Understanding Relapse/Recurrence in Addiction Recovery: A Natural Part of the Journey

It’s important to normalize the potential for a relapse (now more commonly referred to as recurrence or recurrence of use) as you begin and during your road to recovery. A recurrence isn’t the ultimate failure in recovering from your substance use disorder (SUD); in fact, it’s actually a common and completely normal part of the overall journey that you shouldn’t beat yourself up over. Feelings of shame, guilt, self-blame, or other negative self-talk are only likely to lessen your confidence and discourage you from continuing.

That’s why I believe it’s so important to familiarize yourself with the possibility of a brief episode – so it doesn’t feel like some immense, horrific event that should never ever happen. That isn’t to say you shouldn’t work hard to avoid a recurrence – just know that all efforts and repercussions, including not giving up and forgiving yourself, are a part of your individual responsibility. Recovery is an ongoing process, after all, and the fact that you want to get better is what truly matters.

First Things First: Destigmatizing the Term

Now that we’re nearly a quarter of the way through the 21st century – and coming up on the 100th anniversary of the founding of AA – we know more about substance use disorder than ever before. As a result, we also know just how common a brief return to substance use really is. That’s why what we’ve always called a “relapse” is so often just another part of the recovery journey – and why the idea that your recovery is over if you have this experience, has become outdated.

In fact, I’d argue that the term “relapse” itself is on the verge of becoming outdated. As a society, we’ve grown and changed as our understanding of SUD has grown and changed – and so should the language we use to talk about it. Just as we use people-first language to discuss those who have a substance use disorder (i.e., “person with SUD” instead of “addict”), it’s important to use terms that accurately describe what is happening during what we call a relapse. A “recurrence”  or “episode” of substance use is a more accurate term than “relapse,” which is a general term that implies the end of the recovery journey and a return to addiction. In part, that’s because we use the term “recurrence” when we discuss the treatment and potential return of many other chronic diseases – so why not SUD?

In short, as I discuss this frequent component of the recovery timeline, you’ll continue to see the term “recurrence of use” in place of “relapse.” Recovery should be about extending help, kindness, and support, and by reducing our use of stigmatized terms, we can do just that for ourselves and those around us.

What a Recurrence Means For Those Struggling With SUD: Why Is It Natural?

When you’re dealing with a chronic condition like SUD, continuous and active recovery is difficult work. Just as you wouldn’t criticize someone whose medical disorder is currently worsening while they’re trying to improve their health, you shouldn’t punish yourself or act like the hard work you’ve accomplished so far means nothing. After all, even illnesses you’d thought you finally eradicated can unexpectedly return.

People often ask me about recurrence, wanting to know how it’s addressed or treated within recovery circles or just my general thoughts on it. More than anything, I want to emphasize again that it’s a very natural part of recovering from addiction. The attitude towards recurrence within substance use disorder — also only recently recognized as deserving more gravity than “addiction,” which can carry connotations of blaming those afflicted — is slowly being dismantled. The truth is, not everyone can thrive under the antiquated recovery approach where once you reach sobriety, you are cured; we live the rest of our lives with the risk factors and underpinnings of SUD, and a recurrence will always be a possibility.

Conducted research suggests nearly half of individuals who seek recovery from SUD will have at least one episode or recurrence. Despite this, our society has developed a stigma surrounding the topic, painting the recovering person as weak or otherwise condemnable.

I want anyone who is struggling after an episode to know that they are not alone and they matter; I knew someone who experienced a recurrence amidst extremely stressful circumstances after several years of sobriety and felt compelled to take their own life rather than seek help. I want you to know that this experience is far too common an occurrence to cause you to harm yourself. While it can seem like the longer you have been “fully” recovered and away from substance use, the worse a recurrence is, it can happen to anyone and not for lack of trying. A mistake is nothing someone who truly cares about your recovery journey would criticize you for, and that should include yourself.

What Are the Top Three Factors That Contribute to a Recurrence of Use?

