Between forty and sixty percent of people in recovery who get treatment for substance use disorder experience a relapse. Contrary to popular belief, a relapse, also called a recurrence, does not happen at random. Emotional triggers like stress or grief and environmental triggers such as a movie or a party that has substance use can have consequences, even for those who have been sober for years. These overwhelming experiences can make someone feel inclined to use again, but awareness about the stages of relapse and what can cause a relapse helps prevent them.
Terence Gorski, an expert on substance abuse that contributed greatly to literature about recovery, first identified the ten stages of a relapse to help people with substance use disorder navigate their symptoms. It emphasizes the subtle signs that indicate a relapse may happen. Knowing these points can help you identify when your sobriety is in jeopardy so that you can turn to healthy coping mechanisms instead of using drugs or drinking alcohol.
Stage 1: Denial
During recovery, you should be proud of yourself—you’ve been diligently working on getting better, and it shows. You have a different lifestyle, different priorities. Whether you are freshly coming out of an inpatient program or are years deep into sobriety, you don’t want to use again. When even the slightest hint that you miss using drugs or alcohol surfaces, you quickly bury that feeling deep down. Denial is an emotional avoidance—it keeps us from being honest with ourselves and distances us from reality. This anxiety, the fear of using again, may be a fleeting feeling, but an overwhelming one, so you ignore it in hope that it will dissipate.
Stage 2: Avoidance and Defensiveness
During the second stage, you will convince yourself that going back to your old habits is not in the cards. It’s just not you. It is easier to say, “I’ll never use again” than to analyze the red flags you are exhibiting. To divert attention away from your own situation, you will begin to worry excessively about others. This can look like giving sage advice on recovery or refusing to see yourself in those who are struggling, using, or having thoughts of using. Besides, you’re not like them! If anyone asks about your progress, you’ll get defensive. You know that there is a fissure in your framework, but you are trying desperately to separate yourself from what you consider a personal failure—your urge to use.
To distract yourself, you turn to other compulsive or impulsive activities instead of healthy coping mechanisms. In earnest, you try to distract yourself by going to as many 12-step meetings as possible in order to feel that you’re modeling the right behavior. And some people isolate themselves from family and friends—it can be hard to socialize during this time. The loneliness only worsens your internal struggle as you bottle it all up instead.
Stage 3: Crisis Building
In the next stage, you will develop tunnel vision, feeling consumed by a single thought or fear (such as spiraling back into addictive tendencies). Instead of considering other options, only one true solution to your problems, drugs or alcohol, seems to come up. Catastrophizing your personal feelings, you believe everything is going poorly. It becomes harder to make plans with friends and keep them. You might fantasize about what you could do to help yourself, but every time you start to become hopeful, the feeling of failure is too strong. And it only weighs you down more.
These negative thought patterns can develop into a minor depression, which will affect your sleep, concentration, and mood. It becomes harder to commit time to recovery groups. It becomes harder to talk about what’s going on internally. You fixate on anything but the urge to use.
Stage 4: Immobilization
This stage is characterized by pessimism and lack of action. All of the worrying from the previous stage compounds into a state of immobility. You will start envisioning more hopeful scenarios but will not take proactive measures to achieve them. Daydreaming often about escaping your reality, you spend more time fantasizing than living in the present.
This version of what you want your life to be reflects the guilt you feel over wanting to use. In this fictitious scenario, you are in control of your life and your addiction. Meanwhile, in real life, every personal failure makes you feel like you will never get better, even after minor inconveniences.
Stage 5: Confusion and Overreaction
The fifth stage of relapse is fraught with inner turmoil. Instead of being able to work through tough feelings, you become irritated by smaller issues in your interpersonal relationships, turning them into bigger problems. You’re afraid of your friends, family, and sober network drawing attention to how you’ve lost your focus on sobriety. It is easier to build walls than bridges, and so you hide behind a curtain of hostility. You are easily angered, triggered by everyday circumstances. Your anger and overreactions cause tension in your relationships.
Stage 6: Depression
Minor depression intensifies during the sixth stage of relapse, developing into a severe state. Sleeping is difficult—you may develop insomnia or sleep for half the day. Eating is difficult—you may binge eat, replacing the urge to use with a different unhealthy coping mechanism, or you may find eating regularly too difficult to manage. It becomes a lot harder to take initiative, whether that be going to meetings, making plans, or sticking to a regular sleep schedule.
You think that nobody cares, but they notice you’ve changed. This period of depression is recognizable to your loved ones, especially when they don’t hear from you for days or weeks at a time. As you isolate, trying to hide your urges to use drugs or drink, they may bring up this change in behavior to you; however, submerged in guilt and heavy denial, you will disavow this truth, possibly hurting them in the process.
Stage 7: Behavioral Loss of Control
Severe depression progresses into apathy about recovery. You become dissatisfied with the direction your life is taking, disappointed in yourself. You might still be in denial about your cravings, but you certainly recognize the chaos of your daily life—and it’s weighing you down.
You won’t go to meetings and appointments as regularly as you should or miss them altogether. And you excuse this choice by telling yourself that if you are experiencing such a difficult time, then going to these sober spaces doesn’t matter anymore. It becomes harder to care about your sobriety as you once did; you no longer have the confidence that you need to take ownership of your recovery; You will openly reject any outside help, abandoning your support circle and creating conflict between you and loved ones. And as your hopelessness continues to grow, it clouds your judgment, dreams, thoughts, and sense of self.
Stage 8: Recognition of Loss of Control
You can no longer bury your denial; it festers over time and then balloons into an unmanageable size. Becoming aware of the problem to the point where you can’t deny it is painful and anxiety-inducing. You might feel powerless as the urge to use becomes a constant, unstoppable thought. It becomes harder to concentrate on school, work, or daily life, and life overall feels unmanageable.
Your focus on negative emotions translates into self-pity. To make yourself feel better, you begin to convince yourself that a moment of social drinking or using will not hold serious consequences. You start imagining yourself using or drinking as you once did. And you might purposely lie to others in order to disguise your revelation—that you are struggling to focus on your sobriety.
Stage 9: Option Reduction
Right before you relapse, the intensity of what you’re experiencing leads to a lot of resentment—for your life, for the world, for your recovery. You stop journaling your thoughts, attending therapy sessions, and completely abandon all group meetings. You no longer focus on the twelve steps and try to hide this from everyone in your life.
You may feel lonely, angry, unfulfilled, and stressed. Your urges to use become an ever-present thought lodged in your brain. You can no longer focus on anything else and convince yourself that the only way to relieve the calamity in your life is to use again.
Stage 10: The Relapse Episode
Any tensions come to a boiling point during the final stage of relapse. You may feel as if you have lost control of your life, contemplate suicide, feel unable to function in daily life, and even come down with an ailment from all of the stress. Self-destructive behaviors may manifest as you take out your anger on yourself. Psychologically, you’ve changed—the pain is too much to fend off and using again feels like the only option besides suffering. After initial use, you will feel ashamed and guilty, and convince yourself that you cannot be helped and that your future is hopeless.
Relapse is not synonymous with failure. Overcoming challenges and being self-aware is part of anyone’s recovery journey. You don’t need to give up or feel as if all your efforts were for nothing. Having to make amends and patch up our missteps is a natural part of life and accepting that we are not perfect is a piece of that. Look to family, friends, your sober network, and any other connections you made during treatment for support. If you have a recovery coach or a sponsor, be honest about your experience. They want to be there for you. You will be able to get back the control you want as you continue to grow within your recovery.