment Program After Relapse

What is a Drug or Alcohol Relapse?

A relapse on drugs or alcohol involves a return to substance misuse after a period of abstinence and recovery.² It is different from a “slip” or a “lapse” in which a person briefly has a drink or uses drugs but quickly stops afterward. A relapse involves returning to your previous patterns of a substance misuse beyond a slip.

Many people find themselves in a cycle of relapse, which is why the National Institute on Drug Abuse (NIDA) defines addiction as a chronic relapsing disorder.³

The term “chronic” does not apply to everyone. Some people enter recovery and stay there for life. The majority, however, do not. According to research statistics, 40% to 60% of people experience a substance use disorder relapse.⁴

There are several stages of relapse, and each one holds cues and triggers for addiction relapse. The stages include emotional, physical, and mental addiction relapse triggers. Paying attention to your thoughts, feelings, and behaviors during the stages and seeking help can prevent a significant relapse.

Common Relapse Triggers

Addiction relapse triggers are stimuli that prompt a response. Triggers for addiction relapse are considered external by some researchers and internal by others. What is agreed on is that a stimulus sets into motion a series of physiological and psychological reactions that awaken your memories of when you were intoxicated—not the memories of the damage and destruction alcohol or drugs caused you, but the times you felt good.⁵

External Triggers

Common external relapse triggers include:⁵

• Attending a party or celebration where alcohol is present, and they may expect you to drink too
• Going places or doing things that are associated with drinking or misusing drugs, such as watching the Super Bowl, happy hour after work, driving by your former dealer’s home
• Running into people, you associate with alcohol or drugs, like the person who introduced you to substance use or your former dealer
• Watching movies or shows that glamorize alcohol or drug misuse
• Hearing coworkers talking about going to happy hour after work or parties they attended over the weekend
• Receiving awards, promotions, and other outstanding achievements that you would typically misuse substances to celebrate

Internal Triggers

Common internal relapse triggers include:⁶

• Feeling left out or excluded from activities because you no longer drink or misuse substances
• Having mental health symptoms that often appear in early recoveries, such as depression and anxiety
• Having money or access to money
• Having physical symptoms that may reappear once you become sober, such as pain or headaches
• Feeling lonely, bored, tired, hungry, and other ways that you did not feel before due to being intoxicated
• Encountering stressors throughout the day without proper relaxation and stress management skills
• Feeling anger, joy, guilt, fear, excitement, and other emotions that you used to control by drinking alcohol or misusing drugs
• Worrying about weight gain or what others are thinking about you
• Rationalizing reasons to drink alcohol or misusing substances, as if you deserve a reward for being abstinent for a while
• Feeling overconfident in your recovery
• Searching or longing for romantic relationships in recovery takes your focus off being sobriety
• Coping with relationship problems with your spouse or partner by yourself
• Lacking good sleep that helps the body heal and restore itself

What to Do If You Are Experiencing Relapse Triggers

One of the most crucial factors when dealing with addiction relapse triggers is recognizing it is just a trigger. Once you see it for what it is, you can work a plan to overcome them.⁷ Recognizing relapse triggers or signs of relapse is a learned skill.

Each time you identify a trigger and avoid a relapse, your self-confidence grows. You start believing in yourself and that you can maintain sobriety. And you can. Recognizing relapse triggers is just one step in preventing relapse. You must have a plan for what to do after experiencing a trigger.

Think of yourself as a builder. You need good tools and equipment to construct a building that will last forever. Think of good tools as the activities you can do and skills you can learn to improve your abilities as a builder. The more tools in your toolbox, the easier it is to complete the job. In this case, it is easier to identify addiction relapse triggers and prevent a return to substance misuse.

Learning the signs of relapse and prevention skills is often referred to as recovery capital, the internal and external tools that help you maintain long-term recovery.⁷

Receiving counseling and support is the best form of recovery capital. Individual and group therapies and support groups are a good starting point for when you feel a trigger. If you are already in counseling, think about returning to a higher level of care or increasing the number of sessions you attend if the relapse triggers become unmanageable. If you are not in counseling, sign up for a group or work with a therapist.⁷

Coping Skills for Relapse Triggers

Below are some activities you can use as tools to help you overcome relapse triggers:^1,6,7

• Meditation, yoga, or time in prayer
• Thought-stopping techniques
• Volunteer work in your community
• Participate in 12-step or other recovery activities
• Practice breathing techniques for relaxation and regulating bodily responses
• Learn a new hobby
• Listen to music that makes you feel better
• Watch comedy movies or television shows that make you laugh
• Draw, paint, or engage in other forms of art
• Journal your thoughts and feelings
• Exercise or play a sport
• Contact members of your support team

Other ways to help you avoid addiction relapse triggers include drug avoidance behaviors, such as limiting your access to money, looking for a job, cleaning the house, cooking or baking, scheduling time, attending an online webinar, going back to school, or getting your GED.⁸ The key is to create a list of activities that distract you from the trigger and benefit you in some way.

