The Stages of Relapse

Relapse is a process, it’s not an event. In order to understand relapse prevention you have to understand the stages of relapse. Relapse starts weeks or even months before the event of physical relapse. In this page you will learn how to use specific relapse prevention techniques for each stage of relapse. There are three stages of relapse.

Emotional relapse
• Mental relapse
• Physical relapse


  • Emotional Relapse

In emotional relapse, you’re not thinking about using. But your emotions and behaviors are setting you up for a possible relapse in the future.

The signs of emotional relapse are: Restless, Irritable and Discontent
• Anxiety
• Intolerance
• Anger
• Defensiveness
• Mood swings
• Isolation
• Not asking for help
• Not going to meetings
• Poor eating habits
• Poor sleep habits

The signs of emotional relapse are also the symptoms of post-acute withdrawal. If you understand post-acute withdrawal it’s easier to avoid relapse, because the early stage of relapse is easiest to pull back from. In the later stages the pull of relapse gets stronger and the sequence of events moves faster.

Early Relapse Prevention

Relapse prevention at this stage means recognizing that you’re in emotional relapse and changing your behavior. Recognize that you’re isolating and remind yourself to ask for help. Recognize that you’re anxious and practice relaxation techniques. Recognize that your sleep and eating habits are slipping and practice self-care.

If you don’t change your behavior at this stage and you live too long in the stage of emotional relapse you’ll become exhausted, and when you’re exhausted you will want to escape, which will move you into mental relapse.

Practice self-care. The most important thing you can do to prevent relapse at this stage is take better care of yourself. Think about why you use. You use drugs or alcohol to escape, relax, or reward yourself. Therefore you relapse when you don’t take care of yourself and create situations that are mentally and emotionally draining that make you want to escape.

For example, if you don’t take care of yourself and eat poorly or have poor sleep habits, you’ll feel exhausted and want to escape. If you don’t let go of your resentments and fears through some form of relaxation, they will build to the point where you’ll feel uncomfortable in your own skin. If you don’t ask for help, you’ll feel isolated. If any of those situations continues for too long, you will begin to think about using. But if you practice self-care, you can avoid those feelings from growing and avoid relapse.



  • Mental Relapse

In mental relapse there’s a war going on in your mind. Part of you wants to use, but part of you doesn’t. In the early phase of mental relapse you’re just idly thinking about using. But in the later phase you’re definitely thinking about using.

The signs of mental relapse are:
• Thinking about people, places, and things you used with
• Glamorizing your past use
• Lying
• Hanging out with old using friends
• Fantasizing about using
• Thinking about relapsing
• Planning your relapse around other people’s schedules

It gets harder to make the right choices as the pull of addiction gets stronger.

Techniques for Dealing with Mental Urges

Play the tape through. When you think about using, the fantasy is that you’ll be able to control your use this time. You’ll just have one drink. But play the tape through. One drink usually leads to more drinks. You’ll wake up the next day feeling disappointed in yourself. You may not be able to stop the next day, and you’ll get caught in the same vicious cycle. When you play that tape through to its logical conclusion, using doesn’t seem so appealing.

A common mental urge is that you can get away with using, because no one will know if you relapse. Perhaps your spouse is away for the weekend, or you’re away on a trip. That’s when your addiction will try to convince you that you don’t have a big problem, and that you’re really doing your recovery to please your spouse or your work. Play the tape through. Remind yourself of the negative consequences you’ve already suffered, and the potential consequences that lie around the corner if you relapse again. If you could control your use, you would have done it by now.

Tell someone that you’re having urges to use. Call a friend, a support, or someone in recovery. Share with them what you’re going through. The magic of sharing is that the minute you start to talk about what you’re thinking and feeling, your urges begin to disappear. They don’t seem quite as big and you don’t feel as alone.

Distract yourself. When you think about using, do something to occupy yourself. Call a friend. Go to a meeting. Get up and go for a walk. If you just sit there with your urge and don’t do anything, you’re giving your mental relapse room to grow.

Wait for 30 minutes. Most urges usually last for less than 15 to 30 minutes. When you’re in an urge, it feels like an eternity. But if you can keep yourself busy and do the things you’re supposed to do, it’ll quickly be gone.

Do your recovery one day at a time. Don’t think about whether you can stay abstinent forever. That’s a paralyzing thought. It’s overwhelming even for people who’ve been in recovery for a long time.

