What Causes Relapse? Factors to Consider in Recovery
Published: 03/9/2022 | Author: Mona Bapat, Ph.D., HSPP
Relapse to substance use can occur at any point in your recovery journey. Several different risk factors can increase the likelihood of experiencing a relapse, but knowing what causes relapse can help you avoid it and seek extra support.
In this article:
- Lack of Internal Motivators
- Lack of Therapy
- Prematurely Ending Treatment
- Inadequate Interpersonal Support
- How Unaddressed Medical Conditions Contribute to Relapse
- Stages of Relapse
- What Else Can I Do to Help Prevent Relapse?
Lack of Internal Motivators
You are more likely to avoid relapse if you have personal motivations for recovery. While legal mandates or pressures from people in your life can encourage you to get into treatment, your personal reasons are more likely to keep you in treatment and maintain sobriety afterward.1
An example of an internal motivator would be that you have a life goal you want to achieve, such as a certain career path. Boredom can also be a cause of relapse, so having hobbies and goals to work on helps reduce the time spent thinking about using substances. Moreover, if you believe that recovery can help you achieve your goals, you are more likely to prevent relapse.2
Other internal motivators that people have reported for getting treatment and avoiding relapse include:3,4,5
- Devotion to religious or spiritual practice
- Desire to improve self-esteem
- Concerns about physical and mental health
- Concerns about substance use worsening
Thus, identifying your internal motivations for overcoming addiction can encourage you to persist on your path to recovery.
Lack of Therapy
Therapy plays a vital role in treatment and relapse prevention, and treatment plans that only include detox and medication management without therapy have a greater risk of relapse. At each stage of your recovery journey, therapy gives you the skills to move forward, including: 2, 3, 6, 7
- Belief in yourself: Techniques like cognitive behavioral therapy (CBT) can boost your confidence to control substance use, which is a crucial part of relapse prevention. Working with a therapist to process and face personal struggles can help you change your thought process and boost self-esteem.
- Coping skills: If you have turned to drugs or alcohol to cope with stressors for a long time, a therapist’s guidance can help you learn problem-solving and healthy strategies to take care of yourself, such as meditation, deep breathing, or journaling.
- Constructive thought processes: You can also learn how to change your thought processes so they are more helpful and positive. For example, you can learn more effective ways of thinking about cravings and how to manage them.
- Emotional regulation: Therapy can help you learn how to face and manage your negative emotions. Research has found that negative emotions can lead to cravings, one of the major causes of relapse.
- Sustained growth: A therapist can provide you with ongoing support and skill development to sustain the gains you make in treatment and deal with the setbacks.
Prematurely Ending Treatment
Leaving a treatment program before completing it also puts you at greater risk for relapse. Medical professionals are highly aware of what causes substance abuse relapse, and their programs are designed to minimize the likelihood of it occurring. As the continuum of care for treatment is tailored to each individual’s needs, completing the full length of a program is pivotal to transitioning into daily life in recovery.11
For instance, you might think that if you have abstained from substances for a month, you can stop your 90-day treatment program. However, suddenly stopping a program removes a source of support for your recovery and limits how much you can learn. The full course of a program is designed to provide professional help and guidance that can set you up for long-term recovery to minimize chances of relapse.
Research also shows that shorter programs are less effective than longer, 90-day programs. The longer a person engages in treatment, the higher their likelihood of maintaining sobriety. 8
Inadequate Interpersonal Support
Support from other people in your daily life is vital for long-term recovery. If you are in regular contact with people who still use drugs or alcohol or are exposed to drugs, alcohol, or related paraphernalia regularly, you have a higher chance of relapsing due to the presence of triggers that may activate cravings.2
To develop a strong and healthy social network, connect with friends or family members you trust to support your recovery or join 12-step programs or community groups.2 Engaging with these groups also helps you avoid high-risk environments and develop habits that will support stable recovery.
How Unaddressed Medical Conditions Contribute to Relapse
Untreated physical health conditions could also increase your chances of relapse, as they can make it hard to complete treatment.
Health conditions, such as chronic pain, cardiovascular disease, or migraines, may exhibit more intense symptoms during and after detox. As such, a person’s physical health must be managed alongside any treatment for alcohol or substance use disorder to create the best chances for stable recovery. 9
Some people in treatment may also have used substances to cope with their physical health conditions, providing another layer of dependence on substances that they must address. For example, if you deal with chronic pain and opioid use disorder, you will likely need to work very closely with your medical provider so you do not use opioids to manage the pain and instead use safer alternatives, such as acetaminophen or non-steroidal anti-inflammatory drugs.9
Inform your treatment providers of any medical conditions you have so that they can be sure to include all necessary medical providers in your treatment plan.
Co-Occurring Mental Health Conditions
Just like physical health conditions need to be managed for a successful recovery, it is also critical to address mental health conditions. Treatment for co-occurring mental health and substance use disorders is known as dual diagnosis treatment. Since substance misuse and mental health conditions tend to affect one another in various ways, dual diagnosis treatment is necessary to fully address both conditions and promote long-term recovery. 2
If mental health symptoms increase in severity, individuals may respond by escalating drug or alcohol use to cope, creating a compulsive cycle of substance use. This cycle cannot be broken without addressing mental health symptoms during recovery. As such, when mental health disorders like posttraumatic stress disorder (PTSD), depression, anxiety, or insomnia go untreated, your chances of relapsing are much higher than if such conditions are managed.2
Further, as with physical health conditions, the process of treatment may heighten the symptoms of mental health conditions. For example, if you have PTSD, detox could intensify your PTSD symptoms, which could lead to a desire to use alcohol or drugs.10
Therefore, it is imperative to inform treatment providers if you have a mental health diagnosis so you can seek dual diagnosis treatment and minimize your chances of relapse.
