Relapse Signs and Symptoms

After completing treatment, one of the greatest fears newly recovering people face is relapse.  Relapse is a process, not a quick, situational event. It begins in subtle ways and increasingly moves the individual into a position of believing that renewing alcohol or drug use is the only action that makes sense.

Addiction is sometimes referred to as a “feelings disease.” It’s no surprise that the relapse process often begins in the emotional arena. Signs to watch for are bottling up emotions, not going to recovery support group meetings, attending meetings but not sharing, isolating from friends and family, poor eating, sleeping and exercise habits, and focusing on other people’s problems. Intolerance, defensiveness, and mood swings are also signs to look out for. Pointing these things out in a safe and supportive way can go a long way to help someone see that the relapse process is beginning.

How Does Relapse Happen?

If the emotional relapse process isn’t interrupted, there is an increased risk of transitioning into the mental arena. The experience of this can be like getting caught in the middle of an argument in one’s own mind. The arguments for and against renewing use begin to crop up in the thought life, creating distraction and stress. They are not fleeting thoughts of using. These thoughts are being driven by and driving the desire to make an actual choice to return to using substances.

As the emotional relapse compounds into the mental, relapse cravings or psychological urges to use substances begin occurring. Also, thinking of schemes to better control using starts cropping up along with fantasizing about using, looking for opportunities to use – hanging out with former using partners in locations where using is made easier. At this stage, a plan to renew use is being formulated. The individual often appears restless, irritable, and discontent. Making the right choices becomes increasingly difficult as the pull to return to using becomes stronger.

Developing Relapse Prevention Skills

As part of our program at The Ridge, we teach our clients how to work with denial, recognize the relapse process In their emotions, thoughts, and behaviors as well as develop plans and practice skills to interrupt it.

It is a common misconception that relapse prevention program be used when a person is experiencing cravings or using thoughts. There are a vast array of relapse prevention skills that can easily be implemented into a recovering person’s daily schedule.

Common Symptoms Of Early Recovery

Common post-acute withdrawal symptoms when recovering from addiction include insomnia and fatigue.  These are common potential triggers for relapse. By implementing physical exercise and a balanced diet, one can improve the quality of sleep. This can be done by setting up and following a structured sleep, exercise, and eating schedule.  By doing this, one can retrain the body to sleep better and will also help reduce the risk of relapse. Good sleep hygiene supports the brain’s healing process while it restores dopamine production to normal levels.

Relapse Prevention Techniques – Mindfulness

A helpful relapse prevention technique is a grounding technique called the 5-4-3-2-1 coping technique. It takes you through the five senses to focus on the moment and avoid thoughts of using alcohol or other drugs, anxiety, negative self-talk, and any other unhealthy thought or feeling that may lead someone to want to use to escape.

The 5 steps begin by taking a few deep breaths, followed by the following:

  1. Acknowledge five things you see around you.
  2. Acknowledge four things you can touch around you.
  3. Acknowledge three things you can hear around you.
  4. Acknowledge two things you can smell around you.
  5. Acknowledge one thing you can taste around you.

End this exercise with a long, deep breath. Focusing on your senses will help you gain self-awareness and increase mindfulness, which will help you accomplish daily tasks, overcome unhealthy thoughts or feelings, feel more in-control and less overwhelmed, and reduce the risk of relapse.

Breathing is central to life, as you know. What many do not know, however, is how much control you have over your life by simply changing your breathing patterns. Breathing is not only connected to various essential functions throughout your body, but it also has a large effect on your brain chemistry. Breathing greatly impacts your emotions and helps regulate your overall mood. This is why deep breathing is so essential with one’s mental health.

Triggers That Lead To Relapse

The most common triggers for many recovering alcoholics and addicts are hunger, anger, loneliness, and feeling tired. By doing a regular inventory of HALT, one can help prevent the risk of relapse. Whenever feeling a craving to use, or in general feeling anxious or “off,” ask yourself if you are feeling any of these symptoms and respond to them if you are.

Triggers can be internal (anxiety, irritability, stress, anger, low self-esteem) or external (people, places, or things that remind one of their past use). Making a list of internal and external triggers and discussing them is an efficient way to gain awareness of one’s triggers and reduce the risk of relapse. It also helps to have a quick response plan for triggers that includes grounding techniques.

Deep Breathing and Mindfulness To Prevent Relapse

Deep breathing releases neurotransmitters in your brain, many of which trigger feel-good chemicals resulting in relaxation, happiness, and pain reduction. Deep breathing, and the resulting increased oxygen flow, also encourage your body to exhale toxins. A useful deep breathing technique is the 4 x 4. Take four deep breaths in through your nose and hold, then release for four seconds. You should feel your diaphragm moving in and out while you breathe. Deep breathing is an excellent relapse prevention technique because it can be utilized virtually anywhere without anyone knowing you’re doing it.

If you find yourself having the desire to drink or get high and you are debating what to do, a great tool is playing the tape through first. To play the tape through, you must play out what will happen in your mind until the very end. Imagine what will happen in the short and long-term future if you decide to drink or use. Think of the consequences that would occur if you used vs. if you did not use. This can help with your decision-making and reduce the risk of relapse.

Mindfulness meditation is a concept that teaches individuals to become more self-aware. When we are more self-aware, we are better able to cope with potential triggers to relapse. A study by the National Center for Biotechnology Information found outcomes that suggest significant improvement in individuals in recovery who follow a mindfulness meditation relapse prevention program versus those who do not use mindfulness meditation.

The individuals using mindfulness meditation remained clean and sober longer and reported less cravings and increased awareness and acceptance. With Mindfulness meditation, participants are encouraged to learn to “roll with” their cravings, rather than fight them. Acceptance that cravings will come is a learned skill through this practice, while implementing relapse prevention skills. Concepts such as acceptance, letting go of personal control, and the use of prayer and meditation are hallmarks of mindfulness meditation.

The core concept of mindfulness is paying attention, awareness, or focus on what you’re doing, where you are, who you’re with, and more. To start the process of becoming more mindful, simply notice what you are doing with no judgement. It can be helpful to write down one’s daily activities by tracking them with a smartphone to bring more awareness to what you are doing, thinking, and feeling. This can lead to tremendous insight and empowerment over cravings.

Get Help Today With Relapse Prevention Techniques

Implementing these relapse prevention techniques into your daily schedule can greatly help reduce the risk of relapse. Contact The Ridge to learn more about inpatient, outpatient, detox treatment programs and learn more relapse prevention skills and get help today.

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About Marc Whitsett, M.D.

Dr. Whitsett is Board Certified in Internal Medicine and Addiction Medicine. He is the Medical Director for The Ridge and Northland Treatment Center. You can read his full bio here.