One day at a time, means you should match your goals to your emotional strength. When you feel strong and you’re motivated to not use, then tell yourself that you won’t use for the next week or the next month. But when you’re struggling and having lots of urges, and those times will happen often, tell yourself that you won’t use for today or for the next 30 minutes. Do your recovery in bite-sized chunks and don’t sabotage yourself by thinking too far ahead.

Make relaxation part of your recovery. Relaxation is an important part of relapse prevention, because when you’re tense you tend to do what’s familiar and wrong, instead of what’s new and right. When you’re tense you tend to repeat the same mistakes you made before. When you’re relaxed you are more open to change.



  • Physical Relapse

Once you start thinking about relapse, if you don’t use some of the techniques mentioned above, it doesn’t take long to go from there to physical relapse. Driving to your dealer. Driving to the liquor store.

It’s hard to stop the process of relapse at that point. That’s not where you should focus your efforts in recovery. That’s achieving abstinence through brute force. But it is not recovery. If you recognize the early warning signs of relapse, and understand the symptoms of post-acute withdrawal, you’ll be able to catch yourself before it’s too late.



As a reminder, addiction is a process that involves (1) compulsion to drink alcohol or use other drugs, (2) a loss of control over drinking alcohol or using drugs, and (3) continued drinking or drug use despite negative consequences. In addition, addiction involves (1) obsessive thinking about drinking alcohol and using drugs and (2) relapse, or a return to alcohol or drug use after a period of not drinking or using. Addiction affects people’s thinking. For example, addiction can make people feel that if they don’t drink alcohol or use drugs for a few days or weeks, their problems are over. However, stopping drinking alcohol and using drugs does not mean that the addiction is over. Rather, not drinking alcohol and using drugs is the beginning of the recovery process.

Why Are Relapse Prevention Skills Important?

Relapse prevention skills are essential to learning to live a happy life in recovery. One day at a time, one can learn to implement these coping skills to prevent relapse and live a life beyond their wildest dreams. 

Recovery from alcohol or other drugs is a process of personal growth with developmental milestones. At any stage of recovery, there is risk of relapsing, making relapse prevention skills highly important to know and understand. Some of the most common triggers of relapse include:

  • Boredom
  • Stress
  • Money problems
  • Relationship issues
  • Certain sights and smells
  • Anger

Most alcohol and drug treatment centers educate clients on relapse prevention techniques and help clients learn them in order to maintain recovery and achieve short- and long-term goals. There are a vast array of relapse prevention tools one can implement into their daily routine to help prevent relapse. There is a common misconception that relapse prevention skills should only be used when someone is having a desire to use. However, relapse prevention skills should be implemented into each recovering person’s daily schedule and routine to prevent or reduce the risk of cravings.


The top 10 relapse prevention skills include:


1. Self-Care

Common post-acute withdrawal symptoms when recovering from addiction include insomnia and fatigue. By implementing physical exercise and a balanced diet, one can improve their quality of sleep. This can be done by setting up and following a structured sleep, exercise, and eating schedule.  By doing this, one can retrain the body to sleep better and will also help reduce the risk of relapse.


HALT is an acronym for Hungry, Angry, Lonely, and Tired. Whenever feeling a craving to use, or in general feeling anxious or “off,” ask yourself if you are feeling any of these symptoms. The most common triggers for many recovering alcoholics and addicts are hunger, anger, loneliness, and feeling tired. By doing a regular inventory of HALT, one can help prevent the risk of relapse.

When, therefore, we were approached by those in whom the problem had been solved, there was nothing left for us but to pick up the simple kit of spiritual tools laid at our feet. p. 25 Big Book

3. Mindfulness Meditation

Mindfulness meditation is a concept that teaches individuals to become more self-aware. When we are more self-aware, we are better able to cope with potential triggers to relapse. A study by NCBI found outcomes that suggest significant improvement in individuals in recovery who follow a mindfulness meditation relapse prevention program versus those who do not use mindfulness meditation. The individuals using mindfulness meditation remained clean and sober longer and reported less cravings and increased awareness and acceptance. With Mindfulness meditation, participants are encouraged to learn to “roll with” their cravings, rather than fight them. Acceptance that cravings will come is a learned skill through this practice, while implementing relapse prevention skills. Concepts such as acceptance, letting go of personal control, and the use of prayer and meditation are hallmarks of mindfulness meditation. A simple practice of mindfulness meditation, developed by Spirit Rock co-founder, Jack Kornfield, is a mantra to repeat 3 times while gently and mindfully focusing on your breath:

May I be filled with loving kindness

May I be well

May I be peaceful and at ease

May I be happy.

