Common Triggers of Relapse

in Addiction
Published Jul 10, 2020

Relapse — or returning to use — is a common hurdle in the road to long-term recovery, which is why we’re spending July focusing on this specific subject. This week we interviewed clinical director, Steve Carleton, LCSW, to find out why relapse happens, what the common triggers are, and possible solutions.

What are the main causes of relapse/return to use?

Steve: Return to use is most often a slow drift back into high risk situations. Change is such a difficult process and over time there is a natural move back towards old thoughts, feelings, and behaviors. There are certainly times when unforeseen triggers arise and despite best efforts the pressure to use is overwhelming, however, these are more rare. In short the main causes a person returning to use are TRIGGERS.

The vast majority of treatment is designed to help people become aware of the people, places, things, experiences, and internal cues that lead to thoughts about using. Humans spend the majority of our lives on auto-pilot. Overcoming years of auto-pilot that results in use requires a tremendous amount of awareness. Identifying and anticipating triggers is the work of recovery. If addiction is a Ferrari with really crappy breaks speeding out of control, Recovery is like a mail truck driving on the opposite side and making frequent stops. Slowing down the process is essential to success.

Ambivalence about quitting is normal and another common reason for using again. It would be so great if commitment to change were static! But as we have all learned (addiction or not) our minds go back and forth. People have to have safe outlets to share when the inevitable thoughts about using arise.  If I were to pick the two most common causes of returning to use, ambivalence and not being prepared for a trigger.

risk of relapse

Are there any particular risk factors?

Steve: Unresolved trauma, an unsupportive recovery environment, and drifting away from supports are all high risk factors to using again. Using substances is often the response to troubling issues. In treatment, much time is spent resolving ambivalence and identifying and preparing for triggers. This is really important work but unfinished emotional business (trauma, loss, or other significant life events) can quickly escalate into a crisis. Treatment must uncover and address the individual’s drivers and patterns of use.

In short, the risky factors the ones that are not being addressed. You cannot prevent a return to use if you don’t see the trigger coming.

What can be the consequences of returning to use?

Steve: The biggest consequence is often shame that leads to further use and consequences. We do not want people to return to use and at the same time it is sometimes a much needed learning experience. Mistakes offer a great opportunity for growth. Providers and clients must accept that their will be bumps in the road, while also doing everything possible to avoid them. The biggest risk is something called “abstinence violation syndrome.” Basically, shame from one small mistake can lead people to years long use. We want to avoid this by making it easier to disclose use and help people get back up as quickly as possible when they fall.

In your experience, what are some effective coping strategies that might prevent relapse?

Steve: A daily routine is the best protection against relapse. Drifting slowly back towards use is common and having a way routinely focus the mind on sobriety and set sober intentions goes a long way. People do much better when recovery becomes proactive and valued. Also, anticipate the next crisis. The vast majority of our interactions and activities are predictable. Take note when your gut tells you something is risky and put some effort into preparing what your response will be if it triggers thoughts or urges to use.

Pick up the phone and call someone. This seems so simple but like many have pointed out that phone can feel like it’s a thousand pounds. To address this, have conversations with your trusted confidants before the crisis. Ask and/or inform them they are who you would call when thinking about using. Asking for help and support is hard so I urge folks to not wait until there is a crisis to establish this strategy.

Lastly, the most reliable predictor of success in recovery is days in a recovery environment. Simply, the more days people spend in an activity centered around recovery the higher probability they will not return to use. Recovery environment is intentionally broad here and encompasses any activity where the focus is on recovery and/or growth.

At Gallus Medical Detox, we believe there that recovery is possible for everyone and there is dignity in healing. Call us today and take the best first step towards your recovery: