What Are the Stages of Addiction or Substance Use Relapse?
The basics
Addiction is a chronic disease. That means that there’s no lifelong cure for it, but it can be treated. The symptoms of substance use disorder can be managed to the point where they’re no longer interfering with your everyday life.
Recovery from substance use disorder is rarely linear. Most of the time, the road to recovery is long and complex. In other words, recovery is a journey — and not a destination. And along that road, there may be times when you take some steps back.
Relapse is when someone has a setback or worsening of their health symptoms after a temporary improvement in their condition. For people with substance use disorder, relapse happens when a person is able to stay away from drugs and alcohol for a time period, but then slips back into using.
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Relapse is often a part of substance use recovery, but don’t let that discourage you. Relapse is a part of recovery from any chronic condition, not just substance use disorder. And just because relapse may be part of the process doesn’t mean that you can’t recover from substance use disorder.
Relapse unfolds in stages, and you can prevent yourself from having a full relapse if you pay attention to the signs of each stage and take appropriate action when it’s needed.
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Our Author:
N. Saya Des Marais, MSWSaya Des Marais, MSW, is a masters-level social worker, mental health professional, Motivational Interviewing trainer, and mental health content writer. She has both personal and professional experience working with people with substance use disorder.
What is a substance use relapse?
We often talk about relapse in terms of addiction recovery, but it’s a term that can be applied to any health condition. For example, someone could live with diabetes and have their symptoms (and blood sugar levels) well under control for years — only to suffer a relapse, or a worsening of their symptoms.
In substance use, relapse is understood as a process (lasting for weeks, or even months) that eventually leads a person who has recovered from addiction to start using drugs and/or alcohol again.
Some people may believe that relapse only happens when someone returns to uncontrolled drug or alcohol use, but experts say this isn’t the case. There are many warning signs that lead up to using again, and these warning signs are also considered to be part of the process of relapse.
Relapse is common when recovering from substance use disorder, but it doesn’t mean you’ve failed. It’s just a part of the recovery process that signals you need to make changes to your recovery plan. You’ve also probably learned lots of healthy coping skills during your first attempt at sobriety, and these are successes that should be celebrated, too.
What are the stages of relapse?
Relapse prevention expert, Terrence Gorski, broke down the process of relapse into 11 phases with 37 specific warning signs. Although breaking down the process of relapse into this much detail is helpful for treatment providers, it can be overwhelming when you’re the one actually going through a relapse.
That’s why some experts in the addiction field have narrowed Gorski’s 11 stages into only 3 broader stages:
Emotional relapse
Mental relapse
Physical relapse
Emotional relapse
Experts say that the first stage of relapse is emotional relapse, which usually happens long before you start using drugs or alcohol again.
In this stage, you are probably not thinking about using substances again. You’re not even entertaining the idea: You’re still committed to recovery. However, you may notice that you start to feel restless, depressed, or lonely. If you don’t practice proper self-care when you start feeling this way, you unconsciously set yourself up to start using drugs and alcohol again further down the line.
People often experience denial during emotional relapse, which is what makes it so dangerous. You might think to yourself, “There’s no way I’ll ever use again.” Because you don’t see yourself as being at risk for relapse, you might not take the action that’s needed in this stage to prevent yourself from starting to use again.
On top of this denial, other signs of emotional relapse include:
Isolating yourself from others because of difficult emotions
Poor eating or sleeping habits (self-care)
Bottling up your feelings
Going to fewer peer support meetings, going to meetings but not sharing, or stopping attending altogether
Disengaging from substance use treatment
Focusing on others’ problems instead of your own
In this stage, the most important thing to focus on is practicing good self-care. People often start experiencing emotional relapse, but the denial that comes along with this stage prevents them from taking care of themselves in the ways that they should. But if you don’t take care of yourself now, you put yourself at risk of moving further along into the other stages.
