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 5 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.
Stay Positive: Recovery is Possible
It may not seem like it now, but continued hard work and perseverance will pay off over time. Recovery is not a time-limited activity that’s once and done. Rather, recovery takes time and is an ongoing process. Besides, recovery does not occur in a straight line. 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.
This reality should not serve as a deterrent or indicate in any way that every person in early recovery is going to relapse, or even that relapse is inevitable—because it is not. What each individual can take to heart is the advice from addiction experts that recovery is possible. Maintain a positive attitude, continue to work to improve on the foundation of recovery first begun during treatment, be among like-minded and supportive friends, family, and allies, and keep sight of earnestly desired goals.
