Relapse is common. The National Institute on Drug Abuse estimates that 40% to 60% of people relapse in recovery — a figure that falls to 15% after five years of sobriety, according to another study. You may already know the most common relapse triggers — stress and anxiety are the big ones — but there are also some lesser-known factors that can bring on a return to using a substance and/or acting on a compulsive behavior like gambling, watching porn or shopping.
What’s first important to realize, though, is that a relapse often begins before someone actually returns to using, says Terence T. Gorksi, founder of the GORSKI-CENAPS model of recovery and relapse prevention. In Gorski’s research with recovering alcoholics, he found that those who relapsed built up to taking a drink. That may, for example, shifts like distancing themselves from their sponsor or meetings, pushing away people who support sober living or planning out a place to drink where they won’t be seen. “Most people make the decision to start drinking before they actually start,” Gorski says, even if they don’t fully realize it. Gorski likes to compare a relapse to a smooth, comfortable descent on a waterslide, with triggers being the bumps in between the tubes that momentarily jolt you to attention. “The trigger is short-lived and it goes away and you forget about it,” he says. “But as you go further down, the trigger events get more serious and you can’t ignore them, and the triggers start putting you around the people and the places and the things that activate craving.”
As Pamela Peeke, M.D., author of The Hunger Fix: The Three-Stage Detox and Recovery Plan for Overeating and Food Addiction and an expert in food addiction, says: “A craving is a craving, whether it’s crème brulee or heroin.” The body’s physiological response is stronger for some substances than others, of course, she adds, yet all addicts in recovery must learn to remain vigilant. “There are many, many roads into the rewards center of the brain,” Dr. Peeke cautions. “But at the end of the day, it’s the same destination, it’s just at different orders of magnitude.” In other words, it’s crucial to stay aware of all the various — and often the more subtle — ways your brain and body can be triggered, including these lesser-known (and perhaps surprising) relapse triggers and warning signs, shared by Gorksi and Peeke:
- Trying to get back to “normal.” Too often, initial relapse warning signs go unnoticed because these triggers — be it people, places, things or behaviors — were simply part of the addicted person’s “normal” life before he or she became addicted, says Gorski. “Many people are surprised, because they work really hard after they’ve destroyed their lives to get their life back to the way it was before they became an alcoholic or an addict,” he explains. “And they never stop to think that they became an alcoholic and an addict because they were living that way.” Life will — and should — be different than it was before addiction. In recovery, Gorski says, “the whole goal is to connect with reality, learn how to handle it, and you begin growing and maturing and becoming more and more capable to handle and deal with both the good and the bad aspects of recovery.”
- Overconfidence. Sure, self-confidence can be a healthy part of recovery, says Gorski, but it shouldn’t be confused with what he calls “the shallow bravado” that leads to a relapse. The latter is accompanied by thoughts like, I’m cured, and if I’m cured, I don’t have to attend all these meetings,” he says, as well as, often, anger or resentment at needing to continue with a recovery program. “They absolutely convince themselves they will never drink again,” Gorski notes. “'[So, they think,] if I’m never going to drink again, why do I have to go to a meeting today?” This line of thinking takes the urgency out of the recovery process and begins the disruption of the very habits you’ll need to maintain your sobriety.
- Your mom (and other people who love you). Peeke encourages people to examine what she calls your “tribal members,” otherwise known as “the people you hang out with,” she says. “Who’s in your tribe? And of those tribal members, who’s enabling?” Stressful relationships with anyone from family members to coworkers can become triggers for a relapse, as can interacting with those who have access to whatever it is you’re addicted to, whether that’s cocaine or candy. While it’s probably not surprising to hear that some people will naturally be bad for your sobriety, you may also need to examine relationships for more subtle triggers, says Peeke, who uses food addiction as an example. “It could be your mother,” she says. “She loves you to death, but she’s always plying you with whatever hyper-palatable foods — which means sugary, fatty, sometimes salty foods — that will ignite that reward center and cause a relapse.”
- Overextending yourself. “[Some] people try to make themselves OK in their own recovery by overly sponsoring other people,” explains Gorski. “They’ll pick up a lot of people [to sponsor] and they feel like, if I can keep them sober, I can keep myself sober.” However, by overextending themselves, they eventually start to burn out. Though it’s often not visible to others, Gorski says his experience in studying relapse indicates that the person may be having an internal struggle with guilt and “feeling like a phony because they’re hiding or lying about things they’re really thinking.” However, he adds, “they don’t want to tell anybody about it because they don’t want to jinx the newcomers. And then pretty soon it gets so painful to attend meetings.”
- TV. A trigger can be anything that makes you stop paying attention, says Peeke. “The minute you become mindless, that’s when you’re vulnerable to running into huge problems.” For example, television can be a big trigger, particularly in the case of food addicts. “What do you become when you watch TV?” Peeke asks. “Mindless — and you self-soothe mindlessly.” The same applies to other activities that function similarly to distract you, including hours spent online or on social media.
- Recovery plans and other tools that have “stopped working.” It’s not uncommon in recovery to find that the habits and strategies that gave you a lot of satisfaction and comfort during the first three to six months of your recovery now feel as if they just don’t have an effect anymore, says Gorski. His reminder: “Recovery is a process, not an event … Instead of thinking, I’ve got this one recovery plan that’s going to work for me forever,” Gorski says, flexibility and resiliency will help you weather what he calls the “typical tragedies of life,” such as job loss or the death of a loved one, without relapsing. As life changes, it makes sense that your recovery plan (and a relapse prevention plan, if you have one) will also need adjustments.
- Happy events. While a loss or crisis seems like a natural trigger to start using again, too often people in recovery don’t realize that a positive change — getting married, for example, or being promoted at work — can also be stressful. “Any rapid change, be it positive or negative, generates stress,” Gorksi says. “The brain experiences stress because you have to adapt and adjust, which takes energy. What are viewed as positive events are really stressful for everybody.” A happy occasion is cause for celebration. “And when we’re celebrating, we let our guards down,” says Peeke. “The question is, can you happily celebrate without caving to the craving?” The key, she adds, is to have a plan in place beforehand; if alcoholism is your issue, know going into a party that you’ll drink Perrier with a twist of lime instead of a cocktail; or if you are addicted to food, eat some yogurt before going so you aren’t as vulnerable to the dessert spread. “You have to be prepared,” she says plainly. “Always think ahead … Instead of saying, ‘I’ll have half of the cake there and I’ll eat every single dessert set up here,’ instead you’ll do something differently.”
- Not enough sleep. According to a recent study published in the Journal of Addiction Medicine, when people in the early stages of alcohol recovery were treated for insomnia they had a lower chance of relapse. Researchers found that sleep disturbances could be five times higher for those in early recovery than for the average person. Poor sleep quality can also be a trigger for food addicts, since sleep deprivation disrupts appetite and hormones that regulate hunger. When you’re not getting enough sleep, Peeke says, “it’s almost impossible to rein yourself in and to think straight and be focused.”