10 Most Common Triggers of Substance Abuse Relapse
- Withdrawal symptoms (anxiety, nausea, physical weakness)
- Post-acute withdrawal symptoms (anxiety, irritability, mood swings, poor sleep)
- Poor self-care (stress management, eating, sleeping)
- People (old using friends)
- Places (where you used or where you used to buy drugs)
- Things (that were part of your using, or that remind you of using)
- Uncomfortable emotions (H.A.L.T.: hungry, angry, lonely, tired)
- Relationships and sex (can be stressful if anything goes wrong)
- Isolation (gives you too much time to be with your own thoughts)
- Pride and overconfidence (thinking you don’t have a drug or alcohol problem, or that it is behind you)
The Stages of Relapse
Relapse is a process, it’s not an event. In order to understand relapse prevention, you have to understand the stages of relapse. Relapse starts weeks or even months before the event of a physical relapse. In this page, you will learn the early warning signs of relapse and specific relapse prevention techniques for each stage of relapse. There are three stages of relapse.
The signs of emotional relapse are:
- Mood swings
- Not asking for help
- Not going to meetings
- Poor eating habits
- Poor sleep habits
The signs of emotional relapse are also symptoms of post-acute withdrawal. If you understand post-acute withdrawal it’s easier to avoid relapse, because the early stage of relapse is easiest to pull back from. In the later stages, the pull of relapse gets stronger and the sequence of events moves faster.
Early Relapse Prevention
Relapse prevention at this stage means recognizing that you’re in emotional relapse and changing your behavior. Recognize that you’re isolating and remind yourself to ask for help. Recognize that you’re anxious and practice relaxation techniques. Recognize that your sleep and eating habits are slipping and practice self-care.
If you don’t change your behavior at this stage and you live too long in the stage of emotional relapse you’ll become exhausted, and when you’re exhausted you will want to escape, which will move you into mental relapse.
Practice self-care. The most important thing you can do to prevent relapse at this stage is to take better care of yourself. Think about why you use. You use drugs or alcohol to escape, relax, or reward yourself. Therefore you relapse when you don’t take care of yourself and create situations that are mentally and emotionally draining that make you want to escape.
For example, if you don’t take care of yourself and eat poorly or have poor sleep habits, you’ll feel exhausted and want to escape. If you don’t let go of your resentments and fears through some form of relaxation, they will build to the point where you’ll feel uncomfortable in your own skin. If you don’t ask for help, you’ll feel isolated. If any of those situations continues for too long, you will begin to think about using. But if you practice self-care, you can avoid those feelings from growing and avoid relapse.
In mental relapse, there’s a war going on in your mind. Part of you wants to use, but part of you doesn’t. In the early phase of mental relapse, you’re just idly thinking about using. But in the later phase, you’re definitely thinking about using.
The signs of mental relapse are:
- Thinking about people, places, and things you used with
- Glamorizing your past use
- Hanging out with old using friends
- Fantasizing about using
- Thinking about relapsing
- Planning your relapse around other people’s schedules
It gets harder to make the right choices as the pull of addiction gets stronger.
Techniques for Dealing with Mental Urges
Play the tape through. When you think about using, the fantasy is that you’ll be able to control your use this time. You’ll just have one drink. But play the tape through. One drink usually leads to more drinks. You’ll wake up the next day feeling disappointed in yourself. You may not be able to stop the next day, and you’ll get caught in the same vicious cycle. When you play that tape through to its logical conclusion, using doesn’t seem so appealing.
A common mental urge is that you can get away with using, because no one will know if you relapse. Perhaps your spouse is away for the weekend, or you’re away on a trip. That’s when your addiction will try to convince you that you don’t have a big problem and that you’re really doing your recovery to please your spouse or your work. Play the tape through. Remind yourself of the negative consequences you’ve already suffered, and the potential consequences that lie around the corner if you relapse again. If you could control your use, you would have done it by now.
Tell someone that you’re having urges to use. Call a friend, a support, or someone in recovery. Share with them what you’re going through. The magic of sharing is that the minute you start to talk about what you’re thinking and feeling, your urges begin to disappear. They don’t seem quite as big and you don’t feel as alone.
Distract yourself. When you think about using, do something to occupy yourself. Call a friend. Go to a meeting. Get up and go for a walk. If you just sit there with your urge and don’t do anything, you’re giving your mental relapse room to grow.
Wait for 30 minutes. Most urges usually last for less than 15 to 30 minutes. When you’re in an urge, it feels like an eternity. But if you can keep yourself busy and do the things you’re supposed to do, it’ll quickly be gone.
Do your recovery one day at a time. Don’t think about whether you can stay abstinent forever. That’s a paralyzing thought. It’s overwhelming even for people who’ve been in recovery for a long time.
One day at a time means you should match your goals to your emotional strength. When you feel strong and you’re motivated to not use, then tell yourself that you won’t use for the next week or the next month. But when you’re struggling and having lots of urges, and those times will happen often, tell yourself that you won’t use for today or for the next 30 minutes. Do your recovery in bite-sized chunks and don’t sabotage yourself by thinking too far ahead.
Make relaxation part of your recovery. Relaxation is an important part of relapse prevention because when you’re tense you tend to do what’s familiar and wrong, instead of what’s new and right. When you’re tense you tend to repeat the same mistakes you made before. When you’re relaxed you are more open to change.
Once you start thinking about relapse, if you don’t use some of the techniques mentioned above, it doesn’t take long to go from there to physical relapse: going to get a drink; calling your dealer for example for opioids, cocaine, or marijuana.
It’s hard to stop the process of relapse at that point. That’s not where you should focus your efforts in recovery. That’s achieving abstinence through brute force. But it is not recovery. If you recognize the early warning signs of relapse and understand the symptoms of post-acute withdrawal, you’ll be able to catch yourself before it’s too late.
Dr. Balta is the Medical Director at FCR for more than 10 years. Dr. Balta is Board Certified in Psychiatry and Addiction Medicine, Certified Psychoanalyst. As well, as having Psychiatric Training at The Albert Einstein School of Medicine Psychiatric Residency Program In New York City and Psychoanalytic Training at The William Alanson White Institute in New York City. While working in New York City, gained funding Grants for the treatment of Substance Abuse Disorders from SAMHSA , HRSA and the City of New York.