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When people first get sober or clean, they’re usually on high alert for the triggers that may set them off (as the most common causes of relapse). Yet, even those who’ve gone through extensive drug and alcohol rehab may be unclear as to what causes relapse. Not only that but those who don’t understand the mindset of early recovery can benefit from understanding the common reasons people relapse.
What is a relapse? Following a period of abstinence, resorting to the first drink or use of drugs constitutes a “lapse.” When that initial drink or drug use starts to spiral into excessive drinking or drug use, that pattern is a “relapse.”
Early Recovery Pitfalls
During early recovery, often defined as the first 90 days to the first full year or two of sobriety, many newly sober people find themselves going through the same types of pitfalls that could send them into a relapse. For the individual who’s just completed drug and alcohol treatment and is in recovery for the first time, the process may seem all too new, frightening, and uncertain. But even those who’ve been through rehab numerous times aren’t immune to pitfalls that could propel them into relapse. Indeed, these pitfalls are so commonly associated with relapsing that they’re typically among the most common causes of relapse.
What Are the 8 Most Common Causes of Relapse?
Relapse rates are high for alcohol and many substances and, although any relapse is something to take seriously, relapse is considered a part of the overall recovery process. Indeed, many individuals need to go through rehab and treatment several times following relapse before they achieve sufficient self-efficacy and a stable enough foundation of recovery to remain abstinent. A guide from the National Institute on Drug Abuse (NIDA) indicates that relapse rates for substances range from 40 to 60 percent, while the National Institute on Alcohol Abuse and Alcoholism (NIAAA) says that an estimated 90 percent of alcoholics experience one relapse (at least) during four years.
Yet, narrowing down a list of causes to the most common cause of relapse is valuable, in that it helps those in recovery and those who support their recovery to remedy a potential relapse when and if it does occur.
1. Post-Acute Withdrawal
Post-acute withdrawal, which starts shortly after the acute phase of withdrawal, is the most common cause of relapse after abstinence and into early recovery. Unlike acute withdrawal’s mostly physical symptoms, the most predominant symptoms in post-acute withdrawal syndrome (PAWS) are emotional and psychological. These are typically similar for most types of addiction, whereas the physical symptoms of acute withdrawal are often different and specific to certain substances.
PAWS symptoms include:
- Swings in mood
- Anxiety
- Energy variation
- Irritability
- Low level of enthusiasm
- Concentration (variable)
- Sleep disturbances
In PAWS, many symptoms often overlap with depression, although the PAWS symptoms tend to gradually improve over time.
Suggestions for Remedy
Getting immediate help to overcome the uncomfortable and possibly debilitating effects of PAWS and helping avoid a full relapse is the best course of action. While it may not require going back to treatment in a residential rehab facility, seeing a therapist or an addiction treatment professional can help to minimize PAWS and allow for an easier transition back to recovery-oriented behavior and goals. Counseling is especially recommended if PAWS and depression coincide since many individuals in recovery from substance use disorder also suffer from a mental health disorder, including depression.
2. Stress
Another common reason for relapse is stress. While everyone experiences stress, when a person is in recovery from drug and alcohol addiction, the enormous burden that stress places on their ability to cope with its negative effects is often too much to handle. When a person is desperate for a way to get rid of the stress, reaching for a drink or using drugs can seem like the only way to find relief. This likely doesn’t end with a single drink or using drugs just once, but can escalate into continued and excessive drinking and drug use resulting in full relapse.
Suggestions for Remedy
Many effective remedies for managing stress exist that are readily available and easy to use. These include:
- Exercise
- Meditation, including mindfulness meditation
- Yoga
- Spirituality and prayer
- Laughter
3. Insomnia
As researchers from the University of San Francisco noted in a study reported in 2014, insomnia may be the cause of higher rates of relapse and alcohol-related issues and is a problem that is both “prevalent and persistent” in early recovery. Researchers said early recovery insomnia may be five times higher than among individuals in the general population, and it may last for a lengthy period (months to years).
Suggestions for Remedy
While sleep medications may be prescribed to help address insomnia experienced in early recovery, many addiction treatment experts discourage this practice, as it could contribute to misuse, abuse, and addiction to those medications. There is some evidence that behavioral treatments such as cognitive behavioral therapy (CBT) may be a better treatment for insomnia. Researchers noted that treatment of insomnia in early recovery is so important to continuing sobriety and helping prevent relapse and should be an integral part of a recovery plan.
4. Changes in Expected Outcomes
Everything may have been going fine following treatment and for the first half-year of abstinence. Then, something happened that dashed hopes of achieving certain desirable recovery goals, and the disappointment and feelings of failure surfaced and dominated everyday thoughts. For some people, not being able to repair the damage their addiction caused to relationships, career, finances, and social standing is enough to send them back to alcohol and drug use. Such reversals of expected outcomes can be a common cause of relapse.
Suggestions for Remedy
Avoid thinking in terms of absolutes, since typically nothing in life is so clearly defined. Not being successful in repairing a fractured personal or family relationship at this point doesn’t mean what’s been accomplished thus far in recovery is a failure. It also doesn’t mean irreparable loss. Perhaps there can be some form of relationship in the future, although it may not ever be the same. Getting past the awful feeling of disconnection and self-loathing for this seeming inability to repair what was once so prized may best be helped with additional counseling.
Joining a support group with other individuals seeking to effect positive changes in their lives post-addiction treatment is highly recommended by addiction experts. In a way, the support group serves as a substitute family, especially since there is a shared connection, earnest desire to see members succeed, and ongoing encouragement to maintain sobriety.