If you don’t catch yourself when you’re in emotional relapse, or if you catch yourself but don’t commit to good self-care practices, you may start feeling restless, tense, and uncomfortable. You may then move into the second stage: mental relapse.
Mental relapse
Mental relapse is when you’re at war with yourself, and uncertainty is at an all-time high. Part of you is still committed to recovery and sobriety. But another part of you desperately wants to use drugs or alcohol again. This internal struggle is at the heart of mental relapse.
Mental relapse is also when cravings kick in. In emotional relapse, you’re in denial. You’re not yet thinking about using drugs or alcohol. In mental relapse, the thought of using is on your mind. You may be tempted to use drugs and alcohol to try to escape from the uncomfortable feelings that you struggled with in emotional relapse.
The deeper you go into mental relapse, the weaker your resistance to using becomes. The voice that tells you to use drugs and alcohol to escape gets stronger and stronger.
Some other signs of mental relapse include:
Reminiscing: You think or reminisce about people, places, and things that you associate with your past life using drugs and alcohol. For example, you might visit a bar to hang out with the friends you used to drink with.
Bargaining: You have thoughts like, “I’ll just get high one more time and then I’ll never do it again.”
Glamorizing or minimizing: You glamorize past drug or alcohol use, or you minimize the negative effects of use. You could have thoughts like, “Man, those were the good old days.”
Lying: You lie to others about your thoughts, feelings, or behaviors to try to hide the fact that you’re thinking of using again.
Planning: You try to plan how you could use drugs or alcohol and maintain control. For example, you promise to yourself that you’ll only use on the weekends
Looking for ways to relapse: This could mean researching who you might buy drugs from.
It’s important to note that having occasional cravings is a normal part of recovery, especially early recovery. Just because you think about drugs and alcohol sometimes doesn’t mean you’re in mental relapse. In mental relapse, people actively look for excuses and justifications as to why it would be OK to use under certain circumstances.
Getting support is essential in mental relapse. If you don’t get the help you need, you may end up physically relapsing.
Physical relapse
Physical relapse, the final stage of relapse, happens when someone actively uses drugs and alcohol again. You can have a lapse, which is when you just use one time, or a full relapse, which is when you’ve returned to using drugs and alcohol regularly or in an uncontrolled way.
It isn’t impossible to get back on the road to recovery after you’ve had a full physical relapse. However, of the three stages of relapse, physical relapse is the hardest to stop.
Why do the stages of relapse matter?
Most people, even when they’re in recovery, mistakenly think of relapse as something that only happens when you start using drugs and alcohol again. When you have a deeper understanding of the stages of relapse, you can see clearly that this isn’t the case.
The process of relapse starts long before the physical relapse occurs. When you understand the full complexity of relapse, you can see that there are many different factors that lead to using drugs or alcohol again. The temptation to use substances again doesn’t usually happen suddenly when presented with the opportunity.
Bottling up uncomfortable feelings, not taking care of yourself, and not getting support when you need it are all things that set you on a path that may eventually end in physical relapse. The further you head down this road, the harder it becomes to stop yourself from using.
That’s why it’s so important to be familiar with the stages of relapse and to recognize when you’re in the first stage, emotional relapse. If you catch yourself while you’re in this stage of relapse, you have the highest chance of being able to prevent physical relapse.
Once you’ve already had a physical relapse, it can be difficult (but not impossible) to restart your journey of sobriety. Preventing physical relapse is often a much easier way.
Is relapse always a part of recovery?
No, but it often is. Studies show that most people who are trying to recover from drug and alcohol addiction will go through physical relapse at least once. Although treatment programs are successful in helping people make the initial recovery from substance use disorder, less than 15% of people stay sober during their first year of recovery.
Relapse is the most challenging part of substance use recovery. Many people who seek treatment for substance use disorder have relapsed at least once. They may seek treatment because they’ve already tried to walk away from drugs and alcohol on their own, only to be knocked back down by relapse.
This may sound discouraging, but it doesn’t mean that you’re guaranteed to relapse before you can make a full recovery. Again, relapse is a part of recovery from any chronic condition.
