11 stages of relapse
4- 11 Stages of Relapse
Based on research evidence, this page provides you with information on the common changes that happen in our attitudes, feelings and behaviors before we finally get to a place where we think we have no choice but to use drugs again.
- Step 1: Unhealthy emotions
- Step 2: Denial
- Step 3: Compulsive behaviours
- Step 4: Triggers
- Step 5: Interior chaos
- Step 6: Exterior turmoil
- Step 7: Loss of control
- Step 8: Addictive thinking
- Step 9: High-risk situations
- Step 10: RELAPSE
- Step 11: Aftermath of relapse
Researchers Terence T. Gorski and Merlene Miller identified a set of warning signs or steps that typically lead down to a relapse. Over the years, additional research has confirmed that the steps described in the Gorski and Miller study are “reliable and valid” predictors that commonly cause many of us in recovery to relapse. If you are trying to maintain your recovery and avoid having a relapse, it is important to recognize the warning signs and take action to avoid the physical relapse that is the final step in this downward progression. Below is an adapted summarized version of this study that aims to help you just do this. For the full version of this research study, please refer to:
Relapse is more than just using drugs again. It is the process of becoming so dysfunctional in recovery that going back to our old ways of dealing with life seems like a reasonable choice. The relapse process is a lot like knocking over a line of dominoes. The first domino hits the second, which hits the third, and soon a chain reaction starts that throws us in the vicious cycle of addiction. We need to be aware of the first domino that hits us, the first problem that is usually our inability to cope or manage our emotions in recovery. If we are not aware and fail to use the program to address these initial problems, by the time the last domino falls our problems have accumulated and naturally we revert to our habitual way to deal with them – that is we use drugs.
The progression of problems that lead to relapse is called the relapse process. Each individual problem in the sequence is called a relapse warning sign. The entire sequence of problems is called a relapse warning sign list. The situations that we put ourselves in that cause or complicate the problems are caused high-risk situations. It’s important to remember that we don’t relapse because of the last problem in the sequence. We start using drugs because the cumulative weight of the problems that we failed to address becomes so unbearable, that as addicts we are bound to go back to our instinctive ways of dealing with them – namely we use drugs.
Here are the 11 stages that addicts in recovery commonly go through in sequential order, before they finally find themselves in a place where they think they have no choice but to use drugs again.
Stage 1: Unhealthy emotions
- We stop using drugs and put together some kind of a recovery plan to help us stay clean. Initially we do fine. At some point in recovery, though, we hit a problem that we are unwilling or unable to cope with emotionally. We feel stuck in recovery and don’t know what to do. Then we begin to change our attitude towards recovery and decide that working our program is just not as important as it was. We begin to return to what is referred to in Fellowships as “stinking thinking”, namely, insane addictive thinking. We know something is wrong, but can’t identify exactly what it is because we cannot identify our emotions and have not developed healthy ways of processing or expressing them.
Stage 2: Denial
- Instead of recognizing that we’re emotionally stressed or unable to cope with our emotions and that we should be asking for help from others in the Fellowship, we use denial to convince ourselves that everything is OK, that we have no problems. It’s a mechanism familiar to us, one we used when in active addiction when confronted with uncomfortable feelings. This is not the type of denial that we have a drug problem, its denial that we are experiencing emotional stress and that we are feeling overwhelmed. Our instinctive way is to convince ourselves that everything is OK, that we haven’t picked up drugs so our recovery is fine. We disregard how e are feeling and don’t use recovery tools to get ourselves back on solid recovery. Recovery tools such as sharing about how we honestly feel with our sponsor or at our meetings. Then, we may suddenly get hit with a major problem in our life, or maybe begin to feel overwhelmed and out of control because of our inability to cope with our emotional problems. We may begin to over react or concentrate on our internal issues and loose sight of the things we need to do to keep ourselves clean on a daily basis. The result is we begin to distance ourselves from our support system, our Fellowship and working our program becoming more and more confused and angry at the quality of our recovery.
