Relapse is a normal part of recovering from a substance use disorder (SUD). It doesn’t mean that you’ve failed or that you can’t heal; it’s simply a possibility in the journey to sobriety.
For a person with an SUD, a relapse involves using a substance again after a period of abstinence. Between 40-60% of people who receive treatment for an addiction will relapse at some point [1].
Relapse triggers are the stimuli or scenarios that prompt you to take a substance again. They are nuanced, and you can be more sensitive to certain triggers than others, depending on your personal experiences and predispositions. In this article I describe some of the most common relapse triggers, the effects they have, and how to manage them.
What Are Relapse Triggers?
Relapse triggers are situations, feelings, or influences that cause you to use a substance you have been recovering from. A relapse trigger can appear at any time and negatively affect you, regardless of whether you have just started treatment, have finished a program, or have been sober for a long time.
Relapse triggers can be internal or external: they may be a memory or sensation (internal) or a context or stimulus (external). If you have previously relapsed, you are still susceptible to relapse triggers. In fact, research shows that a previous relapse can increase the likelihood of relapsing again in the future [2].
Much like a literal trigger, relapse triggers can initiate a long, destructive sequence of events, but they can be managed and avoided.
What Are the Most Common Relapse Triggers?
These are the most common relapse triggers. Keep in mind that you may not be affected by each one; you may also respond particularly strongly to one and less so to others.
Stress. You may use substances to cope with high-pressure work environments, daily responsibilities, or a persistent feeling of overwhelm. If you become stressed during such a fragile time as recovery, you’re likely to turn back to substances.
Relationship troubles. Whether family, friends, or a partner, relationship difficulties can be extra hard for someone with an SUD to manage. You’re likely to use substances to escape conflict or to calm down after confrontations.
Places where substances are available/used. Even just being in the alcohol aisle of a supermarket is challenging for people in recovery. A bar or party can feel like torture. Seeing and smelling substances creates a high risk of reuse.
Loneliness. Recovery can feel very isolating, and if you have been in a residential program, an abrupt transition to the outside world can be destabilizing. If you don’t have a support community around you, you can easily look for the familiar comfort of substances.
Boredom. Being unoccupied or having consistent time and space for the mind to wander can be dangerous for someone with a SUD. A lack of time spent productively can push you to relapse.
A set-back in recovery. Missing an appointment, repeating a behavior, or not advancing as quickly as hoped can feel demotivating. Self-esteem is often low among people with addiction, and feeling like you’re ‘not doing well’ can lead you to use again.
Associative memories. Seeing someone who used substances with you, or who reminds you of your addiction, can make you think about substance use. The same applies for places and events that are associated with using.
Anyone can be influenced by relapse triggers, but one study shows that people with the following characteristics are most vulnerable to them [3]:
- Using substances from an early age
- Dysfunction of the brain reward system
- Poor physical health
- Sleep disturbances
- Co-occurring psychiatric disorders
- Smoking
- Low socioeconomic status
- Negative life events
How Can I Manage Relapse Triggers?
Simple steps can alleviate the risk of relapse triggers arising and help you feel prepared if you do.
Make a plan. Develop a list of people, scenarios, and places linked to substance use and prepare a response if these things show up; it could include breathing exercises, listening to music, or having a sentence ready to be excused and leave quickly.
Try new things. Creating a new routine can be a helpful way to remove triggers. A new hobby, walking route, or social circle not only lowers relapse triggers; it’s a good source of motivation and confidence-building.
Learn to be mindful. Yoga, meditation, and journaling are exercises to help come back to the present and to regulate the nervous system. Doing these consistently can mean you aren’t thrown off course by relapse triggers.
Think of HALT. Hungry, angry, lonely, tired? Recognizing and meeting these basic needs can mean overcoming some triggers.
Speak to someone. Checking in daily with someone, making social plans, and continuing therapy keep you connected to people, which can dilute the power of triggers.
Practice self-care. Recovery is an ongoing journey. Relapse triggers and cravings are obstacles along the way, but it’s beneficial to meet them without judgment. They’re there, they’re natural, but they don’t have to be interacted with.
How to Not Feel Bad After Relapse
A relapse can happen. If it does, it can be considered temporary. Addiction causes chemical changes in the brain that make quitting a substance after prolonged use incredibly hard. There’s no definitive number for how many times a person relapses, but research suggests the median number is two [4].
After a relapse, try not to panic or retreat. Reach out to someone you trust, and put your safety first before attempting to figure out next steps. If you’re already in a program, share with your care team what has happened. If you’re not in a program, seek treatment as soon as possible.
Medical care can reduce the risk of relapse among people with an addiction [5]. It also integrates targeted relapse-prevention techniques, so you can recognize your specific triggers and develop skills to actively prevent relapse.
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Sources
[1] National Institute on Drug Abuse. (July 2020). Drugs, Brains, and Behavior: The Science of Addiction. nida.nih.gov.
[2] Domino, K. et al. (March 2005). Risk Factors for Relapse in Health Care Professionals With Substance Use Disorders. The Journal of the American Medical Association.
[3] Bülent Yazıcı, A. Raşit Bardakçı, M. (December 2003). Factors Associated with Relapses in Alcohol and Substance Use Disorder. The Eurasian Journal of Medicine.
[4] Kelly, J. et al. (July 2019). How Many Recovery Attempts Does it Take to Successfully Resolve an Alcohol or Drug Problem? Estimates and Correlates From a National Study of Recovering U.S. Adults. Alcohol, Clinical and Experimental Research.
[5] Andersson, H. et al. (March 2019). Relapse after inpatient substance use treatment: A prospective cohort study among users of illicit substances. Addictive Behaviors.
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