Unfortunately, there can be many things that may push you back toward substances or offer opportunities for temptation. These can counter your initiative and efforts to remain in recovery. Fighting against and trying to prevent the familiar cravings and temptations is no easy task, and any success, no matter how small, is a win that cannot be taken away from you.

Here are three common factors that can lead to a recurrence:

Stress and Trauma

One major factor that can contribute to a recurrence is going through something extremely distressing or traumatic – or even being triggered into reliving or remembering an upsetting event. When you’re confronted with great amounts of stress, you may want nothing more than to get away from an unpleasant situation. This can bring back memories of the numbing comfort using substances can bring you and can even mislead you into believing you can use substances to regain control of your life.

Triggers and Reminders of Good Times

Another situation that can make a recurrence feel imminent is being reminded of people, places, or things associated with your addiction and active substance use. Spending time around people or in places that evoke memories of how misusing substances feels can easily cause you to slip back into that state of mind. These reminders can make you want to relive the good old days without thinking of the negative aspects those days brought into your life. It can be challenging to avoid triggers and find ways to cope, but this active participation in your own recovery is crucial in preventing a recurrence.

Mental Health and Withdrawal Issues

Mental health is the final most common influence on people grappling with the potential for a recurrence. Our brains have come to depend on the pleasure-inducing chemicals we introduce to them, leaving us at risk. Eliminating the effects a substance has had on the brain over the years can be strenuous and feel close to impossible. Enduring withdrawal symptoms during early detox and recovery poses a high possibility of either a recurrence or an episode.

Pre-existing mental illnesses, such as depression, anxiety, and difficulties managing stress, can also increase the likelihood of an episode. When these arise during early recovery and are paired with withdrawal, the risk of a recurrence in an attempt to achieve a state of numbness is at an all-time high.

What Are the Three Stages of a Recurrence in Order?

Most people simply think of a recurrence as using a substance after refraining for a period of time, but it’s actually a bit more complex. Rather than an event, a recurrence is a continuous process that develops over time and has unique stages that can be halted if recognized and dealt with.

Emotional Recurrence

The first inkling that you may be heading toward a recurrence is known as emotional recurrence. This state of being can entail the recovering individual suppressing their negative emotions, neglecting their health, and distancing themselves from behaviors that support their self-care and recovery maintenance. Examples of early emotional recurrence can include not opening up at meetings, skipping recovery meetings altogether, self-isolation, blaming/lashing out at others instead of focusing on recovery, and developing other poor habits for recovery.

Sudden mood changes or outward reactions like anger, sadness, or defensiveness can be an indicator of an impending recurrence or episode. During this phase, you may begin thinking about using substances again, urges coming to the surface as the grip on your emotional wellness diminishes.

One easy way you can check in with yourself to see if you’re truly taking care of yourself and whether your feelings are really an urge to return to substance is by using the acronym HALT. This stands for hungry, angry, lonely, and tired, and experiencing any of these feelings may well be what’s really setting off your emotional recurrence. The basis of self-care is sometimes as simple as ensuring you’re regularly eating food that’s good for your body, trying to get to the root of why you may feel angry, socializing within your routine, and understanding the impact of sufficient rest. Slacking on personal hygiene and the usual treatment for your emotional problems is also evident in the absence of enough self-care.

Mental Recurrence

Mental recurrence means the recovering person is beginning to crave the substance or the sensations surrounding their past substance use. This can involve thinking about or actively seeking out triggers, glamorizing/fantasizing about substances and misuse, and romanticizing previous experiences using substances. Their mind may be consumed with images and other stimuli associated with substance use, highlighting any and all fond memories and sensations of active use.

Giving in to reminiscing about addiction is a way of reliving it and a form of self-temptation, making an actual recurrence event more likely. At this point, you may find that you’ve not actually used a substance. However, if you find yourself wondering how you can gain access to substances and/or lying to others about your intentions and wavering state, you are likely in the midst of a mental recurrence.

Physical Recurrence

A physical recurrence is what most people think of when they hear the term “relapse” – when someone has followed through with returning to substance use while in recovery from SUD. Physical recurrences can take the form of a single, brief episode or a longer recurrence. Recurrences can be scary for loved ones and those with substance use disorder, but it’s nothing to be ashamed of or to keep to yourself. It’s a normal occurrence, especially early in your recovery journey or during particularly stressful periods of life.

