Skip to content

Danger Ahead: Recognizing the Warning Signs of a Relapse

You did it. You made the most difficult decision of your life and you followed through. Through all the forgotten promises, all the failed attempts, all the excuses and rationalizations, you made it. You got clean.

Now you are living your new life of sobriety. It may seem like smooth sailing after the pain and fear of detox.

But anyone who has been in recovery for a while knows that complacency may well be the greatest threat to sobriety that you could ever face. In fact, perhaps the only danger nearly as significant is the opposite to complacent over-confidence. If you are living in constant terror of relapse, white-knuckling your way through every day of abstinence, you are probably going to be at as great a risk of relapse as if you foolishly believed it could never happen to you.

Fortunately, there is a space between the polarities of complacency and terror, a happy medium where you locate and exercise your own power over your life and recovery. This is where you come to accept that you are neither immune to relapse nor doomed to it. You can, in fact, avoid relapse if you know how to identify the warning signs and intercede before it’s too late.

Understanding Your Individual Relapse Risk

Relapse can happen to anyone in recovery. It is simply an inevitable feature of any chronic disease. However, there are some factors that can make those with substance use disorder (SUD) more vulnerable to relapse. Understanding if you are at an elevated risk of relapse, though, by no means suggests that you should resign yourself to it. Quite the contrary.

In fact, by understanding your individual relapse risk, you will be more empowered to design a long-term recovery strategy that best meets your needs. For example, if you have been diagnosed with a mental health disorder, such as depression or anxiety, then you may be more vulnerable to relapse, particularly if you have more than one mental illness, such as co-morbid depression and anxiety (1, 2, 3). However, seeking consistent, high-quality mental healthcare can help mitigate these risk factors.

In addition to mental health comorbidities, genetic factors and life history may also influence your relapse risk. For example, if you have experienced trauma, and childhood trauma in particular, then your vulnerability to relapse is likely to be greater than that of the general population (4, 5, 6, 7, 8, 9, 10, 11). Similarly, if you have a family history of addiction, then your genetic predisposition may require you to seek additional support in maintaining your sobriety (12, 13). Fortunately, even these relapse risks can be countermanded through strategies such as trauma-informed care or medically-supervised pharmaceutical therapies.

Life Experiences and Environment

Past life experiences, genetics, and comorbidities are far from the only potential warning signs of a relapse. In fact, while these past events may well have been factored into your early recovery strategy, and addressed during your initial detox, there are many circumstances that can arise after you get clean which may indicate a looming relapse. When you’re in recovery, there are specific life events, environments, and behavior patterns that you need to be wary of because they can significantly undermine your efforts to abstain. These include:

  • Poor stress management: Every life has its stressors. There’s simply nothing you can do about that. However, while you often can’t control the stress in your life, you can control your response to it. If you fail to be proactive in managing your stress, though, then you may well be setting yourself up to use again (14, 15). Taking definitive steps to lower both the physiological and psychological response to stress, such as engaging in mindfulness meditation or participating in an exercise or sports program, can reduce the likelihood that you will turn again to drugs or alcohol as a coping mechanism (16, 17).
  • Triggering environments: Over time, substance misuse becomes a learned behavior, meaning that the environments and contexts in which you most frequently used can trigger cravings that lead to relapse if you return to them once sober (18, 19, 20). In other words, if you find yourself doing the same things, in the same environments, and with the same people as when you were using, you may well be setting yourself up for relapse because your brain is being flooded with the stimuli, the environmental cues, that it has come to associate with drinking and/or drug use. That means that if you want to stay sober, you’re going to need to remove yourself and keep away from situations that trigger your cravings and remind you of your past use.
  • Poor self-care: Let’s face it: Life gets busy at times. It can be easy to put yourself at the bottom of your own priorities list when you have so many people depending on you, and so many responsibilities to tend to. However, when you’re in recovery, neglecting to take care of your own physical, mental, and spiritual needs is the perfect groundwork for a relapse. Research has shown that cultivating a well-structured, disciplined lifestyle that emphasizes self-care, including maintaining a healthy diet, getting lots of physical activity and consistent, quality sleep, and enjoying healthy social interactions can help reduce the risk of relapse. The evidence suggests that by adhering to such a lifestyle pattern, you are not only preventing the physical and mental health disorders that can lead to drug use as a form of self-medication, but that you are also counteracting that chaotic behavior patterns, including poor diet and sleep, as well as sedentarism, that were likely characteristic of your life under addiction (21, 22). When you find yourself reverting to old, disordered patterns, you may well be on the precipice of returning to drugs and/or alcohol as well.
  • Not working your program: As we’ve seen, one of the greatest threats to continued sobriety is complacency. If you’ve been working on your recovery for a while, it can be tempting to think you have the addiction licked, that you’re “cured.” In fact, addiction, as everyone in recovery learns sooner or later, is a lifelong disease. And though every recovery program is unique, what unites them all is the reality that the need for them in the recovering addict’s life will never go away. Your recovery program is the fortress you build around yourself, the refuge you turn to in order to protect yourself from relapse. But if you stop going to therapy, quit attending meetings, or allow all those steps, all those healthful behaviors that supported you in early recovery to begin to slip away one by one, then you are in the danger zone. Nature abhors a vacuum, after all, and if you are not actively working on your recovery, on your sobriety, each and every day by doing what you know has worked for you, doing what helped you get clean in the first place, then almost inevitably you’re going to fill the void with the things that made you sick in the first place. This is why it is imperative to find, and maintain, strong after-care strategies for sustaining your recovery, including support groups, counseling, and related resources (23, 24, 25).

