Relapse

What is relapse?

Recovering from a dependence on alcohol or another drug is a process that can take time.¹ A relapse (or multiple relapses) is one part of recovering from alcohol and other drug dependence and can often be a feature of the recovery.²

A relapse happens when a person stops maintaining their goal of reducing or avoiding use of alcohol or other drugs and returns to their previous levels of use.^3,4

This is different to a lapse, which is a temporary departure from a person’s alcohol and other drug goals followed by a return to their original goals. For example, a person who has set a goal of not drinking alcohol may end up having a glass of wine at a party, only to return to their alcohol goal the following day.⁴

The degree of substance use can vary within a lapse, but what makes a lapse different from a relapse is that it’s a brief period of substance use followed by a clear return to the person’s recovery goals.

Why does relapse happen?

Many things can lead a person to relapse. There’s a strong connection between dependent alcohol or other drug use and personal challenges. These can cause problems at work, ongoing emotional and psychological issues, and social or economic problems such as financial hardship, rejection by social support networks and challenges in personal relationships.⁵

Much like dependent drug behaviours themselves, the process of recovery – and the reasons for relapse – can be very personal. A relapse isn’t a sign that the person is ‘weak’ or a ‘failure’ – it’s just a continuation of old coping patterns that need to be replaced with new ones.²

Causes of relapse

There are a range of circumstances that may promote relapse.

• Situations that tempt the person to return to drug use – for example, circumstances or places where the person would previously have used alcohol or another drug.
• Circumstances that act as a trigger for substance use as a coping strategy – for example, insecure housing, professional or personal setbacks, social pressures or social stigma.
• Pre-existing mental health or emotional issues.
• Pre-existing physical health issues. Poor physical health can cause some people to use non-prescription pharmaceutical drugs, particularly when they have persistent pain.
• Guilt caused by lapsing. A person trying to abstain from substance use can experience internal conflict or guilt if they end up lapsing. If not managed properly, this situation can lead to self-blame and guilt that in turn mean the person is more likely to continue substance use as a coping mechanism.³

It may take several attempts to get the right management strategies to maintain an alcohol and other drug goal in the long term.⁵

What to do when a person you know relapses

Managing relapse is part of the long-term strategy of alcohol and other drug recovery. Solutions are both immediate and focused on long-term behavioural changes.

What to do straight away

• Seek medical support if the person is experiencing unusual or significant symptoms. There are particular risks if they haven’t used a substance for a long time.⁶
• Ensure, if possible, that the person has support people nearby to make sure they stay safe.
• Call upon the person’s previously agreed support network: friends, a family doctor or a 24-hour alcohol and other drug information/counselling service.

What to do in the short to medium term

• It can take five or six attempts before a person successfully maintains change, so reassure the person that relapse can be common.
• Encourage the person to think of a relapse as an opportunity to learn more about their drug-use triggers.⁷

Overdose risk during relapse

When a person uses a drug regularly, they develop tolerance to it, which means they need to use more to get the same effect. If a person doesn’t use it for a while, their tolerance to the drug may drop. So, when they take their usual amount after a break, it could be too much for the body to cope with and lead to an overdose.

Overdose due to changed tolerance is a specific risk for people who return to a drug after a period of non-use. For instance, after release from prison and during detoxification and/or rehabilitation. Someone on naltrexone, for example, can be at risk if they use soon after stopping oral medication, or skipping a dose, or when the effects of a naltrexone implant have ceased.⁸

If an overdose is suspected, seek medical assistance immediately.

Preventing relapse long term

Long-term solutions for managing relapse are about preventing relapse as much as possible. The following strategies have been effective for people who are dependent on alcohol or another drug in helping to reduce the risks of relapse on the road to recovery.

• Avoiding certain people, places and things. Steering clear of people, places and situations that used to lead the person to use alcohol or other drugs.
• Calling upon clinical and non-clinical support as needed. A strong support network, whether through a service provider or an informal network of supportive friends and family, will help avoid negative behaviours and situations.
• Doing meaningful activities. Encourage the person to build a sense of positive self-image and pride by doing things they like and that have a positive impact on the community, e.g. joining a community sporting group, choir or special interest group.
• Self-care and a balanced lifestyle. Not taking care of yourself physically and mentally can be a trigger for substance use. Encourage the person to adopt healthier lifestyle behaviours, e.g. getting enough sleep and time for recuperation, eating nourishing food and having a clean living environment.
• Thinking differently. Along with the person’s short-term goals of reframing the way they see events, encourage them to try to learn from their mistakes, build a positive self-image and set future goals, including goals unrelated to their alcohol and other drug use.⁹

Additional strategies for those at-risk

If a person has ongoing emotional, physical and/or mental health issues, they may need to use additional strategies to help their recovery and prevent relapse.

• Finding the right mix of medications, e.g. antidepressants or anti-anxiety medications – the person should work with their GP or psychiatrist to find a medication that works for them
• Alternative tactics that encourage a more holistic wellness approach, e.g. meditation, mindfulness-based therapies or yoga.¹⁰
• Psychological help, e.g. psychotherapy, cognitive behavioural therapy, or alcohol or other drug therapy
• Developing self-care routines for diet, exercise and rest.¹¹

Key points

• Dependence has social, psychological and physical dimensions. It needs the right mix of strategies to address it over time, just like any other chronic condition.
• It can take time to find the right mix of strategies. There’s no ‘quick fix’ to some of the underlying issues that can cause people to use alcohol and other drugs.
• Every person’s experience of treatment, recovery and dependence is different. One person may finally be able to achieve their alcohol or other drug goal after two attempts, while another may take five or six attempts, or even more. The management of recovery has to meet the specific needs of the person who is trying to work out their goal.⁴