Common Relapse Triggers to Avoid

After transitioning out of rehab and heading back home or into a sober living program, every individual in recovery will encounter several triggers that can cause a relapse. If you are currently in recovery, you’ve probably realized by now that there’s no way to avoid everything that may cause you to stumble, but there are several ways to combat these triggers long before you ever experience them.

How Often Does Relapse Occur?

According to the National Institute on Drug Abuse, 40 to 60 percent of people who are treated for substance use disorders will relapse at some point. These rates are similar to other chronic diseases like hypertension (50 to 70 percent) and asthma (50 to 70 percent).¹

Although these numbers may be discouraging, the important thing to remember is that relapse is not a sign that addiction treatment failed. Drug detox, rehab, and other forms of treatment are not cures for addiction, and substance use disorders cannot be cured. Rather, research shows evidence-based treatment methods can help people manage their addiction(s) more effectively.

Not everyone will relapse, but for some, it can be a part of the recovery process. To fully recover from addiction, you must modify the harmful behavioral and thought patterns in your life. If you relapse, it’s a red flag that you need to get with your doctor or treatment provider to resume treatment or modify your existing treatment plan.

“Why Do I Want to Relapse?”

Many things can trigger a relapse, but often, people who return to risky living environments after treatment (such as where they used to use drugs or drink) are much more likely to relapse than those who don’t.

Other common factors that lead to relapse include:

• Stress
• Physical fatigue
• Depression
• Chronic pain
• Unemployment
• Negative mindset/self-pity
• Lack of recovery support and aftercare

Certain places, people, or things from your past can come back to haunt you in recovery, so if you feel like you want to relapse, you should meet with your treatment provider to discuss this. You may need to resume your treatment and find an alternative living situation, such as a sober living home, where you will receive ongoing sobriety support.

What Are Internal and External Triggers?

A trigger is anything that can cause someone to drink or use drugs following a period of sobriety. Examples can include relationships, emotions, thoughts, feelings, physical illness, stress, and lack of sleep, among many other things. Relapse triggers can be internal or external and they are things that you’ve learned to associate or pair with drug or alcohol use.

Internal Triggers

Internal triggers are thoughts or emotions that make you want to use drugs or alcohol. For example, you may feel a lot of anger when you run into your ex-boyfriend and his new girlfriend at the store, which may make you want to drink. Or, when you’re out having fun with your friends, you may feel confident and in control, so you may permit yourself to smoke marijuana because you convince yourself that you deserve it.

Internal triggers are extremely powerful and they are often much more difficult to deal with than external ones because you cannot always control the way you feel or the passing thoughts you think. You can avoid a certain situation or person, but you cannot just avoid feeling depressed or angry.

Internal Triggers
Negative emotions	Fear, anger, sadness, loneliness, depression, anxiety, guilt, irritation, jealousy, shame, feeling criticized, exhaustion, insecurity, stress
Positive emotions	Passion, strength, happiness, sexual arousal, confidence, celebratory joy, excitement

Managing internal triggers requires introspection and mindful behavior, which is why therapy and addiction treatment is so helpful.

External Triggers

External triggers are certain activities, locations, people, objects, images, situations, and events that can make you want to use drugs or drink alcohol. For example, you may drive past a bar you used to frequent and suddenly get the urge to drink again. Or, you might see an advertisement that makes you want to get drunk with your old friends.

External triggers can be very powerful and sometimes, you may not be able to dissociate certain things with your past substance abuse. As a result, when you are confronted with those things, you may experience a very strong desire to drink or get high again.

External Triggers
Objects	Powdered sugar, a belt, needles, empty prescription bottles, wine bottles, or beer bottles, magazines
Situations	Being overwhelmed at work, caring for children, losing a job, family gatherings, parties, getting paid, major life changes like moving or getting a divorce, concerts, going out with friends on Friday night, holiday celebrations
Places	Bathrooms, restaurants, bars, certain friends’ homes, parks, hotels, former drug stash locations
People	Drug dealers, friends, co-workers, spouses, friends, employers

Unlike internal triggers, you do have a little more control over external triggers. Meaning, you can purposefully avoid certain places, cut off relationships with certain people, and take other intentional actions to limit your exposure to triggers.

How Are Stress and Relapse Connected?

According to Psychology Today, stress is a key risk factor in addiction and relapse.² This is something that researchers have long known to be true. When it comes to addiction recovery, things like stressful life events combined with a lack of coping skills can create the perfect storm for a relapse.

Clinical research has shown that the physical effects of stress on the brain have a lot to do with a person’s drug-abusing behavior in response. For instance, people who experience high emotional stress are more likely to have poor impulse control and may have a harder time delaying gratification.³

Chronic stress also decreases gray matter volume in the area of the brain that is associated with cognitive control and stress regulation. When the brain experiences stress, the part of the prefrontal cortex that is involved in the deliberative understanding and analyzing of a situation is essentially shut down. As a result, a stressed-out person’s brain loses the ability to produce thoughtful behavior and the person is much more likely to give in to alcohol and drug abuse to cope with daily life.³

What Are the Most Common Relapse Triggers?

