Warning Signs of an Alcohol or Drug Relapse

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Relapse is so common in the alcohol and drug recovery process, that it is estimated more than 90 percent of those in recovery have at least one relapse before they achieve lasting sobriety.

But a relapse sometimes called a "slip," doesn't begin when you pick up a drink or a drug. It is a slow process that begins long before you actually use. The steps to relapse are actually changes in attitudes, feelings, and behaviors that gradually lead to the final step, picking up a drink or a drug.

If you are working toward long-term sobriety and want to avoid having a relapse along the way, it is important to recognize the following warning signs and take action to keep them from progressing into a full-blown relapse.

Signs and Steps that Typically Lead to a Relapse

Researchers Terence T. Gorski and Merlene Miller identified a set of warning signs or steps that typically lead up 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 of alcohol and drug relapses.

Change in Attitude

Change in attitude: For some reason, you decide that participating in your recovery program is just not as important as it was. You feel something is wrong, but can't identify exactly what it is.

Elevated Stress

An increase in stress in your life can be due to a major change in circumstances or just little things building up. Returning to the "real world" after a stint in residential treatment can present many stressful situations. The danger is if you begin over-reacting to those situations. Be careful if you begin to have mood swings and exaggerated positive or negative feelings.

Reactivation of Denial

This is not the denial that you have a drug or alcohol problem, it's denial that the stress is getting to you. You try to convince yourself that everything is OK, but it's not. You may be scared or worried, but you dismiss those feelings and you stop sharing those feelings with others.

Recurrence of Withdrawal Symptoms

Anxiety, depression, sleeplessness and memory loss can continue long after you quit drinking or doing drugs. Known as post-acute withdrawal symptoms these symptoms can return during times of stress. They are dangerous because you may be tempted to self-medicate them with alcohol or drugs.

Behavior Changes

You may begin to change the daily routine that you developed in early sobriety that helped you replace your compulsive behaviors with healthy alternatives. You might begin to practice avoidance or become defensive in situations that call for an honest evaluation of your behavior. 

Social Breakdown

You may begin feeling uncomfortable around others and making excuses not to socialize. You stop going to your support group meetings or you cut way back on the number of meetings you attend. You begin to isolate yourself.

Loss of Structure

You begin to completely abandon the daily routine or schedule that you developed in early sobriety. You may begin sleeping late, or ignoring personal hygiene or skipping meals. 

Loss of Judgment

You have trouble making decisions or you make unhealthy decisions. It may be hard to think clearly and you become confused easily. You may feel overwhelmed for no apparent reason or not being able to relax. You may become annoyed or angry easily.

Loss of Control

You make irrational choices and are unable to interrupt or alter those choices. You begin to actively cut off people who can help you. You begin to think that you can return to social drinking and recreational drug use and you can control it. You may begin to believe there is no hope. You lose confidence in your ability to manage your life.

Loss of Options

You begin to limit your options. You stop attending all meetings with counselors and your support groups and discontinue any pharmacotherapy treatments. You may feel loneliness, frustration, anger, resentment, and tension. You might feel helpless and desperate.

Final Stage: Relapse

You attempt controlled, "social" or short-term alcohol or drug use, but you are disappointed with the results and experience shame and guilt. You quickly lose control and your alcohol and drug use spiral further out of control. This causes you increasing problems with relationships, jobs, money, mental and physical health. You need help getting sober again.

Preventing Relapse

Relapse following treatment for drug and alcohol addiction is common and predictable, but it is also preventable. Knowing the warning signs and steps that lead up to a relapse can help you make healthy choices and take alternative action.

If a relapse does happen, it is not the end of the world. If it happens, it is important that you get back up, dust yourself off and get back on the path to recovery.

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Article Sources

  1. National Institute on Alcohol Abuse and Alcoholism. Alcohol Alert No. 6 PH 277 October 1989. Updated October 2000.


  2. Miller WR, Harris RJ. A simple scale of Gorski's warning signs for relapse. J Stud Alcohol. 2000;61(5):759-65. doi:10.15288/jsa.2000.61.759


  3. Kelly JF, Hoeppner BB, Urbanoski KA, Slaymaker V. Predicting relapse among young adults: psychometric validation of the Advanced WArning of RElapse (AWARE) scaleAddict Behav. 2011;36(10):987–993. doi:10.1016/j.addbeh.2011.05.013