How Bayshore Can Help

At Bayshore, our caring team of multidisciplinary addiction recovery specialists is uniquely qualified to support your sobriety not only through the early stage of recovery but also across the weeks, months, and years to come. We specialize in designing personalized long-term recovery aftercare plans to support both your sobriety and your overall wellness. This includes connecting you with highly qualified experts in addiction recovery, mental and physical healthcare, and life coaching in your hometown. In this way, you are never more than a short drive or phone call away from the help you need, when you need it. Contact us today to discuss how our team at Bayshore can help you build and maintain the happy, healthy, drug-free life you deserve.

At Bayshore Retreat we have extensive knowledge in treating substance abuse and co-occurring mental health issues. We understand that Mental Health Disorders can be the root cause of substance abuse. We use the latest scientific research and holistic approach for drug and alcohol addiction treatment.

  1. Oliva, F., Nibbio, G., Vizzuso, P., Jaretti Sodano, A., Ostacoli, L., Carletto, S., & Picci, R. L. (2018). Gender Differences in Anxiety and Depression before and after Alcohol Detoxification: Anxiety and Depression as Gender-Related Predictors of Relapse. European addiction research, 24(4), 163–172.
  2. Anker, J. J., & Kushner, M. G. (2019). Co-Occurring Alcohol Use Disorder and Anxiety: Bridging Psychiatric, Psychological, and Neurobiological Perspectives. Alcohol research : current reviews, 40(1), arcr.v40.1.03.
  3. Bradizza, C. M., Brown, W. C., Ruszczyk, M. U., Dermen, K. H., Lucke, J. F., & Stasiewicz, P. R. (2018). Difficulties in emotion regulation in treatment-seeking alcoholics with and without co-occurring mood and anxiety disorders. Addictive behaviors, 80, 6–13.
  4. Norman, S. B., Tate, S. R., Anderson, K. G., & Brown, S. A. (2007). Do trauma history and PTSD symptoms influence addiction relapse context?. Drug and alcohol dependence, 90(1), 89–96.
  5. Reynolds, M., Mezey, G., Chapman, M., Wheeler, M., Drummond, C., & Baldacchino, A. (2005). Co-morbid post-traumatic stress disorder in a substance misusing clinical population. Drug and alcohol dependence, 77(3), 251–258.
  6. Schäfer, I., Langeland, W., Hissbach, J., Luedecke, C., Ohlmeier, M. D., Chodzinski, C., Kemper, U., Keiper, P., Wedekind, D., Havemann-Reinecke, U., Teunissen, S., Weirich, S., Driessen, M., & TRAUMAB-Study group (2010). Childhood trauma and dissociation in patients with alcohol dependence, drug dependence, or both-A multi-center study. Drug and alcohol dependence, 109(1-3), 84–89.
  7. Poppa, T., Droutman, V., Amaro, H., Black, D., Arnaudova, I., & Monterosso, J. (2019). Sexual trauma history is associated with reduced orbitofrontal network strength in substance-dependent women. NeuroImage. Clinical, 24, 101973.
  8. Ullman, S. E., Relyea, M., Peter-Hagene, L., & Vasquez, A. L. (2013). Trauma histories, substance use coping, PTSD, and problem substance use among sexual assault victims. Addictive behaviors, 38(6), 2219–2223.
  9. Ullman, S. E., Townsend, S. M., Starzynski, L. L., & Long, L. M. (2006). Correlates of comorbid PTSD and polysubstance use in sexual assault victims. Violence and victims, 21(6), 725–743.
  10. Mousali, A. A., Bashirian, S., Barati, M., Mohammadi, Y., Moeini, B., Moradveisi, L., & Sharma, M. (2021). Factors affecting substance use relapse among Iranian addicts. Journal of education and health promotion, 10, 129.