Research has shown that certain triggers or cues bring back seeking or wanting behaviors involving drugs and alcohol.⁴ Here are a few of the most common relapse triggers someone in recovery may experience.

1. Exposure to drugs or alcohol

Whether you’re at the grocery store, hanging out with friends, or walking down the street, you’re likely to encounter someone drinking a beer, stocking a shelf with liquor, or even using an illegal substance. Seeing someone use a substance or even just seeing it sitting on a shelf can cause you to fantasize about using it again.

2. Emotional highs or lows

Sadness, depression, and anger can lead to relapse just as much as extreme happiness can. Some people experience cravings when they’re feeling good because they want to feel even better, while the same person may also experience cravings when they’re feeling especially down or sad.

3. Rekindling old relationships

Seeing an old friend you used to use drugs or alcohol with can cause you to develop urges or cravings to use again. Additionally, running into an old drug dealer or spending time with a person who uses drugs and alcohol are both extremely dangerous and tempting situations to be in.

4. Places you used to use drugs and/or alcohol

The places you used to use drugs or drink alcohol carry strong memories and may cause you to linger on thoughts of using again. Whether it’s a friend’s house, a bar or club, or a particular neighborhood near your home, it’s normal to feel a need or want to return to those places.

5. Special events

Holidays, birthdays, graduations, and other celebratory events are often associated with substance abuse. On the other hand, the anniversary of a loved one’s death or a funeral may also conjure thoughts and emotions that lead to substance use. Regardless of whether it’s a celebratory or sad event, you may experience cravings that you otherwise wouldn’t during these times.

6. Certain objects

Objects like syringes, wine glasses, pill bottles, or pipes may be difficult for you to look at. These objects may remind you of your previous use and can cause you to linger on thoughts of using drugs or alcohol with old buddies or alone at your home.

How to Manage Triggers in Recovery

Managing your relapse triggers is a process that takes time and a skill that you will develop and strengthen with practice. Unfortunately, it’s not as easy as simply following the bulleted list below. However, with the right treatment and support, you can succeed at living a sober and happy life in recovery. Here are the primary ways you can manage triggers in recovery.

• Remove all alcohol, drugs, and related paraphernalia from your home.
• Avoid high-risk situations and locations.
• Avoid spending time with people who use drugs or abuse alcohol.
• Use the tools and strategies you learned in rehab to manage your thoughts and behavior when you are confronted with an opportunity to use alcohol or drugs.
• Confide in your sober peers and sponsor.
• Be open and honest about your feelings and cravings.
• Ask for help when you need it.
• Resist the temptation to isolate yourself and get involved in peer activities, volunteer, or find a social hobby instead.
• Prioritize self-care with proper nutrition, a healthy sleep routine, and daily physical activity.
• Start new traditions with sober friends and family.
• Enroll in a sober living program to receive continued support after rehab.
• If a relapse happens, quickly address it by telling a trusted sober peer, counselor, sponsor, or treatment professional.

What Are the Three Stages of Relapse?

Although triggers are certainly a factor in the relapse process, the triggers themselves do not cause immediate substance use. Instead, they initiate the process of relapse, which typically occurs in three stages: emotional relapse, mental relapse, and physical relapse.⁵

3 Stages of Relapse
Emotional Relapse	Having unhealthy emotional responses Neglecting self-care Skipping IOP meetings Not sharing in meetings Focusing on the needs of others instead of yourself Isolating from others Neglecting proper nutrition, sleep habits, and practicing poor hygiene
Mental Relapse	Bargaining with yourself Replacing one substance with another Rationalizing the use of drugs and alcohol by minimizing the consequences Permitting yourself to use drugs or alcohol on certain occasions Convincing yourself that you can control occasional drug or alcohol use Dwelling on or acting on thoughts of using addictive substances
Physical Relapse	Using an addictive substance in a situation in which you believe you will not get caught Developing a habit of uncontrolled drug or alcohol usage again Obsessing about using drugs or drinking more and more

1. Emotional Relapse

In this stage of relapse, you are not typically thinking about using again. Instead, you are setting yourself up for relapse with unhealthy emotional responses and poor-self care. In many cases, this includes skipping IOP meetings, not sharing in those meetings, focusing on the needs of others instead of yourself, isolating yourself from others, and not caring for yourself properly (unhealthy meals, lack of sleep, and poor hygiene). This relapse stage is typically characterized by the acronym HALT, which stands for hungry, angry, lonely, and tired.

2. Mental Relapse

In this stage, you are battling yourself, constantly fighting an inner war between not using and using. You might begin bargaining with yourself, replacing one substance with another or you might begin to rationalize the use of drugs and alcohol by minimizing the consequences. You might also start permitting yourself to use a substance once or twice a year, thinking you’ll be able to control your usage habits. Although it’s important to note that occasional thoughts of using while in recovery are normal and even frequent, dwelling or acting on those thoughts is what will lead to relapse in the end.

3. Physical Relapse

This stage is what most of us associate with relapsing: actually using a substance. Most often, a physical relapse takes place during a situation in which you believe you will not get caught. Then a single use leads to uncontrolled usage and you find yourself unable to stop and continually obsess about using more and more.

