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 the recovery process from alcohol and other drug dependence, and can often be a feature of the recovery.2
A relapse happens when a person stops maintaining his or her goal of reducing or avoiding use of alcohol or other drugs and returns to 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 a lapse is a brief period of return to substance use followed by a clear return to the person’s recovery goals.
Why does relapse happen?
Many things could lead a person to relapse. There is a strong connection between dependent alcohol or other drug use and personal challenges, 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 highly personal. A relapse is not a sign that the person is ‘weak’ or a ‘failure’ – it is merely 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 engage in non-prescription use of 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
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What to do when a person you know relapses
Managing relapse is part of the long-term strategy of alcohol and other drug recovery. This means that the solutions are both immediate and focused on long-term behavioural changes.
What to do straightaway
- 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 is not uncommon.
- 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 then doesn’t use it for a while, their tolerance to the drug may drop, so when they take their usual amount after a break from using, 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 using a drug after a period of non-use, at times such as post-release from prison, 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 really about preventing relapse as much as possible. The following strategies have been proven 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 at one time led the person to use alcohol or other drugs is important.
- 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, so 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 people in at-risk groups
If a person has ongoing emotional, physical and/or mental health issues, they may need to use specific strategies in addition to those listed above to help them recover 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 approach, e.g. meditation, mindfulness-based therapies or yoga10
- Psychological help, e.g. psychotherapy, cognitive behavioural therapy, or alcohol or other drug therapy
- Developing self-care routines in regard to diet, exercise and rest.11
- Dependence has social, psychological and physical dimensions and 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 is 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
- Best D & Lubman D (2012) The recovery paradigm: a model of hope and change for alcohol and drug addiction. Australian Family Physician41(8) 593-597.
- Sack D (2012) Why relapse isn’t a sign of failure. Psychology Today.
- Stephens RS, Curtin L, Simpson EE & Roffman RA (1994) Testing the Abstinence Violation Effect construct with marijuana cessation. Addictive Behaviours 19(1) 23-32.
- Department of Health (2004) Relapse prevention and management. From Working with young people on AOD issues: learner’s workbook. Canberra: Australian Government Department of Health.
- Brady KT & Sonne SC (1996) The role of stress in alcohol use, alcoholism treatment and relapse. Alcohol Research and Health23(4) 263-271.
- Penington Institute (n.d.) Overdose Awareness Day: overdose basics. Victoria: Penington Institute.
- Davis KE & O’Neill SJ (2005) Special report on relapse prevention: a focus group analysis of relapse strategies for persons with substance use and mental disorders. Psychiatric Services 56(10) 1288-91.
- Ivanovski B and Malhi GS (2007) The psychological and neurophysiological concomitants of mindfulness forms of meditation. Acta Neuropsychiatrica19(2) 76-91.
- NPS MedicineWise (2015) Chronic pain: limited evidence for opioids. New South Wales: NPS MedicineWise.
- Marsh A, Dale A & Willis L (2007) A counsellor’s guide to working with alcohol and drug users. Western Australia: Alcohol and Drug Office.