What to Do If You Relapse

Because substance use disorders are chronic diseases, you will experience ups and downs in recovery. It is common for some people to relapse. Rather than give in to addiction relapse triggers and head into a downward spiral of guilt, shame, and continued misuse, you must reenter the stages of recovery.¹

Abstinence

The abstinence stage is where you will make major life changes, including stopping your misuse of substances and getting rid of the people, places, and things associated with your misuse. Here you commit to recovery.
Post-acute withdrawal is when you may continue to experience withdrawal symptoms, but coping involves working with your treatment team, who can provide medication, counseling, and more.

Repair

The repair stage is when you start working on your recovery program. You go through the processes to repair relationships with friends and family, implement healthy alternatives to substance misuse, and start taking care of yourself and meeting your emotional, mental, and physical needs.

Growth

The growth stage involves learning new skills for recovery, such as learning how to stop negative thoughts and replace them with positive ones. Also, you learn how to set healthy boundaries, how addiction is a disease, and how volunteering and giving back aid in recovery.

You can reenter the stages of recovery by doing the following:¹

• Keep your head up high because relapsing does not mean failure
• Seek a higher level of care that will help you reenter recovery
• Admit your relapse to your sponsor or support team who can help you get back into treatment
• Restart medication for withdrawal and cravings if needed
• Practice self-care
• Make changes necessary for recovery

Find a Treatment Program After Relapse

The sooner you enter a treatment program after relapse, the better. If you give in to triggers for addiction relapse early in recovery, you may be able to move to a higher level of care temporarily until you are stabilized in recovery again.

If you have been sober for a while, you may need an assessment by a treatment provider to determine which level of care will benefit you the most. The level of care is typically assigned based on the American Society of Addiction Medicine (ASAM) guidelines.⁹

Inpatient detox will likely be needed if you have relapsed long enough to experience severe withdrawal symptoms. Here, you can receive medication to curb withdrawal and cravings.⁴ If you aren’t experiencing withdrawal symptoms but need to be in a healthy environment to restart your recovery, inpatient rehab may be the best fit.

Partial hospitalization programs (PHP) and intensive outpatient programs (IOP) are available for those with a supportive, drug and alcohol-free living environment that need a structured counseling program throughout the week. PHP offers twenty or more hours of treatment, while IOP offers 10-12 hours.⁹

You don’t have to make this decision alone, fortunately. You will have a team of support within a treatment program to help you make the best level of care choice. Finding an addiction treatment program is as easy as making a phone call. Call our confidential helpline at 800-996-6135(Who Answers?) to speak to a treatment support specialist about rehab options.

Resources

1. Melemis S. M. (2015). Relapse Prevention and the Five Rules of Recovery. The Yale Journal of Biology and Medicine, 88(3), 325-332.
2. Maisto, S. A., Witkiewitz, K., Moskal, D., & Wilson, A. D. (2016). Is the Construct of Relapse Heuristic, and Does It Advance Alcohol Use Disorder Clinical Practice?. Journal of Studies on Alcohol and Drugs, 77(6), 849-858.
3. MacKillop J. (2020). Is Addiction Really a Chronic Relapsing Disorder?: Commentary on Kelly et al. “How Many Recovery Attempts Does It Take to Successfully Resolve an Alcohol or Drug Problem? Estimates and Correlates from a National Study of Recovering U.S. Adults.” Alcoholism: Clinical and Experimental Research, 44(1), 41-44.
4. National Institute on Drug Abuse. (2020). Treatment and Recovery.
5. Asensio, S., Hernández-Rabaza, V., & Orón Semper, J. V. (2020). What Is the “Trigger” of Addiction? Frontiers in Behavioral Neuroscience, 14, 54.
6. Center for Substance Abuse Treatment. (2013). Counselor’s Family Education Manual: Matrix Intensive Outpatient Treatment for People with Stimulant Use Disorders. HHS Publication No. (SMA) 13-4153. Rockville, MD: Substance Abuse and Mental Health Services Administration.
7. Center for Substance Abuse Treatment. (2019). Enhancing Motivation for Change in Substance Use Disorder Treatment. (Treatment Improvement Protocol (TIP) Series, No. 35). Rockville (MD): Substance Abuse and Mental Health Services Administration (US).
8. Farabee, D., McCann, M., Brecht, M. L., Cousins, S. J., Antonini, V. P., Lee, A. B., Hemberg, J., Karno, M., & Rawson, R. A. (2013). An Analysis of Relapse Prevention Factors and Their Ability to Predict Sustained Abstinence Following Treatment Completion. The American Journal on Addictions, 22(3), 206-211.
9. Mark TL, Hinde JM, Barnosky A, Joshi V, Padwa H, & Treiman K. (2021). Is Implementation of ASAM-Based Addiction Treatment Assessments Associated with Improved 30-day Retention and Substance Use? Drug Alcohol Dependence. 226:108868.