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What Are the Three Stages of Relapse?

Contrary to popular beliefs, that relapse is a quick, almost situational occurrence, it is actually a slow process that occurs in 3 stages: emotional, mental, and physical. Being aware of these three stages can help prevent relapse before it occurs.

After completing treatment, one of the greatest fears many newly recovering alcoholics and addicts face is relapse. Relapse is very common, even expected for people who are attempting to overcome an addiction. Many people undergo multiple relapses prior to successfully maintaining long-term recovery. Relapsing from alcohol or drugs occurs when an individual is in recovery, or abstinent from their substance of choice, and they return to their previous substance use. Relapse is a process rather than an event. It starts in subtle ways and increasingly gets worse. In order to understand relapse prevention, one must first understand the stages of relapse. Dr. Steven M. Melemis, MD, PhD and Terence Gorski have developed three distinct stages of the relapse process:

  • Emotional relapse
  • Mental relapse
  • Physical relapse

Stage 1: Emotional Relapse

Emotional relapse is the first phase of the three phases of relapse. During this stage, the person is not actively thinking about using drugs or alcohol. However, their emotions and behaviors may be setting them up for a relapse down the road. 

Some of the warning signs of emotional relapse include:

  • Bottling up your emotions
  • Not going to recovery support group meetings
  • Isolating yourself from peers and family
  • Poor eating and sleeping habits
  • Going to meetings but not sharing
  • Focusing on other people and their problems to avoid your own
  • Not managing anxiety, anger, or other emotional problems in a healthy way
  • Intolerance
  • Defensiveness
  • Mood swings
  • Not asking for help
  • Poor self-care emotionally or physically
  • Not having sober fun or taking time for oneself

To prevent getting stuck in the first stage on the road to relapse, it is helpful to ask yourself some questions to gain awareness through self-reflection. Journaling is an excellent place to start. Try asking yourself the following self-reflection questions:

  • Are you being good to yourself?
  • How are you having fun?
  • Are you putting time aside for yourself, or are you getting caught up in life or drama of others?
  • Which coping skills are you using?
  • What can you add to your recovery program to keep you in a safe place emotionally and physically?
  • Are you addressing your emotions, feelings, and thoughts? If so, how? If not, why not?
  • Have you been attending and participating in recovery support meetings?
  • How are you managing daily life stressors?
  • Can you compare your self-care and behaviors now with the way they were when you were actively using? What is similar, and what has changed?

To prevent relapse, it is crucial to recognize that you are in emotional relapse and to immediately change your behavior. If you’re feeling anxious, begin implementing deep breathing techniques. Denial is very common in the emotional relapse stage. When one has been in emotional relapse for a period of time, they begin to feel uncomfortable or not at ease in their own skin. This results in feeling discontent, restless, and irritable. Unfortunately, due to fear of judgement or failure, many do not share how they are feeling when this occurs. However, sharing how you are feeling is crucial at this stage. If you don’t begin practicing self-care, you will become exhausted. When you’re exhausted, you will want to escape. As the tension builds, one becomes at greater risk of moving into stage 2—mental relapse.

Stage 2: Mental Relapse

When we choose to not work on any signs or symptoms of the emotional stage, there is increased risk of transitioning to the second stage of relapse, which is mental relapse. Once in mental relapse, which is best described as a war going on inside one’s mind, the individual is at high risk for physical relapse. Part of them wants to use, while the other part doesn’t. Fantasizing about using is not uncommon in this stage. As individuals go deeper into the mental relapse stage, their cognitive resistance to relapse diminishes and their need of escape increases. It is important to remember that occasional thoughts of using are normal in early recovery, but the thoughts that occur during mental relapse are different as they are thoughts of considering making an actual choice to use rather than a fleeting thought of using.

Signs of mental relapse include: 

  • Cravings or physical and psychological urges to use drugs and/or alcohol
  • Thinking about people, places, and things associated with past use
  • Hanging out with old friends who use alcohol or other drugs
  • Minimizing consequences of past use or glamorizing past use
  • Bargaining
    • In bargaining, individuals start to think of scenarios in which it would be acceptable to use. A common example is when people give themselves permission to use on holidays or visiting family.
    • Another form of bargaining is when people start to think that they can relapse periodically, perhaps in a controlled way, for example, once or twice a year.
    • Bargaining also can take the form of switching one addictive substance for another.
  • Lying
  • Thinking of schemes to better control using
  • Looking for relapse opportunities (hanging out with old friends or missing meetings)
  • Imagining using
  • Fantasizing about using
  • Planning your relapse

It is important to remember that it gets harder to make the right choices as the pull of addiction gets stronger.

Techniques for dealing with mental relapse include:

Play the tape through.

When you think about using, it is easy to believe that you are able to control your use this time. Imagine the consequences of what will happen, whether physical, psychological, or other, and decide if it is really worth it. You may not be able to stop the next day, and you’ll get caught in the same vicious cycle.

Talk to a trusted peer.

A helpful tool is expressing your thoughts and feelings with a trusted friend, family member, or member of a support group. As you begin to share your thoughts and feelings, your urges begin to dissipate. They won’t feel so overwhelming, and you will feel less alone.

Wait for 30 minutes.

Most urges usually last approximately 15 to 30 minutes max. It may feel like an eternity, but if you keep yourself busy or distract yourself, it’ll quickly diminish. Taking a 30-minute walk is also very helpful.

Take it one day at a time.

Try not to focus on whether you can stay abstinent forever. For now, take it one day at a time. This is a great time to become productive and/or take time to focus on yourself.

Use relaxation techniques.

Relaxation is an important tool in relapse prevention. This is because when you’re tense, Relaxation techniques help reduce tension, irritability, cravings, anger, and anxiety. When you’re relaxed, you will be more open to change. Deep breathing and meditation are excellent forms of relaxation techniques. 

Stage 3: Physical Relapse

 When a person doesn’t take the time to acknowledge and address the symptoms from emotional and mental relapse, it doesn’t take long to lead down the path to physical relapse. This includes the act of drinking alcohol or using other drugs. The key is to reach out for help if you find yourself in physical relapse immediately in order to stop the vicious cycle of addiction before it is too late.

Get Help Now

If you recognize the early warning signs of emotional or mental relapse and understand the symptoms and preventative strategies to turn your path around, you’ll be able to catch yourself before it’s too late. Help is out there, whether you’ve reached physical relapse or not. If you find yourself in any of the 3 stages of relapse, you are encouraged to seek help by talking to a dedicated treatment specialist today. There are many support groups and treatment centers available to assist you on getting back on track.

  • Author — Last Edited: October 24, 2019
    Photo of Theresa Parisi
    Theresa Parisi
    Theresa is a Certified Addiction Professional (CAP), a Certified Behavioral Health Case Manager (CBHCM) by The Florida Certification Board, and a Certified International Alcohol and Drug Counselor (ICADC) by The International Certification and Reciprocity Consortium (IC&RC). Theresa is also a Certified Professional Life Coach and volunteers at a local mental health facility helping individuals who struggle with homelessness and addiction.Theresa is a well-rounded clinician with experience working as a Primary Addiction Counselor, Case Manager and Director of Utilization Review in various treatment centers for addiction and mental health in Florida, Minnesota, and Colorado. She also has experience with admissions, marketing, and outreach. Eager to learn, Theresa is currently working on her Master’s Degree in Clinical Mental Health Counseling. As a proud recovering addict herself, Theresa understands first-hand the struggles of addiction. There is no limit to what Theresa is willing to do to make a difference in the field of Addiction!

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