As an individual in recovery, it’s vital that you understand each of these stages of relapse so you can better combat them. This can only be done with peer support and clearly defined relapse prevention strategies. These strategies are formulated in drug rehab and can be practiced safely within a transitional housing situation.

What Are the Symptoms of Relapse?

There are several warning signs and symptoms of relapse you can watch for if a friend or loved one is recovering from addiction. Common symptoms of relapse include:

• Romanticizing or reliving past drug use in a positive light
• Believing one can use drugs or alcohol casually without falling back into addiction
• Displaying sudden behavior changes like becoming increasingly isolated or avoiding a sponsor
• Losing interest in activities or hobbies one has established in recovery
• Refusing to go to recovery meetings or avoiding them
• Displaying doubt in the effectiveness of the treatment or recovery process
• Hanging out with old friends who still drink or use drugs

Recognizing the warning signs before relapse is one of the best ways to intervene early and prevent it entirely.

Addiction Treatment and Recovery Support Programs Reduce Relapse Rates

Although relapse can be a part of the recovery process for some people, addiction treatment programs and personalized recovery support resources can drastically reduce relapse rates. 

During rehab, the use of Cognitive Behavioral Therapy (CBT) helps individuals learn how to work through triggers and other stressful situations that have the potential to cause a relapse. This is supported by clinical research that has found abstinence rates may be increased with the use of CBT methods.⁶

Many other studies also support the conclusion that CBT may improve the way the brain processes information and mediates behavior.⁷ During detox, it’s common for people to experience withdrawal symptoms like depression, anxiety, and severe mood fluctuations, but CBT can help relieve these symptoms by supplying effective management strategies. This provides a smoother transition into sobriety.

In addition to actively participating in CBT methods to treat your addiction, it’s essential that you stay in your treatment program for the entire length of the program. That way, you’ll have the best chance at firmly establishing effective strategies to cope with triggers before you return to mainstream life, where much less structure and supervision exist. According to the National Institute on Drug Abuse, people who stay in addiction treatment longer (90 days or more) are better able to sustain their sobriety long-term.⁸

If you have already relapsed, don’t give up hope. Just because you’ve relapsed doesn’t mean you’ve completely failed. Developing a relapse prevention plan with your counselor before exiting your drug and alcohol rehab program will help ensure that you know how to respond to relapse situations effectively and productively.

A relapse prevention plan also puts clear plans into place to address drug and alcohol use if it happens. These typically involve people in your recovery support circle who can help lead you back to a life that is free of substance abuse and help you get back on track.

What Are Some Holistic Approaches for Relapse Prevention?

When used in conjunction with evidence-based addiction treatment programs and therapeutic interventions like CBT, holistic treatment methods can also reduce your risk for relapse and improve your overall health and wellness for sustained sobriety.

Holistic treatment methods focus on the entire person and not just the addiction. By helping you feel better physically and psychologically, these treatment methods will also improve your ability to manage triggers, challenging life circumstances, and emotional difficulties you may face after rehab.

Some of the best holistic approaches for relapse prevention include:

• Getting enough sleep
• Eating a balanced diet
• Exercising regularly
• Practicing mindfulness meditation
• Practicing yoga
• Trying acupuncture or massage therapy

What is the Best Way to Prevent Relapse?

Just like the treatment process, preventing relapse is a highly individualized process, but staying in treatment for the recommended amount of time is one of the primary factors that will help you stay sober.

After detox and rehab, establishing a sober and supportive environment for yourself is key to maintaining your sobriety. Sober living homes provide many opportunities to establish healthy and genuine relationships with sober peers. They also naturally offer positive peer pressure and ongoing recovery support services like:

• Tiered recovery programming
• Drug and alcohol testing
• Certified peer recovery support programs
• Employment assistance and educational planning
• Volunteer placement
• Access to clinical therapy, medication-assisted treatment, and intensive outpatient treatment

Many sober living homes also encourage family involvement through family therapy, which will improve communication among your loved ones, prepare everyone for your eventual return home, and minimize stress and triggers caused by issues in the home.

While enrolled in a sober living home, you can also choose to receive one-on-one therapy and/or medication-assisted treatment for underlying mental health disorders that have contributed to your addiction, such as bipolar disorder, PTSD, anxiety, or depression. Treating these co-occurring disorders alongside your addiction will increase your ability to maintain long-term sobriety.

If you’d like to learn more about our sober living houses and outpatient support options, please contact the Eudaimonia Recovery Homes admissions team today.

References:

1. https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery
2. https://www.psychologytoday.com/us/blog/science-choice/201705/stress-and-addiction
3. https://www.oxfordclinicalpsych.com/view/10.1093/med:psych/9780199738809.001.0001/med-9780199738809
4. https://www.psychologytoday.com/blog/all-about-addiction/201003/triggers-and-relapse-craving-connection-addicts
5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4553654/
6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2897895/
7. http://www.psychiatrictimes.com/psychotherapy/how-psychotherapy-changes-brain
8. https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/how-long-does-drug-addiction-treatment-usually-last