What Is Relapse, and Why Does It Happen?

Relapse is not a single event, but a process that unfolds in stages. Recognizing these stages can empower individuals to intervene early and use relapse prevention strategies to stay on track. The process typically begins with emotional relapse, where a person may experience feelings of denial, anger, or isolation, even if they are not consciously thinking about using substances. During this stage, self-care and support from loved ones are especially important.

The next stage is mental relapse, which involves internal struggles such as cravings, thoughts about using, or even fantasizing about substance use. This is a critical period where coping skills and mental health support can make a significant difference. If these thoughts are not addressed, they can lead to the final stage: physical relapse, which is the actual act of using drugs or alcohol after a period of sobriety.

Marlatt’s cognitive behavioral model highlights that high-risk situations—such as stress, exposure to triggers, or certain social settings—can increase the likelihood of relapse. By identifying these triggers and developing healthy coping skills, individuals can reduce their risk and stay focused on long term sobriety. Support from loved ones, mental health professionals, and recovery groups can provide the encouragement and resources needed to navigate these challenges and maintain progress in recovery.

Here are eight common causes of relapse:

1. Addiction Is a Chronic Disease

Addiction has been misunderstood for many years as a choice instead of a disease. Becoming addicted to drugs or alcohol involves biological, behavioral, and environmental factors. Addictive substances interact with these factors, influencing withdrawal symptoms and relapse risk.

Repeated substance abuse changes the brain. Some addiction experts have described it as the brain being hijacked by drugs or alcohol.

Substance abuse works on the reward center of the brain. A healthy brain rewards us when we do healthy things that support our survival. A brain that’s been exposed to substance abuse rewards us for giving it more drugs and alcohol. Repeated drug exposure leads to neurochemical changes that increase susceptibility to relapse. The “rewiring” of some of the brain’s structural and functional parts makes it believe it needs substances for survival, just like it would food, water, and connections with others. That is why people who are addicted may act out of character, like stealing to support their drug or alcohol use. They have tunnel vision. Getting more substances to either experience the high or ward off withdrawal in the absence of drugs or alcohol is their focus above all else.

Thankfully, the brain has neuroplasticity, which means it can change, adapt, and create new neural pathways. However, it takes time to repair the physical and mental damage of addiction. The longer an individual is in recovery, the more time for the brain to adjust to sobriety and return to a healthier reward system. However, the risk for relapse will always be present. Without treatment, aftercare, and a relapse prevention plan, biological addiction factors can lead to relapse.

2. Encounters With Triggers

Substance abuse changes the brain in ways that make triggers feel impossible to walk away from. After repeated alcohol and drug abuse, the brain develops strong links between people, places, and things associated with substance use. These associations are so strong that just encountering addiction triggers activate the brain’s reward center in a way that creates powerful urges and cravings.

Common relapse triggers include:

• People associated with alcohol and drug use.
• Places where drugs and alcohol were used.

• Stress cues, such as stress-related stimuli or reminders of past stressful experiences.

• Difficult emotions that were usually numbed with substances.
• Events and celebrations where substances are being used.

Stress cues are particularly important because they can activate cravings and drug-seeking behavior, even after a period of abstinence. These cues can trigger neurochemical responses in the brain similar to the drug itself, making relapse prevention strategies that address stress cues essential.

3. Withdrawal Symptoms

Research shows that withdrawal symptoms can play a significant role in addiction relapse. This is the case when people try to go through drug or alcohol detox on their own as well as after longer periods of abstinence. Withdrawal symptoms depend on the substance abused, duration of abuse, and physical makeup, but can include uncomfortable, painful, and even dangerous conditions like:

• Tremors
• Seizures
• Diarrhea and vomiting
• Muscle pain
• Headaches
• Insomnia
• Sweating
• Dehydration

Without the help of medical professionals to ease withdrawal symptoms with research-backed medications and other approaches, it’s very hard to resist the urge to use drugs or alcohol to stop the discomfort that can accompany alcohol and drug detox.

Though physical discomfort from drug or alcohol withdrawal usually gets better within days or weeks, psychological symptoms can linger for some time. This is known as post-acute withdrawal symptoms, or PAWS. The nervous system can take several months to rebalance itself. The result is sometimes symptoms like:

• Depression
• Insomnia
• Agitation and irritability
• Memory problems
• Anxiety
• Confusion

The severity of these symptoms varies for people recovering from drug or alcohol abuse. Research shows that people can be more susceptible to triggers during this period and are at the highest risk of relapse.

4. Lack of Recovery Support

Addiction recovery is a life-long pursuit that requires permanent lifestyle changes and healthy practices to keep up. People without critical support are more vulnerable to relapse.

Being able to talk openly with loved ones or support groups about struggles and urges is a key part of relapse prevention.

The National Institute on Drug Abuse recommends components of drug addiction treatment and recovery practices that can be part of a comprehensive relapse prevention plan, which supports long-term sobriety. Some of these include:

Supportive Loved Ones

Research shows that when people in recovery perceive they have the support of family, it decreases their risk of relapse.

