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Understanding Relapse: Why It Happens and How to Prevent It

On the road to substance use recovery, many people will experience relapse. While this is part of the recovery process for many people, understanding and preparing for relapse can dramatically reduce the risk of experiencing a setback on your path to sobriety.

Working with a team of addiction professionals can not only bolster your defenses against potential relapse but also provide you with the tools to reclaim your sobriety if a relapse does occur.

Understanding Relapse

In general, relapse refers to people returning to substance use after a period of sobriety. Relapse can happen at any stage in the recovery process, and it can be either a single episode of substance use or a prolonged return to active addiction.

But critically, relapse can also be understood as a process. A person who is working toward recovery doesn’t just spontaneously decide to return to addictive behaviors. Instead, there are a number of factors that lead up to relapse, and patterns begin to emerge that can be recognized, prepared for, and worked against.

Identifying these signs of relapse as early as possible is the best way to help people keep on the road to recovery and maintain their abstinence and well-being for years to come. With that in mind, let’s look at a few common predictors of relapse that can influence people’s decisions to return to substance use.

Why Relapse Happens

Typically, there isn’t just a single reason relapse happens. Instead, there is a constellation of factors that can increase the risk of relapse occurring, as well as protective factors that can help people overcome difficult situations without resorting to substance use.

Physical Withdrawal

Drug and alcohol withdrawal is not only incredibly uncomfortable, but it can even be life-threatening in certain situations. If you or a loved one is attempting to break free from substance use for the first time, you should always seek the help of addiction or medical professionals at a medical detox facility or hospital setting.

While each substance has a unique set of withdrawal symptoms, some of the more common challenges people face include:

  • Intense substance use cravings
  • Shakes
  • Insomnia
  • Anxiety
  • Sweating
  • Nausea
  • Diarrhea
  • Nightmares

If substance use withdrawal is left untreated, these symptoms can quickly lead people to abandon their goal of sobriety and seek relief from the physical pain and discomfort they experience during withdrawal.

If they don’t receive the assistance of a medical detox, most people will relapse in these first days of withdrawal. The prospect of overcoming these symptoms often seems overwhelming, and using their drug of choice “just one more time” to find a brief relief can quickly become an overwhelming compulsion.

As difficult as it can be to go through physical withdrawal, there is good news on this front. Medical detox can drastically reduce the symptoms of withdrawal for the most common substance use disorders, and the experience of withdrawal generally only lasts between one and two weeks.

Cognitive Processes

The next predicting factor is cognitive processes — or the ways people think about their substance use. For example, a person new to recovery may be experiencing thoughts such as:

  • “I’ve never been able to get sober before, so why would I think that I can now?”
  • “One drink shouldn’t hurt.”
  • “I need drugs or alcohol to help me in social situations.”
  • “Didn’t I enjoy drugs and alcohol? I want to get back to the good times.”

Scientists have an abundance of terms for these types of thoughts and processes and how they can influence a person’s risk of relapse.

Take the first example above; researchers call this low self-efficacy. When people don’t believe in their own ability to maintain their sobriety, they are more likely to return to substance use.

The second example refers to a cognitive distortion known as minimization. It occurs when people downplay the consequences of substance use, making it more likely for them to relapse in the future.

The third and fourth examples refer to positive expectancies for substance use and nostalgia, respectively.

When people start thinking in these ways, the risk of relapse is incredibly high. But again, there are scientifically proven methods of helping people break these thought patterns and learn new ways of thinking and behaving.

Starting cognitive-behavioral therapy or a relapse prevention program can help people identify, challenge, and change these processes during recovery.

Coping Behavior

The way people cope with stressful situations can influence whether they experience relapse. Typically, people new to sobriety lack a robust set of healthy coping mechanisms, and instead, they turn to unhealthy methods of coping to deal with the challenges in their lives.

While in active addiction, drugs and alcohol are often the primary methods of dealing with stressful situations. Taking a drink or using a drug of choice can reduce stress, alleviate anxiety, or distract people from the challenges they face — at least temporarily.

The problem with drug use as a coping method is that it typically does not solve the problem. Left unaddressed, the problem itself gets worse, and people begin to experience new challenges when they develop a substance use disorder.

This leaves people in early recovery with few tools to handle life’s stressors successfully. Rather than facing their problems head-on, they avoid them — this is called avoidance coping. This coping can take many forms, such as procrastination, distraction, or denial of the problem altogether.

Alternatively, people may turn toward attempting to reduce their emotional distress rather than the problem itself — this is known as emotion-focused coping. This pattern of coping often turns to self-pity, excessively sharing emotions with others, or escapism.