If this has happened to you, know that you haven’t failed or rendered your recovery invalid. Similarly, your support system should not abandon you or punish you for faltering in your steps toward recovery and stability. That’s because you are still on the path of recovery, where recurrences can and do occur.

How Do You Stay Motivated After a Recurrence?

Be Transparent

It can be very daunting to admit a recurrence to your support group or loved ones, whether you’re hesitating for fear of their adverse reactions or your own feelings of guilt. However, take heart in the fact that you haven’t let anyone down; your support system will likely feel relieved you’ve decided to be transparent about your episode because it means you are still dedicated to your path of recovery. The bottom line is that no one knows how hard your unique version of SUD is, and you can’t take on the burden of others’ judgment or assume how they will feel. Your focus should be on how you treat yourself.

Create a Relapse/Recurrence Prevention Strategy

If you haven’t done so already, create a prevention plan and find coping methods that work for you so you can minimize the chances of future recurrences. The key is to develop the self-awareness necessary to identify what your specific triggers are and how you can either avoid or deal with them. Learn what people, media, locations, and other stimuli remind you of your experiences with substance use as well as those you associate with active addiction and the accompanying feelings. Understanding what personally triggers you into a dangerous headspace isn’t always simple, so remember it can be a slow process – being gentle with yourself will only help.

Put Your Prevention Skills to Work

If you have already outlined a prevention plan that includes which steps and measures you can take in the event of an occurrence, now is the time to put them to use. This may include leaning on your support network or utilizing the available resources within a program, especially aftercare. You may also feel inclined to take new approaches, such as enlisting the help of a professional trained in supporting those actively fighting substance use.

There are also small acts you can do by yourself that may refocus your energy or occupy spare time, which can prevent temptation while accomplishing self-care and improvement. Some ideas are picking up an old hobby or getting into a new one, working out or simply spending time in nature, journaling, and doing something creative or expressive.

Review the Signs

It’s vital, during this sensitive time, to be honest with yourself and someone you trust about what is currently happening in your world or what’s absent from your recovery that led to a recurrence. Recognize the signs you were inching slowly back towards active substance use, the stressors that contributed to your drifting, as well as the triggers you experienced (and maybe ones you didn’t notice before). You can journal your thoughts about what being sober means to you, in definition and significance, and what you’ve found to be the most important aspects of recovery.

The goal is not to assign blame or make an excuse. Instead, you’re fully accepting the fact you are dealing with a chronic disease that’s resilient and often calls for modifying one’s environment or approach to recovery. By addressing things that led to recurrence before, you can begin to move forward.

What You Do Next Is What Really Matters

Recovery isn’t a linear journey. That means that no one expects you to one day become infallible. As obvious or silly as it may sound, remember that you’re on your own side – please don’t be overly critical of yourself. Instead, be compassionate and patient with yourself just as you would with someone else working through a life-long condition. Defend yourself against any negative thoughts, assumptions, or characterizations that may cross your mind regarding your recurrence, recovery efforts, and you as a person.

For more information about maintaining long-term recovery, avoiding or recovering from a recurrence, or taking that first step on a long journey, reach out to me today. I have faith in you, and you don’t need to do this alone.

Stay Strong, 

Jim

Sources:

1. Nagy, N. E. S., Ella, E. I. A., Shorab, E. M., Abdel Moneam, M. H. E., & Tohamy, A. A. (2021). Assessment of addiction management program and predictors of relapse among inpatients of the Psychiatric Institute at Ain Shams University Hospital. Springer Nature – PMC COVID-19 Collection. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9579533/
2. Substance Abuse and Mental Health Services Administration, Melemis, S. M., & American Psychiatric Association. (2018). Prevention and Response to Recurrence of Use. Retrieved from https://integrationacademy.ahrq.gov/products/playbooks/opioid-use-disorder/monitor-patient-and-program-progress/prevention-and-response-recurrence-use

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