It is important for individuals to enter treatment or re-enter treatment programs as needed to support long-term recovery and reduce the risk of relapse. In the absence of family support, close friends and peers in recovery can play a significant role in long-term sobriety.

Recovery Groups

Support groups like 12-step based Alcoholics Anonymous and Narcotics Anonymous provide accountability and peer support in sobriety. This same type of support can be found in alternatives to the 12 Steps like SMART Recovery or Refuge Recovery.

Continued Care

Research shows people that continue with some form of aftercare upon completing addiction treatment are more likely to stay sober. However, many individuals who complete rehab do not follow through with aftercare treatment recommendations, putting them at risk for relapse. Aftercare resources provide extended care after treatment and may include:

• Individual counseling
• Psychiatry appointments and medication management
• Mutual support groups (NA/AA, Refuge Recovery, SMART Recovery)
• Addiction education
• Sober living residences
• Alumni programs

Therapy

Individual therapy sessions with a behavioral health professional helps people in recovery continue working on underlying issues that contribute to substance abuse. Trauma, unhealthy attachment styles, and other behavioral health issues can take several years to identify, manage, and change.

Behavioral therapies play a crucial role in modifying attitudes and behaviors related to substance use, managing triggers, and preventing relapse.

Being aware of these challenges and continuing to work on them can mitigate the drive to self-medicate with drugs and alcohol. Research has shown that a cognitive behavioral therapy approach is particularly beneficial for people recovering from substance abuse.

Contingency management, another behavioral intervention, uses reinforcement techniques such as token or voucher systems to motivate abstinence and prevent relapse.

5. Poor Self-Care

Lack of sleep and other poor self-care habits have been linked to addiction relapse. Poor self-care can also serve as a relapse warning sign to loved ones, as people in active addiction often let hygiene, nutrition, and other healthy habits go by the wayside.

Healthy self-care can help people feel better overall, making it easier to abstain from drugs and alcohol. These may include practices like:

• Exercise
• Getting enough sleep
• Meditation and mindfulness
• Proper nutrition
• Taking prescribed medications as instructed
• Attending to spiritual needs
• Engaging in fun, fulfilling sober activities

Regular exercise, meditation and proper nutrition can have positive effects for the reward center of the brain. Religious and spiritual activities help people feel connected to something bigger than themselves, which can alleviate feelings of isolation that can accompany addiction and recovery.

6. Difficult Feelings

Before sobriety, people in recovery may have used drugs or alcohol to numb difficult feelings like sadness, anger, grief, and fear. That’s why intense emotions can be an alcohol or drug relapse trigger. It’s not just difficult feelings. Even feelings of joy and happiness can be tied to drug and alcohol abuse. Alcohol and drug addiction treatment can help people learn to manage emotions and their responses to them. It’s important to have healthy tools to draw on when emotions feel overwhelming. Learning coping strategies is also essential for managing triggers and cravings, which helps reduce the risk of relapse.

7. Boredom and Isolation

Loneliness and isolation are known factors that put people at risk of relapse. Often recovery means eliminating former friends and changing where time is spent. This can feel lonely, especially in the early stages of recovery. It can take time to build a sober network of peers.

Connections with other people in sobriety can provide critical support in recovery. Having people to lean on and socialize with who understand the struggles of addiction is

important in life free of drugs and alcohol. Boredom is also a risk factor for alcohol and drug relapse. When people are addicted, substance abuse occupies most of their time and energy. Finding ways to fill that void takes time. Drugs and alcohol may have also been a way to relieve boredom. It can be a difficult cycle to break.

8. Co-Occurring Disorders

Internal factors such as depression and anxiety symptoms put people at higher risk for relapse. Mental illness is an underlying issue that can fuel substance abuse. As part of a successful relapse prevention plan, people in recovery who struggle with depression, anxiety, or other mental health disorders need to manage symptoms with therapy and any prescribed medications.

We Can Help

If you or a loved one has relapsed, we can help. At Footprints to Recovery, we use research-based therapies and alternative approaches that address the reasons behind your substance abuse. We’ll help you identify the situations that led to relapse, learn from them, and move forward. You’ll work with a therapist and case manager to develop a thorough relapse prevention plan that supports long-term recovery.

The most important thing after a relapse is to seek help and support right away to ensure your safety and get back on track.

Our addiction treatment programs provide a full continuum of care that includes:

• Medical detox
• Residential treatment programs
• Partial hospitalization program
• Intensive outpatient programs
• Outpatient programs
• Recovery homes

In addition to these levels of care, there are other treatment options available for relapse prevention, such as behavioral therapies, support groups, and individualized treatment adjustments.

If you are thinking about returning to drug rehab, call us for a free, confidential consultation. We understand what you’re going through, and we can help. For some people, even one drink can trigger a return to problematic use, so maintaining abstinence is crucial. Our treatment aims to help you regain control over your life and maintain sobriety.