November 2018

The Stages of Relapse

By Scott Swanezy


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.  As you read, you will learn the early warning signs of relapse and specific relapse prevention techniques for each stage of relapse.  There are three stages of relapse: emotional relapse, mental relapse and physical relapse.


In emotional relapse, you are 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: anxiety, intolerance, anger, defensiveness, mood swings, isolation, note asking for help, not going to meetings, poor eating habits and 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 state of relapse is easier to pull back from.  In the later stages the pull of relapse gets stronger as the sequence of events moves faster.


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


If you do not change your behavior at this stage and you live too long in the stage of emotional relapse you will become exhausted, and when you are exhausted you will want to escape, which will move you into mental relapse.


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 do not take care of yourself and create situations that are mentally and emotionally draining that make you want to escape.


For example, if you do not take care of yourself and eat poorly or have poor sleep habits, you will feel exhausted and want to escape.  If you do not let go of your resentments and fears through some form of relaxation, they will build to the point where you will feel uncomfortable in your own skin.  If you do not ask for help, you will 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.


In mental relapse there is a war going on in your mind.  Part of you wants to use, but part of you does not.  In the early phase of mental relapse you are just idly thinking about using.  But in the later phase you are 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 hard to make the right choice as the pull of addiction gets stronger.


When dealing with mental urges, play the tape through.  When you think about using, the fantasy is that you will be able to control your use this time.  You will just have one drink/drug.  But play the tape through.  On drink/drug usually leads to further usage. You wake up the next day feeling disappointed in yourself.  You may not be able to stop the next day, and you will get caught in the same vicious cycle.  When you play that tape through to its logical conclusion, using does not 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 or friends are away for the weekend, or you go away on a trip.  That is when your addiction will try to convince you that you do not have a problem, and that you are really doing your recovery to please someone other than yourself.  Play the tape through.  Remind yourself of the negative consequences you have 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 are having urges to use.  Call a friend, a support, or someone in recovery.  Share with them what you are going through.  The magic of sharing is that the moment you start to talk about what you are thinking and feeling, your urges begin to disappear.  They do not seem quite as big and you do not feel as alone.

When thinking 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 do not do anything, you are giving your mental relapse room to grow.


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


Recovery happens one day at a time.  Do not think about whether you can stay abstinent forever.  That is a paralyzing thought.  It is overwhelming even for people who have 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 are motivated to not use, then tell yourself that you will not use for the next week or the next month.  But when you are struggling and having lots of urges, and those times will happen often, tell yourself that you will not use for today or for the next 30 minutes.  Do your recovery in bite-sized chunks and do not sabotage yourself by thinking too far ahead.


Relaxation is another helpful tool in recovery.  Relaxation is an important part of relapse prevention, because when you are tense, you tend to do what is familiar and wrong, instead of what is new and right.  When you are tense you tend to repeat the same mistakes you made before.  When you are relaxed you are more open to change.


Once you start thinking about relapse, if you do not use some of the techniques mentioned about, it does not take long to go from there to physical relapse: going to get a drink; calling your dealer for product.


It is hard to stop the process of relapse at that point.  That is not where you should focus your efforts in recovery.  That is 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 will be able to catch yourself before it is too late.


Scott Swanezy is an addiction and substance abuse counselor in Westchester County. He can be reached at 914-434-9945 and visit for more information.



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