- It is important to bear in mind as well, in the early days of recovery a great majority of us suffer from withdrawal symptoms, which plays havoc on our emotions and makes us vulnerable to a relapse. Anxiety, depression, sleeplessness and memory loss are some of its symptoms. It feels to us like we are on a roller coaster of emotions going from one extreme to another. We need to recognize that these extremes, these ups and downs, are a normal part of our healing process in recovery. That they are temporary and will pass with time. We need to be careful not to become impatient and use our uncomfortable feelings as an excuse to use drugs.
Stage 3: Compulsive behaviours
- The next step in the downward progression to using drugs again is that we try to cope with our problems and emotional stresses by engaging in compulsive behaviours as opposed to using recovery tools to manage them. Our thinking goes back to its old, insane yet familiar ways of dealing with life and we begin to engage in external activities as our means to escape or feel relief. We know that we do not want to use drugs again but we are also not using the tools of our program to cope with life’s problems in a healthy way. So we may start overworking, over-eating, dieting, or over-exercising. We may get involved in addictive relationships or use sex as a way to deny our feelings. In our meetings and with our family and friends, we may become overbearing and controlling in the unconscious hope that by exerting power over others we can control or ease our emotional stress. Though these behaviours offer temporary relief by distracting us from our real stress, they do nothing to resolve them. We may be feeling and acting “in good recovery” on the surface, but we are angry and frustrated inside.
- Behaving differently from what we are feeling inside is a sure symptom of an emotional relapse. This is when we need to remember that honesty is the one essential criterion that will help us maintain our recovery. But when we become dishonest with ourselves and start resorting to compulsive behaviours to fix ourselves, we slowly abandon our recovery program and support system and do what comes naturally to us – namely use drugs to cope with our problems. During this phase of the process towards a full relapse, we may start making irrational choices and use poor judgment. We may become defensive or argumentative, if people try to warn us of our behaviour or try to help us. We may give up on our daily recovery routine and go back to our old habits. Habits such as isolating ourselves, sleeping late or ignoring our personal hygiene, etc. We may make plans of the things we need to do in order to feel good about recovery again, but then our distorted thinking, having come back in full force, makes a thousand excuses not to implement them. We may get angry with others and blame them for why our life is not working out the way we want it to. We may get ourselves caught up in trivial matters, exaggerate them in our minds and spend all our time and energy obsessing about them. By now, our compulsive behaviours create more and more problems and we feel evermore angry and frustrated as a result of their consequences. Whilst all this mayhem is building up in our life, we slowly loose sight of what should be our primary focus in life and we abandon the things we need to do to maintain our recovery.
Stage 4: Triggers
- Then something happens that triggers us. Our triggers tend to be people, places or situations that remind or prompt us to use drugs. When we are in solid recovery and using the tools of our program, we can usually manage our triggers. We go to a meeting, talk to our sponsor or we pray to our Higher Power to remove our obsession with using drugs. But now that we are already experiencing an emotional relapse, a trigger snaps us and sets us off. For example, we may see someone on TV using drugs, or go to a place that reminds us of our using days, and suddenly we feel out of control and unable to deal with life in recovery.
Stage 5: Interior chaos
- When we get triggered our stress level jumps up and our erratic emotions take control of our thinking. This leads us to the next phase, the mental relapse. During the mental phase our thinking patterns become insane and distorted again. This is the time when our obsession to use drugs comes back and the reality of our condition is overridden by denial and our fantasies of the “good old days”. It is during these times that we need to remind ourselves who we are and why we wanted to get clean- work a Step 1 again. We need to remember that we are people suffering from a disease that has rendered both our mind and body abnormal. We need to remember that we no longer have the luxury to use drugs again and that we should stay focused on working our program if we hope to maintain our recovery.
- Remember that relapse almost always grows from the inside out. It’s not external problems that make us use drugs again; it’s our inability to cope with our emotions and our distorted thinking that finally convince us we have no choice but to use drugs. We may think we have no way of resolving a problem and that the only way to cope with life is to revert to our old and familiar ways. When we get triggered during the mental phase of a relapse, we have most probably distanced ourselves from the support of our Fellowship. We have allowed ourselves once again to get locked in the confines of our addict minds and have abandoned using the tools of our Steps to help us deal with life.