These are just two examples of negative coping behaviors many people use in early recovery, which can increase their risk of relapse. These coping strategies — like substance use itself — only provide temporary relief and don’t help people resolve their stressors and challenges.

Mood States

Mood states can lead people to make emotional, impulsive decisions — often including the decision to relapse. Anxiety, depression, anger, and loneliness can all be a warning sign for impending relapse, but surprisingly, for some, so can excitement and euphoria.

Negative mood states are perhaps the easiest to understand. No one likes feeling anxious, lonely, or depressed, and especially early in recovery, people will often feel like a return to substance use can alleviate these difficult experiences.

But it’s just as important to consider how positive mood states can be risk factors for relapse as well. Some of the most common situations where people relapse include celebrations or parties, where people are filled with joy and excitement. Feelings of elation can lead to people dropping their defense, feeling a sense of lowered inhibition, and being more likely to engage in drug or alcohol use.

Environmental Factors

Just as internal states can influence whether a person is about to relapse, so can external events. People who live with a substance use disorder often have memories tied to particular situations, such as parties, bars, friends’ houses, or even their own homes.

When people enter into these situations, they often experience what addiction researchers label a “trigger” — or a sudden impulse to return to substance use. These places can spark cravings, remind people of substance use, and encourage them to relapse.

This isn’t just relegated to certain locations, either. People can feel triggered when they see certain people, such as their parents, high school friends, or boss. They can experience a trigger when they listen to certain music, watch certain television shows, or even have certain foods that spark cravings and thoughts of relapse.

Of course, each of these environmental factors is highly individual. What triggers one person may not be triggering to someone else, and it’s vital that people identify their own triggering events that could increase their risk of relapse.

How to Prevent Relapse

With so many different factors contributing to relapse, it may seem like it is unavoidable. But each of these various events that can increase an individual’s risk for relapse can be overcome, especially if you seek treatment at a specialized addiction treatment center.

These are some of the best ways to plan for and break free from these relapse risk factors.

Relapse Prevention Programs

Relapse prevention programs were invented to help people understand the process of relapse and provide actionable tools to help people resist temptation when it occurs. In general, relapse prevention programs have a few main components:

  • Identifying high-risk situations and personal risk factors
  • Creating a relapse prevention plan
  • Teaching healthy coping methods
  • Building support systems to help maintain recovery

By helping clients understand relapse as a process, identify the early warning signs of relapse, and avoid high-risk situations, a relapse prevention program provides a comprehensive set of plans and strategies to help people maintain their recovery long-term.

Cognitive Behavioral Therapy

Cognitive-behavioral therapy (CBT) has a long history of treating a number of common mental health challenges effectively. It is the gold standard of evidence-based practice in mental health care and can be used as a tool to help people overcome several of the challenges that may lead to relapse.

CBT is built upon the foundation of a simple understanding that our thoughts, behaviors, and moods all influence one another. This provides three distinct targets for intervention and can help people to break thought patterns that can ultimately lead to them experiencing relapse.

The goal of CBT in relapse prevention is to help people change the cognitive processes that lead people to think they can’t sustain sobriety, need drugs or alcohol, or can return to substance use without consequences.

Further, it can help treat many co-occurring mental health disorders, such as depression or anxiety, which can contribute to mood states that may drive people toward relapse.

Mindfulness Strategies

Mindfulness strategies have quickly become one of the leading tools in helping people overcome cravings and resist relapse. Mindfulness is learning to become entirely present in the moment. By learning this skill, people can sit with their cravings without feeling the need to take action upon them until the craving passes on its own.

The use of mindfulness in preventing relapse has created its own set of evidence-based therapies, including mindfulness-based relapse prevention (MBRP). MBRP is built upon the foundation of traditional relapse prevention programs but has quickly proven itself to be an even more effective strategy for helping prevent relapse.

Get Professional Help

If you’re new to substance use recovery or are considering getting sober for the first time, starting treatment at a professional addiction treatment center is the surest path to preventing relapse in your journey toward recovery.

To get started with treatment at APN, call our team, start a conversation with one of our representatives by calling 855.934.1178, using the live chat function on our website, or filling out our confidential contact form to get more information.


  • Larimer, M E et al. “Relapse prevention. An overview of Marlatt’s cognitive-behavioral model.” Alcohol research & health : the journal of the National Institute on Alcohol Abuse and Alcoholism vol. 23,2 (1999): 151-60.
  • Mindfulness-Based Relapse Prevention for Alcohol And …, depts.washington.edu/abrc/mbrp/reprints/MBRPAlcoholSUDs2005.pdf. Accessed 25 May 2024.