“Maybe I can just use occasionally”, or “I’ll just have one to celebrate my two years in recovery”, or “I’m worried I will turn into someone I don’t like.” This is the paradoxical language of relapse. Chronic relapse is like a revolving door or a hamster wheel, where every exit leads back to the same starting point.
But there are ways out, as millions have already done. And so can you, or a loved one you are trying to help.
Relapse is a common aspect of the process of recovery from addiction. Relapse suggests a need to take stock, reassess the situation, and re-engage with some form of treatment [1].
Countless individuals lose their employment, families, freedom, and even lives as a consequence of relapses [2]. It’s important to understand why they occur, ways to prevent them, and how to deal with them.
Relapse prevention is why most people seek treatment, as they’ve already tried unsuccessfully to stop on their own. Chronic relapse in addiction is not a personal failure, but it is an opportunity to learn. It’s a complex issue driven by a combination of psychological, biological, and environmental factors. In this article, I’ll look at why it happens and how it can be overcome.
Why Chronic Relapses Happen
There are a number of intersecting factors that give rise to chronic relapses.
Psychological Factors
Underlying trauma, unresolved emotional pain, low self-esteem, and poor coping mechanisms can fuel chronic relapse. Hopelessness, self-sabotaging thoughts, and unaddressed mental health disorders play a major role.
Biological Factors
Impulse control and mood can be affected by inherited genetics, neurochemical changes in the brain due to substance use, and co-occurring medical health conditions such as depression or anxiety. These may increase vulnerability to relapse.
Environmental Factors
Relapse risk is heightened due to unstable living situations, toxic relationships, peer pressure, lack of supportive resources, exposure to high-stress or high-risk environments, and living around relapse triggers all contribute to relapse risk.
Inadequate Support and Planning
Sustained sobriety is made more difficult due to lack of a robust relapse prevention plan or a supportive social network, and untreated co-occurring mental health conditions.
The Stages of Relapse
While there are various ways of looking at relapse, one approach describes it in three stages: emotional, mental, and physical [2] [3].
Emotional Relapse
During emotional relapse, individuals are not thinking about using. They remember their last relapse and do not want to repeat it. However, their emotions and resulting behaviors are setting the basis for their next relapse.
But they are often in denial of their risk of relapse. This denial can prevent the use of effective techniques to prevent the progression of the relapse. The core of emotional relapse is poor self-care, in all its aspects.
Signs of emotional relapse include:
- Isolation
- Not attending meetings
- Not sharing in meetings
- Focusing on other people’s problems
- Poor sleeping or eating habits
Mental Relapse
The person has an internal struggle between the desire to resume using and the desire to remain abstinent. As individuals go deeper into mental relapse, their cognitive resistance to relapse diminishes, and their need for escape increases.
Signs of a mental relapse include:
- Craving a substance
- Thinking about people/places/things associated with their use in the past
- Exaggerating the positive aspects of past use
- Minimizing the consequences of past use
- Lying
- Bargaining
- Trying to plan ways to use while still maintaining control
- Seeking opportunities to relapse
- Planning a relapse
Physical Relapse
The final stage of relapse occurs when a person resumes the use of the substance. Many physical relapses occur when the person believes their use will go undetected. However, an initial lapse can lead to an increased obsession with further use, which may quickly lead to a relapse of uncontrolled use.
Most importantly, it usually will lead to a mental relapse of obsessive or uncontrolled thinking about using, which eventually can lead to physical relapse.
Stages of Recovery
A common model of recovery includes three stages [2] [4].
Abstinence Stage
This begins as soon as the person stops drinking or using and may continue for one or two years. The primary concerns of the patient are often coping with their cravings and avoiding relapses. There are many risks to recovery at this stage including
- Physical cravings
- Poor self-care
- Wanting to use just one more time
- Struggling with whether one has an addiction
Post-acute withdrawal (PAWS) begins shortly after the acute phase of withdrawal and is a common cause of relapse. It can last up to two years. Unlike acute withdrawal, which has mostly physical symptoms, post-acute withdrawal syndrome has mostly psychological and emotional symptoms, which are expected to gradually improve over time.
Repair Stage
This generally lasts two to three years. The person works to repair the damage caused by the addiction. Although they feel progressively better, once they begin to address past trauma or adverse life events associated with their use, they may feel worse at times.