  11. al’Absi M. (2020). The influence of stress and early life adversity on addiction: Psychobiological mechanisms of risk and resilience. International review of neurobiology, 152, 71–100.
  12. Cozzoli, D., Daponte, A., De Fazio, S., Ariano, V., Quaranta, M. R., Leone, V., Ostuni, A., Casanova, M., Catacchio, C. R., Ventura, M., & Montinaro, F. (2021). Genomic and Personalized Medicine Approaches for Substance Use Disorders (SUDs) Looking at Genome-Wide Association Studies. Biomedicines, 9(12), 1799.
  13. Wang, S. C., Chen, Y. C., Lee, C. H., & Cheng, C. M. (2019). Opioid Addiction, Genetic Susceptibility, and Medical Treatments: A Review. International journal of molecular sciences, 20(17), 4294.
  14. Sharp B. M. (2017). Basolateral amygdala and stress-induced hyperexcitability affect motivated behaviors and addiction. Translational psychiatry, 7(8), e1194.
  15. Milivojevic, V., & Sinha, R. (2018). Central and Peripheral Biomarkers of Stress Response for Addiction Risk and Relapse Vulnerability. Trends in molecular medicine, 24(2), 173–186.
  16. Morais, A., Pita, I. R., Fontes-Ribeiro, C. A., & Pereira, F. C. (2018). The neurobiological mechanisms of physical exercise in methamphetamine addiction. CNS neuroscience & therapeutics, 24(2), 85–97.
  17. Priddy, S. E., Howard, M. O., Hanley, A. W., Riquino, M. R., Friberg-Felsted, K., & Garland, E. L. (2018). Mindfulness meditation in the treatment of substance use disorders and preventing future relapse: neurocognitive mechanisms and clinical implications. Substance abuse and rehabilitation, 9, 103–114.
  18. Bender, B. N., & Torregrossa, M. M. (2020). Molecular and circuit mechanisms regulating cocaine memory. Cellular and molecular life sciences : CMLS, 77(19), 3745–3768.
  19. Namba, M. D., Tomek, S. E., Olive, M. F., Beckmann, J. S., & Gipson, C. D. (2018). The Winding Road to Relapse: Forging a New Understanding of Cue-Induced Reinstatement Models and Their Associated Neural Mechanisms. Frontiers in behavioral neuroscience, 12, 17.
  20. Salery, M., Godino, A., & Nestler, E. J. (2021). Drug-activated cells: From immediate early genes to neuronal ensembles in addiction. Advances in pharmacology (San Diego, Calif.), 90, 173–216.
  21. Mahboub, N., Honein-AbouHaidar, G., Rizk, R., & de Vries, N. (2021). People who use drugs in rehabilitation, from chaos to discipline: Advantages and pitfalls: A qualitative study. PloS one, 16(2), e0245346.
  22. Mahboub, N., Rizk, R., & de Vries, N. (2021). Nutritional parameters and lifestyle practices of people who use drugs undergoing treatment for recovery in Lebanon: a descriptive study. Journal of nutritional science, 10, e16.
  23. Johansen, A. B., Brendryen, H., Darnell, F. J., & Wennesland, D. K. (2013). Practical support aids addiction recovery: the positive identity model of change. BMC psychiatry, 13, 201.
  24. Rampure, R., Inbaraj, L. R., Elizabeth, C. G., & Norman, G. (2019). Factors Contributing to Alcohol Relapse in a Rural Population: Lessons from a Camp-Based De-Addiction Model from Rural Karnataka. Indian journal of community medicine : official publication of Indian Association of Preventive & Social Medicine, 44(4), 307–312.
  25. Stokes, M., Schultz, P., & Alpaslan, A. (2018). Narrating the journey of sustained recovery from substance use disorder. Substance abuse treatment, prevention, and policy, 13(1), 35.


Call Now Button