Like many mental health disorders, substance abuse is a chronic condition in which relapse is common.
Per the National Institute on Drug Abuse, relapse rates for substance abuse are similar to those for chronic physical diseases like diabetes, asthma, and hypertension. In other words, relapse to substance abuse does not mean that treatment has failed, but instead is often part of the challenge of treating substance use disorders.
For this reason, many of the treatments for drug or alcohol addiction are focused around relapse prevention. One way to manage relapse risk is to learn to recognize triggers for substance use and how to prevent them, or interrupt the behavioral response that leads to drinking or drug use. Understanding common triggers and how to prevent or mitigate their effects can reduce relapse risk, enabling abstinence and ongoing recovery.
Triggers of Relapse
When a person develops an issue with substance use, it may be based on a variety of factors. While each individual’s journey to substance abuse is different, there are common reasons that substance use may be initiated and develop into abuse. These include:
- High-stress situations
- Difficult relationships
- History of substance abuse or mental illness
- Traumatic or chaotic events
- Loneliness or lack of social network
For a person who has been through treatment for substance abuse, completion of rehab does not mean that managing the disorder is over. Being exposed to these situations again, or to reminders of them or of the person’s substance use, can cause the person to experience cravings and desires to use again as if treatment had never happened. In addition, certain attitudes about recovery can also lead to cravings or relapse.
These situations are called triggers, and they can vary greatly from person to person. However, there are general categories of triggers that can be watched for and managed to prevent relapse.
As described in an article in Psychology Today, relationships can lead to triggering situations. If the individual in recovery has friends or family who use drugs, stressful relationships in daily life, or an awkward or difficult social life, it may constitute a relapse risk to return to those relationships. The challenges in this case may include:
- Feeling neglected or experiencing an abusive relationship
- Having a partner or family member who encourages substance use
- Regularly experiencing stress in relationships
- Not having a strong support network
- Being in a codependent relationship
Particularly in the case where a relationship experience or stress contributed to initiating the substance use, returning to this relationship unchanged can quickly lead to relapse.
People who have experienced trauma are highly likely to abuse substances, which then leads to addiction. The trauma may be a relapse trigger even after treatment, especially if treatment does not simultaneously treat the trauma. A study in Drug and Alcohol Dependence indicates that, in particular, those with interpersonal or physical issues related to trauma have a higher rate of relapse.
Treating trauma is an important part of treating the substance use disorder in this case, particularly if the behavior started as a self-medicating response to the aftereffects of the trauma.
If a person leaving rehab has to return to unstable circumstances, such as chaotic family life, joblessness, homelessness, or a dangerous neighborhood, it may increase the likelihood that the situation will trigger relapse. As described in an article from Social Science and Public Policy, this can be based in the person feeling ill-prepared to handle the realities of daily life.
If this is the case, it could indicate that further intervention is necessary to help the person transition from treatment to self-support. Oftentimes, these situations may contain various elements of the above triggers, and the person needs more time to learn to manage or prevent the triggers from resulting in relapse.
One trigger that people may not expect is their own attitude about recovery. A variety of different attitudes may make it more likely for a person to relapse, including:
- Overconfidence in one’s own ability to stay sober
- Fluctuating emotional state regarding substance use
- Self-pity or low self-esteem about coping with the disorder
- Anger about the situation
- Shame and guilt
Maintaining a humble, cautious attitude can provide focus and awareness that enable a person to avoid these triggers and continue working at abstinence.
Methods of Prevention
The easiest way to prevent these triggers from disrupting recovery is to avoid them wherever possible. Staying away from situations that lead to triggers can be an effective means of relapse prevention.
Of course, this isn’t always possible. There’s no way to completely eliminate stress from life, and sometimes it’s impossible to avoid certain people, memories, or situations that may serve as triggers. In this case, relapse prevention can be managed through teaching the individual how to mitigate the effect of triggers and break the chain of behaviors that leads to relapse.
Some of these methods include:
- Teaching how to manage stress without drugs or alcohol, such as through yoga or meditation
- Providing Cognitive Behavioral Therapy that identifies triggers and substitutes other responses
- Using a variety of coping techniques to resist triggers
- Offering Contingency Management incentives, Motivational Interviewing, or other tools to resist relapse
- Training in mindfulness techniques, as described in Addictive Behaviors
Many of these tools can be gained through comprehensive substance abuse treatment. Getting help with addiction treatment provides guidance for the individual in these methods of preventing relapse. In addition, treatment can also provide the support structure needed to stay motivated in recovery.
Baird, Andrew F., et al. “‘How Can We Stay Sober?” Homeless Women’s Experience in a Substance Abuse Treatment Center.” (July 3, 2014). SpringerLink, Springer US. Accessed September 23, 2018.
“Drugs, Brains, and Behavior: The Science of Addiction.” (July, 2018). National Institute on Drug Abuse. Accessed September 23, 2018.
Weiss, Robert. “Women, Intimate Relationships, and Addiction Relapse.” (April 23, 2014). Psychology Today, Sussex Publishers. Accessed September 23, 2018.