Growth stage
This stage starts after the individual has largely repaired the damage caused by the addiction, often three to five years after the individual has quit using. It is expected to last for the rest of their lives.
This growth often includes experiences and developing skills they missed due to the addiction, particularly if the addiction started at a young age. This is also the time to deal with any family of origin issues or any past trauma that may have occurred.
In late stage recovery, individuals are subject to special risks of relapse that are not often seen in the early stages.
Breaking the Cycle: Evidence-Based Interventions
There are several approaches to breaking the cycle of relapse [4]:
Talk Therapy
Cognitive Behavioral Therapy (CBT): Targets maladaptive thought patterns and builds healthier coping strategies by challenging black-and-white thinking, often typical of those in early recovery.
Contingency Management (CM): Participants who submit a negative urine drug screen often receive motivational incentives such as a voucher, which they can exchange for various items they desire (i.e., food items, movie passes). Often CM is highly effective in the short-term, but its effect on recovery often diminishes significantly after the rewards cease.
Community Reinforcement: This approach seeks to emphasize the benefits of abstinence and reduce the positive reinforcement associated with drug or alcohol use. A version of this incorporates family and other supportive individuals in the person’s recovery process to a greater extent. It can increase motivation to enter treatment, sustain recovery, and improve the quality of life of those affected by the individual’s addiction.[
Mindfulness-Based Relapse Prevention
Structured mindfulness meditation and relaxation reduces craving and relapse. It has proven beneficial in helping those in recovery. Benefits include
- Reduces tension and stress, common triggers of relapse.
- It helps individuals let go of negative thinking such as dwelling on the past or worrying about the future, which are triggers for relapse.
- This practice prepares you for self-care in all areas of life.
Medication-Assisted Treatment
Especially when combined with counseling, medications such as buprenorphine, methadone, and naltrexone support brain stabilization and reduce cravings..
Trauma-Informed and Dual Diagnosis Treatment
Programs that address both substance use and co-occurring mental health disorders have better outcomes for chronic relapsers.
Breaking the Cycle: Key Strategies
Develop a Strong Support Network
Mentors, recovery groups, and sober friends provide accountability and encouragement.
Relapse Prevention Planning
Working with a therapist, identify triggers and build practical plans for high-risk situations.
Ongoing Care
For long-term recovery, aftercare, therapy, and peer support are essential.
Healthy Coping Mechanisms
Exercise, hobbies, mindfulness, and positive outlets all can substitute for substance use.
Lifestyle and Behavioral Changes
Successful recovery depends on handling life challenges such as repairing relationships, honest self-reflection, asking for help, and maintaining self-care.
| Summary of Factors and Interventions | |
| Chronic Relapse Factors | Breaking the Cycle Strategies |
| Unresolved psychological issues | Cognitive Behavioral Therapy (CBT) |
| Genetic/brain chemistry changes | Medication-assisted treatment |
| Environmental triggers | Avoidance, support network |
| Lack of aftercare/support | Structured aftercare, sober housing |
| Ineffective coping mechanisms | Coping skill development, mindfulness |
| Co-occurring disorders | Dual diagnosis treatment |
Find Supportive Care at Red Rock Recovery
Substance use disorder or addiction can feel insurmountable, but Red Rock Recovery Center is here to help you begin your recovery journey today with our core values of Community, Connection, and Purpose.
Red Rock Recovery Center stands out from most drug and alcohol rehab centers in Colorado by offering a full continuum of care approach to substance use disorder (SUD) and addiction treatment. Our Colorado rehab center is proud to offer an addiction treatment program that includes all necessary steps to healing, from medical detox to aftercare services. Located close to major cities such as Colorado Springs, we are uniquely equipped to help countless families find healing.
Sources
[1] CAMH. nd. Fundamentals of Addiction: Preventing and managing relapse.
[2] Guenzel N, McChargue D. 2023. Addiction Relapse Prevention. [Updated 2023 Jul 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-..
[3] Melemis S. (2015). Relapse Prevention and the Five Rules of Recovery. The Yale journal of biology and medicine, 88(3), 325–332.
[4] Melemis S. nd. Relapse Prevention Plan and Early Warning Signs. (video). Addictionsandrecovery.org