Stage 6: Exterior turmoil
- We can stay in a state of mental relapse for some time, convinced there are no problems. We haven’t picked up drugs, so we tell ourselves there is nothing to worry about. Yet by this point, at some level we know something is wrong with our state of mind. We know the quality of our recovery is not good, but we keep it a secret out of fear, shame or pride. Eventually our addictive ways of thinking lead to problems to our outside world. We may start having fights with family members; we may get into arguments with our co-workers or we may become bitter towards our program or Fellowship. Yet all the time, our problems are accumulating and we have rejected all those who can help us.
Stage 7: Loss of control
- As we try to handle each problem on our own, they begin to overwhelm us and finally, we simply give up. We seek release in other ways, trying to forget our problems by getting involved in compulsive activities that will somehow magically fix us. This approach works for a while, but eventually things start getting out of control. As soon as we solve one problem, two new ones pop up. Life becomes one problem after another, an apparently endless sequence of crises that we try in vain to manage. Finally we recognize that we’re out of control. We get scared, angry and feel frustrated. We say to ourselves, “yes I am clean, am not using drugs and trying to work my program but I feel out of control and just as miserable as before. If this is recovery, who needs it?”
Stage 8: Addictive thinking
- At this stage all our addict defence mechanisms come back in full force. Our disease convinces us that recovery is not working; that it is simply not what we want. We feel miserable and think nobody in the Fellowship understands or can help us. We begin to contemplate seeing our old using friends, deluding ourselves by telling ourselves that we have no intention of using drugs, but want to see them because they are fun. Our thinking convinces us that recovery is too much hard work that we are not enjoying it. Our obsession to use drugs slowly comes back as we give in to denial and fantasize about the good old times. Our disease may start telling us that people at the meetings are against us, and that they don’t understand us. We begin to think that maybe we are not addicts after all, that our drug use wasn’t as bad as what we had thought. Our mind only remembers the “good days” of using drugs and we forget where our disease had taken us. Or we may think that maybe we can use drugs socially or that we can control other types of drugs. Maybe our insane thinking convinces us that after all drugs are not our real problem and that we need to take care of other issues in our life. We prioritize and put our focus on our marital state, our depression, the divorce or our job, believing if these problems were addressed then we will be all right.
Stage 9: High-risk situations
- By this step our emotional state is in such turmoil and our thinking is so distorted that we disregard all our recovery tools and suggestions. We put ourselves in high-risk situations, convinced that we are not going to use drugs. We may believe it is ok to see our using friends, or to visit places where we used to use drugs. Our insanity has reached the point where we believe it perfectly justifiable to do things that we know will bring about our cravings and trigger us to want to use drugs. Examples such as going to our dealer’s house just to have a chat. Or going to a party where there’s drugs around. By now, our disease has sabotaged us into thinking that we can manage being around drugs or people using drugs and that we don’t have a problem.
Stage 10: RELAPSE
- Having reverted to our old ways of feeling, thinking, attitudes and behaving. Having abandoned all recovery tools and support and putting ourselves in high-risk situations that trigger us, eventually we pick up drugs again – have a physical relapse. The way we see it, our choice was to collapse, commit suicide or use drugs. We could collapse from all the physical and emotional stress of our problems. We could try to end our misery by killing ourselves, or we could go back to our old ways of dealing with our problems. As an addict, if you had these three choices, which one would you pick out? Most naturally, we will pick up drugs. We will reach out for the thing that we know will kill the pain and help us cope or escape. The tragedy as we have all experienced is, using drugs does not solve our problems but increases them.
Stage 11: Aftermath of relapse
- Once we have a physical relapse, we tend to follow one of two paths. Some of us have a low-consequence relapse. We realize we have made a mistake by reverting to our old ways of dealing with life, so we reach out for help and get back into recovery. Others continue using drugs, feeling such guilt and shame that they refuse to seek further help. Most of us on the second path develop progressive health and life problems and commit suicide, or die from drug-related medical complications, accidents, or violence.