Stages of Relapse
Relapse is not just one event where you start using drugs or alcohol again but rather a process that occurs in stages. Being aware of these stages and recognizing them can help you intervene and address the issue so you can avoid returning to substance use.11
In this first stage, you are not consciously thinking about using a substance. Instead, something might trigger a negative emotion for you, which can cause behaviors that may eventually cause relapse. Signs that you are experiencing emotional relapse might include:11
- Isolating from others
- Bottling up your emotions
- Not going to 12-step meetings or not taking part if you do go
- Focusing on others’ problems
- Having poor sleeping and eating habits
Self-care at this stage is particularly important since you have had a difficult experience that triggered negative feelings. As soon as you notice any of the above signs, actively care for yourself by doing things such as eating right, exercising, and getting enough sleep. Additionally, reach out to people who support you. These actions can help prevent progression to the next relapse stage.11
In the mental relapse stage, the part of you that wants to use substances battles with the part that wants to stay sober. Some signs of mental relapse may include:
- Craving substances
- Minimizing consequences of past use
- Thinking about things associated with past use
- Trying to convince yourself that there are situations in which substance use is okay, such as holidays or vacations
- Lying to yourself or others about how much you want to use
- Thinking of ways to use substances but with better control
- Planning a relapse
If you notice any of these thought processes, it is imperative to avoid situations in which you are more likely to use substances. Some might think that avoiding such situations is a sign of weakness, but it requires strength to consciously and actively work on your recovery by avoiding high-risk situations.11
Note that short-lived thoughts about using substances are normal in recovery, especially early on. This is different from mental relapse.11
Physical relapse is the stage where you start using substances again. For example, you might think, “I can have just one drink,” and after you do, it quickly leads to uncontrolled drinking.11
There are two key things to note about physical relapse. First, it is just one setback and does not mean that you have failed in your recovery. Turning to your support network and health professionals can help you address when such situations occur.
Second, most physical relapses are a result of having the opportunity to use a substance. You can thus work with your therapist to plan for such situations and come up with ways to remove yourself from them to prevent physical relapse from happening.11
What Else Can I Do to Help Prevent Relapse?
The variety of causes of relapse might seem overwhelming. However, there are things you can do regularly to keep yourself on track. These include:2
- Focus on abstinence one day at a time
- Know that cravings do not last forever, and they will pass
- Reach out to someone in your support network when feeling lonely or distressed, or when having the urge to use substances
- When you have the urge to use, play out in your mind all the negative consequences that can result
- Ask yourself, “Am I HALT (hungry, angry, lonely, or tired)?” These four states are likely to trigger a desire to use drugs or alcohol. Identifying which one you feel and taking appropriate action can help you avoid substances, such as eating if hungry and sleeping when tired
- Write out your motivations for recovery and keep various copies in different places so that you can see them regularly
- Have a healthy diet, get enough exercise and sleep, and make time for activities that promote self-care, such as meditation, journaling, or engaging in hobbies
By remaining aware of what causes relapse, you can better situate yourself for success. Remember that relapse is a process that happens in stages, and monitoring your thoughts and feelings can help you identify the stage you are in and take action to avoid further progression into physical relapse.
For help with locating treatment providers for substance use, please call 800-483-2193(Who Answers?). Our specialists are happy to assist you and are available 24/7.
- Urbanoski, K.A. (2010). Coerced addiction treatment: Client perspectives and the implications of their neglect. Harm Reduction Journal, 7, 1-10.
- S. Department of Veterans Affairs. (2020, September 27). Reducing relapse risk.
- Matzger, H., Kaskutas, L.A, & Weisner, C. (2005). Reasons for drinking less and their relationship to sustained remission from problem drinking. Addiction, 100(11), 1637-1646.
- Obong’o, C.O., Alexander, A.C., Chavan, P.P., Dillon, P.J., & Kedia, S.K. (2017). Choosing to live or die: Online narratives of recovering from methamphetamine abuse. Journal of Psychoactive Drugs, 49(1), 52-58.
- Grosso, J.A., Epstein, E.E., McCrady, B.S., Gaba, A., Cook, S., Backer-Fulghum, L.M., & Graff, F.S. (2013). Women’s motivators for seeking treatment for alcohol use disorders. Additive Behaviors, 38(6), 2236-2245.
- Kober, H., Kross, E.F., Mschel, W., Hart, C.L., & Ochsner, K.N. (2010). Regulation of craving by cognitive strategies in cigarette smokers. Drug and Alcohol Dependence, 106(1), 52-55.
- Witkiewitz, K., Bowen, S., & Donovan, D. M. (2011). Moderating effects of a craving intervention on the relation between negative mood and heavy drinking following treatment for alcohol dependence. Journal of Consulting and Clinical Psychology, 79(1), 54–63.
- Andersson, H.W., Wenaas, M., & Nordfjaern, T. (2019). Relapse after inpatient substance use treatment: A prospective cohort study among users of illicit substances. Addictive Behaviors, 90, 222-228.
- Blondell, R.D., Ashrafioun, L., Dambra, C.M., Foschio, E.M., Zielinski, A.L., & Salcedo, D.M. (2010). A clinical trial comparing tapering doses of buprenorphine with steady doses for chronic pain and co-existent opioid addiction. Journal of Addiction Medicine, 4(3), 140-146.
- Jacobsen, L.K., Southwick, S.M., & Kosten, T.R. (2001). Substance use disorders in patients with posttraumatic stress disorder: A review of the literature. The American Journal of Psychiatry, 158(8), 1184-1190.
- Melemis, S.M. (2015). Relapse prevention and the five rules of recovery. Yale Journal of Biology and Medicine, 88(3), 325-332.