Cravings, habits & relapse
What should you do after a relapse?
Short answer
After a relapse, get safe, then restart your plan as soon as you can and treat the slip as information, not failure. Relapse is common: NIDA puts relapse rates for substance use disorders at 40–60%, compared with 50–70% for hypertension and asthma, and says relapse doesn't mean treatment has failed. It signals a need to resume, adjust or try another treatment. Relapse prevention research also separates a single lapse from a full relapse.
Key takeaways
- NIDA puts relapse rates for substance use disorders at 40–60%, compared with 50–70% for hypertension and asthma.
- Relapse doesn't mean treatment has failed; it signals a need to resume, change or try another treatment.
- A lapse (an initial slip) is different from a full relapse, and a lapse doesn't have to become one.
- Seeing a slip as a personal failure can fuel guilt that makes giving up more likely.
- After a break from alcohol or drugs, NIDA notes a heightened risk of overdose due to lost tolerance.
Is relapse normal?
It's common. According to the National Institute on Drug Abuse (NIDA), the chronic nature of addiction means that for some people, a return to drug use after an attempt to stop can be part of the process. NIDA compares relapse rates for people treated for substance use disorders, 40–60%, with those for people treated for high blood pressure and asthma, 50–70%.
NIDA also says relapse doesn't mean treatment has failed; it indicates that the person needs to speak with their doctor to resume treatment, modify it, or try another treatment. Keep in mind that these figures describe people treated for substance use disorders, so they don't directly apply to every habit.
What's the difference between a lapse and a relapse?
Relapse prevention researchers draw a clear line between the two. A lapse is an initial return to the behavior after a period of chosen abstinence. A full relapse is a return to uncontrolled use, or abandoning the goal altogether.
A lapse can go either way. It might prompt a full relapse, or it can become what researchers call a prolapse, where the problem behavior is corrected and the goal is picked back up. That's why researchers describe relapse as a dynamic, ongoing process rather than a discrete or terminal event.
Why can one slip turn into a full relapse?
How you interpret the slip matters. Researchers call it the abstinence violation effect: viewing a lapse as a personal failure may lead to feelings of guilt and abandoning the goal. In the original relapse prevention model, people who blame a lapse on their own personal failure are likely to feel guilt and negative emotions that can lead to more drinking.
Writing on NIDA's blog, Dr. Nora Volkow makes a related point: if treatment only counts as successful when it produces abstinence, even one-time lapses can trigger unnecessary guilt, shame and hopelessness.
What should you do right after a relapse?
These steps draw on NIDA guidance and relapse prevention research:
- Get safe first. If you used alcohol or drugs after a break, NIDA notes that lapses and relapses carry a heightened risk of overdose due to lost tolerance. If you feel unwell or unsafe, get medical help.
- Stop the slip where it is. Lapse management focuses on halting a lapse early so it doesn't become an uncontrolled relapse.
- Drop the self-blame. Relapse prevention teaches people to see lapses not as failures or a lack of willpower, but as mistakes that signal a need for better planning in similar situations.
- Work out what happened. High-risk situations frequently come right before a first drink after abstinence, so note where you were, who you were with and how you felt.
- Reach out soon. Relapse prevention includes contacting a therapist as soon as possible after a lapse, and NIDA advises talking with your doctor about resuming, changing or trying another treatment.
- Pick your goal back up, with a plan updated for the situation that tripped you up.
How Vow can help
In Vow, a slip is logged without shame: your best streak is kept and a fresh run starts. Your personal reason for quitting, in your own words and optionally with a photo or voice note, resurfaces during cravings and in reminders, and crisis resources by region are always free in the app.
Sources
Each source below was read when this answer was reviewed. Open a source to see the passages the answer relies on.
National Institute on Drug Abuse — Treatment and Recoverynida.nih.gov
The chronic nature of addiction means that for some people relapse, or a return to drug use after an attempt to stop, can be part of the process
Relapse rates for people treated for substance use disorders are compared with those for people treated for high blood pressure and asthma.
Relapse rates for substance use disorders is 40-60%, relapse rates for hypertension are 50-70%, and relapse rates for asthma are 50-70%.
Relapse doesn't mean treatment has failed. When a person recovering from an addiction relapses, it indicates that the person needs to speak with their doctor to resume treatment, modify it, or try another treatment.
Open the sourcePubMed Central — Hendershot, Witkiewitz, George & Marlatt (2011), Relapse prevention for addictive behaviorspmc.ncbi.nlm.nih.gov
in viewing relapse as a common (albeit undesirable) event
an initial return to the target behavior after a period of volitional abstinence
a lapse might prompt a full-blown relapse
the problem behavior is corrected and the desired behavior re-instantiated
best conceptualized as a dynamic, ongoing process rather than a discrete or terminal event
Viewing a lapse as a personal failure may lead to feelings of guilt and abandonment of the behavior change goal.
Open the sourcePubMed Central — Larimer, Palmer & Marlatt (1999), Relapse Prevention: An Overview of Marlatt's Cognitive-Behavioral Modelpmc.ncbi.nlm.nih.gov
A critical difference exists between the first violation of the abstinence goal (i.e., an initial lapse) and a return to uncontrolled drinking or abandonment of the abstinence goal (i.e., a full-blown relapse).
People who attribute the lapse to their own personal failure are likely to experience guilt and negative emotions that can, in turn, lead to increased drinking
Lapse-management strategies focus on halting the lapse and combating the abstinence violation effect to prevent an uncontrolled relapse episode.
view them not as failures or indicators of a lack of willpower but as mistakes or errors in learning that signal the need for increased planning to cope more effectively in similar situations
A central concept of the RP model postulates that high-risk situations frequently serve as the immediate precipitators of initial alcohol use after abstinence.
Lapse management includes contracting with the client to limit the extent of use, to contact the therapist as soon as possible after the lapse.
Open the sourceNational Institute on Drug Abuse, Nora's Blog (Dr. Nora Volkow) — Making Addiction Treatment More Realistic and Pragmatic: The Perfect Should Not be the Enemy of the Goodnida.nih.gov
But as long as treatment is only regarded as successful if it produces abstinence, then even one-time lapses can trigger unnecessary guilt, shame, and hopelessness.
Such services could potentially help mitigate some of the risks associated with lapses and relapses, such as heightened risk of overdose due to lost tolerance.
Open the sourceMedlinePlus Medical Encyclopedia — How to stop drinkingmedlineplus.gov
If you have withdrawal symptoms, such as trembling hands, when you go without alcohol, you should not try to quit on your own.
It may be life threatening.
Open the sourceCDC How Right Now — Find Services and Treatmentcdc.gov
to find resources near you or connect with SAMHSA's National Helpline: Call 1-800-662-HELP (4357)
Open the source
This page is general information, not medical advice, and it does not replace care from a qualified professional. If you are in immediate danger, call your local emergency number. Vow is not a medical service.