Addiction is a chronic disease that needs to be managed on a daily basis. The rates for symptom recurrence (or relapse) aren’t any higher for substance use disorder than they are for other chronic conditions, like asthma or hypertension.
That doesn’t mean that you can’t live a fulfilling, meaningful, and healthy life without active drug or alcohol use.
Having a relapse doesn’t mean you’ve failed. Again, relapse is now understood as an ongoing process, or a series of setbacks that happen while you’re recovering from the disease of addiction. It shouldn’t be encouraged or rewarded, but it also doesn’t mean that your recovery, or treatment, has been a failure.
How to make a plan to prevent relapse
Being aware of the stages of relapse is important because this awareness can help you to avoid physical relapse. There are several things you can do in the stages of emotional and mental relapse to prevent yourself from getting closer and closer to physical relapse.
In emotional relapse
Emotional relapse is the easiest stage to catch yourself and prevent physical relapse.
If you notice signs of emotional relapse, ask yourself:
What do I need right now?
How do I typically take care of myself?
Am I sleeping and eating enough?
Am I having fun and connecting to the people I love?
Am I engaging in my treatment?
Am I connected to and attending self-help groups like 12-step meetings if that’s something that has helped me in my recovery?
Make sure you practice positive self-care if you’re in emotional relapse. Find healthy ways to manage your uncomfortable feelings. Connect to people who support you, and keep going and engaging in meetings, groups, or any other treatment you may be participating in. If you’re not currently in treatment or attending meetings, you should consider doing so.
In mental relapse
It can be hard to get out of mental relapse on your own. If you’re already in mental relapse and having cravings, you should talk to a professional right away. With support, you can work through the thoughts and temptations that you’re having about drug and/or alcohol use and make sure you get back on the right track.
A therapist can support you in avoiding high-risk places, people, and behaviors that may make it more likely that you’ll give into your cravings. They can also use strategies from cognitive-behavioral therapy (CBT) to help you challenge the irrational thoughts you’re having about drugs and alcohol. For example, if you find yourself glamorizing past use, a therapist can point that out to you and help you change your thinking.
Tips for making a relapse prevention plan
On top of being aware of where you are in the stages of relapse, you can also prepare yourself with a relapse prevention plan.
Here are some things to include in your relapse prevention plan:
A list of your triggers
The thoughts and behaviors that are connected to your cravings
Healthy coping skills
Supportive people to contact
Keep in mind
We can’t stress this enough: Having a physical relapse does not mean that you’ve failed at recovery. Relapse is a common part of addiction recovery. However, they can be prevented. By being aware of the stages of relapse and keeping an eye out for warning signs, you can intervene and stop yourself from breaking your sobriety.
More information and resources
Why trust our experts?
References
Best study we found
Melemis, S. M. (2015). Relapse prevention and the five rules of recovery. Yale Journal of Biology and Medicine.
Brandon, T. H., et al. (2007). Relapse and relapse prevention. Annual Review of Clinical Psychology.
Gorski, T. T., et al. (1996). Counselor’s manual for relapse prevention for chemically dependent criminal offenders. SAMHSA Technical Assistance Publication Series.
Hendershot, C. S., et al. (2011). Relapse prevention for addictive behaviors. Substance Abuse Treatment, Prevention, and Policy.
Melemis, S. M. (2015). Relapse prevention and the five rules of recovery. Yale Journal of Biology and Medicine.
Miller, W. R., et al. (2015). A simple scale of Gorski’s warning signs for relapse. Journal of Studies on Alcohol and Drugs.
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Sinha, R. (2011). New findings on biological factors predicting addiction relapse vulnerability. Current Psychiatry Reports.
U.S. Department of Veteran Affairs. (2020). Reducing relapse risk.
If you or someone you know struggles with substance use, help is available. Call SAMHSA’s National Helpline at 1-800-662-4357 to learn about resources in your area.