5. Complacency and Overconfidence
Another red flag warning to pay heed to and another most common cause of relapse involves the line of thinking that “I’m not an addict, and, besides, I can handle it” (drinking, drug use). Why does this rationalization occur in early recovery? After successfully maintaining abstinence for a continuous period, the person in recovery may begin to believe that what initially got them addicted to drugs and alcohol no longer applies. Furthermore, there’s the tendency to mistakenly believe that no matter what comes along, including temptations and triggers, seeing former friends who still use, or other high-risk situations, they can get through the crisis without consequences.
These calculations are mistaken, since most people in early recovery are not fully equipped to handle the overload of risk at a time when they are most vulnerable.
Suggestions for Remedy
It took a lot to get clean and sober, including many behavioral and lifestyle changes that were likely difficult and not desirable. Who wants to give up drinking and drug use that’s so familiar, comfortable, and associated with good times? Granted, the goal of overcoming addiction ranks higher as a priority, but it’s still tough to relinquish longtime habits and friends in order to be sober.
One suggestion for how to handle misplaced confidence is to adhere to personally established boundaries and not forget what recovery has meant up until this point. Life is better lived clean and sober, and reverting to excessive drinking and drug use likely comes at too high a cost. Keep up meeting attendance at support groups and maintain a daily recovery routine to help prevent backsliding.
6. Boredom
Having no focus can zap your resolve. Idleness is not conducive to sustaining sobriety or improving the foundation of recovery. It can be a quick slide into what causes relapse. Allowing the mind to wander during boredom is tantamount to opening the door to tempting thoughts. If nothing pressing demands attention, and the hours drift by with inaction, it’s all too easy to think that going to see former drinking or drug-using friends (who still drink and do drugs) would be a good way to pass the time. It’s not. Still, it can be tough to resist a walk on the wild side.
Suggestions for Remedy
This is a time to step up by going to meetings or jumping on positive lifestyle and behavioral changes. If nothing else, get physically active. Work on a project around the house. Help out a neighbor or take on an assignment at work that will engage your mind and utilize your talents. Talk about needing positive direction with your support group sponsor.
7. Relationships
Getting into a sexual or love relationship too early in recovery can jeopardize all the progress made to date. Addiction experts say that beginning new romantic relationships at this time means placing faith in someone else instead of working on your sobriety foundation. Love relationships especially tax emotions and drain energy by focusing on that person to the detriment of working on your recovery. If that relationship gets shaky, so does your recovery.
Suggestions for Remedy
It’s okay to make new sober friends in early recovery, especially those individuals who share the goal of maintaining sobriety. Avoid romantic entanglement during the first full year of sobriety, though. This is a time to devote to cementing your positive sober lifestyle and learning new ways to deal with life’s everyday stresses.
8. Not Having a Relapse Plan
It isn’t a question of whether the desire to drink and do drugs or the stresses to engage in such activity will return. It’s more a matter of when. Granted, some people are stronger at fending off immediate urges and waiting it out until they pass, but most newly recovered individuals aren’t that confident in their abilities to do so. They also lack a sufficient toolkit or are unpracticed in acting in initiative-taking ways to withstand urges and triggers. Besides, thinking that you’re fully capable of tackling whatever comes along is never a good strategy.
Suggestions for Remedy
What is your plan to address the desire to drink and do drugs or the stresses of everyday life that cause you to consider taking the edge off just this once? Without a plan in place, recovery could be threatened to the point that it’s a cause of relapse.
What constitutes a solid relapse prevention plan? Consider the following:
- Create a written document. A relapse plan is something created with a therapist or treatment team and shared with members of a support group and/or immediate family members (those who support your recovery efforts). This written document serves as a helpful guide to refer to whenever situations arise that could threaten sobriety or are reasons for relapse.
- Include an action plan. A good relapse prevention plan lays out steps to take to deal with triggers and urges. This begins with learning how to identify these triggers and urges.
- Identify people to call. Having a solid relapse prevention plan means identifying trusted individuals you can call and help you through a crisis when facing a cause of relapse. This should be someone familiar with your recovery goals and who has agreed to be available to you day or night. Although this is a strong commitment on their part, be sure to only use it when necessary, yet don’t be afraid to call them even if you’re in doubt about what causes relapse. If you feel your resolve dissipating and don’t think you can manage the situation, it’s time to contact your relapse support person.
- Start a lifestyle and personal self-care plan. Making changes to benefit the new life in sobriety will pay handsome rewards. Self-confidence will increase, along with a renewed enthusiasm for living. Life in sobriety can and should be exciting, uplifting, full of promise, and rewarding. It all begins with making incremental changes that you choose.
- Learn new tools and techniques. There’s always something new that researchers uncover or that other support group members have found effective in triggers and stress coping. Investigate what they are and add them to the toolkit. Over time, there will be many different techniques and strategies to employ so that you can feel confident you’re well-equipped to overcome a cause of relapse.
Stay Positive: Recovery is Possible
While it may not seem like it now, continued hard work and perseverance will pay off over time. Recovery is not a one-and-done or time-limited activity. On the contrary, recovery takes time and is an ongoing process. Besides, recovery is also not a straight-line journey. There are often many detours, slips or lapses, short or long relapses, progress made toward goals, and some backsliding along the way to a sustained and solid sobriety.
Don’t allow this reality to serve as a deterrent or in any way indicate that every person in early recovery is going to relapse, or even that relapse is inevitable — because it is not. Take to heart the advice from addiction experts that recovery is possible. Maintain a cheerful outlook. Continue working to improve on the foundation of recovery first begun during treatment. Interact with like-minded and supportive friends, family, and allies, and keep sight of earnestly desired goals.
