If you’re supporting someone in their journey to recovery, help them stay sober by recognizing triggers, risks and signs they may return to use.
“It’s common for people to return to use at least once during their recovery,” says Kimberly Kabernagel, DO, medical director at Geisinger Marworth. “If their friends and family understand what can cause them to return to use, it helps them stay sober.”
What does relapse mean?
When someone in recovery returns to using a drug or consuming alcohol — that’s considered a relapse. The preferred term is “return to use.”
Return to use is common
A person in recovery might return to use once or multiple times. Of course, losing progress on the path to recovery is challenging and frustrating.
Return to use is risky
When a person in recovery returns to use, it can lead to accidental overdose. When you take a drug often, you build up tolerance. During recovery, your body loses that tolerance. If you take the same amount of the drug as before, you might have an extreme, unexpected — even fatal — reaction.
“That’s why it’s so important to recognize the signs of a return to use,” says Dr. Kabernagel.
Why does someone relapse?
“Long term drug or alcohol use rewires your brain chemistry,” explains Dr. Kabernagel. “It’s physically harder for them to turn away from substances.”
Even in recovery, their brain:
Has a harder time feeling joy: Drugs flood the brain with pleasure-inducing dopamine. Over time, the brain reduces the number of receptors that pick up this chemical. It’s physically harder for someone who’s used substances or alcohol to experience joy. Pair this with a long association between everything substance-related and happiness, and your loved one may be fighting powerful urges to use again.
Feels stressed: As the brain comes off drugs or alcohol, it’s stressed. In recovery, your loved one is more likely to feel depressed, have anxiety and be physically sick. Substance use might provide immediate, if very short term, relief.
Can’t make decisions well: Because of the changes to brain chemicals and receptors, addiction makes it harder to control your impulses. It’s harder to think through decisions and consequences of actions, making it more challenging to resist urges.
What are the warning signs of relapse?
Preventing a return to use begins with identifying the warning signs.
“If your loved one shows these warning signs of returning to use, it’s important to talk to them and help them get more support,” urges Dr. Kabernagel.
Remembering substance misuse positively: A person may reflect on their days of substance misuse as fun or a time of greater creativity, adventure and spontaneity. They gloss over the downsides of serious health, money and relationship problems.
Believing they can use again casually: They may say they “can handle it this time.”
Sudden behavior changes: Someone who’s considering a return to use might isolate themselves or abandon activities and hobbies they developed during recovery.
Visiting people who use or places where they used: When someone in recovery returns to relationships or locations from their old life, they can easily run into powerful triggers to use again.
Saying that recovery doesn’t work: If someone starts badmouthing their treatment or recovery in general, they’re in grave danger of losing their sobriety and need immediate help.
What can trigger a return to use?
Many things can trigger a return to use. They are different for everyone in recovery and can include stress, celebrations or being in the presence of the substance your loved one misused. Often a relapse builds slowly, so loved ones may have a chance to divert a person onto a sober path.
Exposure to triggers
Triggers are cues that remind a person of drugs and alcohol. It could be a smell, a friend who is still using or a setting where a person used in the past. A trigger can make your loved one have a powerful urge to use again.
Stress
Stress — or the attempt to cope with it — is a primary cause of relapse.
“The best way to prepare for this trigger is to recognize what your loved ones’ stressors are,” says Dr. Kabernagel. “If a certain person, situation or activity causes them stress, help them avoid it.”
Any negative emotion can trigger a relapse. Instead of seeking temporary relief in a harmful substance, consider healthier ways to cope with stress and negative emotions, like practicing mindfulness, meditating or exercising.
Celebrations and peer pressure
Not all relapse triggers are negative. Celebrations can trigger cravings and return to use. “You might feel like you can handle one drink, for example, during these times, but often things get out of control,” says Dr. Kabernagel.
One way to protect your loved one from returning to use at a celebration — without avoiding parties entirely — is to be a trusted friend to intervene if they feel any temptation.
“Having a trusted friend or family member present can help someone feel more comfortable reaching out for help and support when they are struggling with urges to drink or use. It will help them balance life in recovery with everyday celebrations,” says Dr. Kabernagel.
Pain or health challenges
For someone with an addiction history, using many common pain medications — especially those for chronic pain — can be hard to manage. They may take more opioids than prescribed, for example. Chronic pain and health problems can also lead to depression, which is often a trigger.
Strong positive emotions
Surprisingly, joy or fun times can also cause your loved one to relapse. They might think, “This is great, but it would be even better with a substance.”
Be a safe place
Reaching out to a friend, family member, therapist or counselor can help your loved one avoid a relapse.
Tell your loved one you support them. Ask them to share if they’re feeling tempted or have concerns. Ask them to carry your number — as well as the numbers of other trusted friends — and call when they’re tempted. Respond if they call.
If your loved one has relapsed, encouraging them to reach out to an addiction treatment center can help them get back on track and regain their sobriety.
Find more tips on helping a loved one in recovery.
Be mindful of your own mental health
If your loved one returns to use despite your efforts, it’s not your fault. Your loved one might not be safe for you physically or emotionally. You might not be the best person to help them. If needed, step away for a time or create and communicate clear boundaries to maintain your relationship. Seek counseling and find online resources like the Substance Abuse and Mental Health Services Administration website and helpline.
Addiction treatment at Geisinger Marworth Treatment Center
If you, a friend, or family member are dealing with substance misuse, addiction or relapse, Geisinger Marworth can help. With inpatient and outpatient programs and numerous counseling resources available, we’ll help you or your loved one find the right treatment path to a healthier life without alcohol or drugs. And we offer specialized family programs to bring healing to all of you.
Next steps:
Learn about addiction treatment at Geisinger Marworth
Geisinger Marworth’s Family Program helps the entire family grow
Signs your loved one may have a substance addiction