The core concept of mindfulness is paying attention, awareness, or focus on what you’re doing, where you are, who you’re with, and more. To start the process of becoming more mindful, simply notice what you are doing with no judgement. It can be helpful to write down one’s daily activities by tracking them with a smartphone to bring more awareness to what you are doing, thinking, and feeling. This can lead to tremendous insight and empowerment over cravings.

4. Know Your Triggers

Triggers can be internal (anxiety, irritability, stress, anger, low self-esteem) or external (people, places, or things that remind one of their past use). Making a list of internal and external triggers is an efficient way to gain awareness of one’s triggers and reduce the risk of relapse.

5. Join a Support Group

Participating regularly in a support group, such as Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) provides support, accountability, education, and the ability to meet peers who understand what you are going through. It further prevents relapse as it decreases feelings of loneliness and the risk of isolation, both of which can be common triggers for relapse. 

6. Grounding Techniques

Stress and anxiety are often the biggest obstacles when it comes to recovery. A helpful relapse prevention technique is a grounding technique called the 5-4-3-2-1 coping technique. It takes you through the five senses to focus on the moment and avoid thoughts of using alcohol or other drugs, anxiety, negative self-talk, and any other unhealthy thought or feeling that may lead someone to want to use to escape.

The 5 steps begin by taking a few deep breaths, followed by the following:

5: Acknowledge five things you see around you

4: Acknowledge four things you can touch around you

3: Acknowledge three things you can hear around you

2: Acknowledge two things you can smell around you

1: Acknowledge one thing you can taste around you

End this exercise with a long, deep breath. Focusing on your senses will help you gain self-awareness and increase mindfulness, which will help you accomplish daily tasks, overcome unhealthy thoughts or feelings, feel more in-control and less overwhelmed, and reduce the risk of relapse.

7. Deep Breathing

Breathing is central to life, as you know. What many do not know, however, is how much control you have over your life by simply changing your breathing patterns. Breathing is not only connected to various essential functions throughout your body, but it also has a large effect on your brain chemistry. Breathing greatly impacts your emotions and helps regulate your overall mood. This is why deep breathing is so essential with one’s mental health.

Deep breathing releases neurotransmitters in your brain, many of which trigger feel-good chemicals resulting in relaxation, happiness, and pain reduction. Deep breathing, and the resulting increased oxygen flow, also encourages your body to exhale toxins. A useful deep breathing technique is the 4 x 4. Take four deep breaths in through your nose and hold, then release for four seconds. You should feel your diaphragm moving in and out while you breathe. Deep breathing is an excellent relapse prevention technique because it can be utilized virtually anywhere without anyone knowing you’re doing it.

8. Make an Emergency Contact List

When an urge comes, it can be difficult to manage it, especially in the beginning of recovery. A very helpful relapse prevention skill is making a list of healthy family members or friends who are also in recovery that you can call for support. Having a safe person to talk to can help you get past the craving and remember why you do not want to return to previous behaviors. Keeping that list on you at all times is important because it is a readily available resource you can use by quickly calling someone safe.

9. Play the Tape Through

If you find yourself having a desire to drink or get high and you are debating what to do, a great tool is playing the tape through first. To play the tape through, you must play out what will happen in your mind until the very end. Imagine what will happen in the short and long-term future if you decide to drink or use. Think of the consequences that would occur if you used vs. if you did not use. This can help with your decision making and reduce the risk of relapse.

10. Get Help

The fear of relapse can be debilitating. However, it does not have to be when you are fully prepared with a toolbox of healthy coping strategies. Implementing these relapse prevention techniques into your daily schedule can greatly help reduce the risk of relapse. Contact a dedicated treatment specialist to learn more about inpatient or outpatient treatment programs to learn more relapse prevention skills and get help today.

The First 90 Days of Sobriety

How To Maintain Sobriety:

Recovery Skills and Tools of Recovery – Coping Skills:

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