Slip, Lapse, or Relapse: When the Plan Has to Change

Disclaimer: This article is only meant for informational purposes and does not replace medical or mental health advice. If you think you have had a slip, lapse, or relapse, reach out to a licensed clinician immediately. If you are in crisis, call or text 9-8-8 in the U.S. For an emergency, call 9-1-1 immediately.

If you drank alcohol or used drugs after recovery, the next questions will be – was this just a slip or a relapse, and what must I do next? The first answer depends on what kind of setback it was, and the second answer will depend on where you are in your recovery.

In this article, we will look into lapse vs. relapse, how a setback develops, warning signs of relapse, and what to do after relapse.

A slip or a lapse is one episode followed by a return to your recovery principles and goals. A relapse is a return to sustained drinking or use, typically followed by a disconnect with your recovery principles and goals. The encouraging news is that both are common; both are manageable.

Slip vs Relapse; Lapse vs Relapse

Here are a few differences between slip, lapse, and relapse:

The line between the two is not very well defined. But it is not the wording you need to focus on. It is about getting back to your recovery – what you do next.

Is Relapse Part of Recovery?

The National Institute on Drug Abuse (NIDA) reports relapse rates of 40% to 60% for substance use disorders. NIDA also says that relapse does not mean treatment has failed. It is a sign that treatment needs to be resumed, changed, or replaced with something different.

This is what we generally mean by relapse is part of recovery. It describes how a chronic condition presents itself and how treatment needs to respond.

However, please note that relapse can be dangerous. Someone who returns to the amount they used before quitting can overdose (such as opioids), because the body is no longer adapted to that dose.

Safety Note: If you notice overdose signs, reach out to 9-1-1 (U.S.) immediately. It is always practical to have naloxone on hand for those who use or used opioids. It restores normal breathing within minutes, but even then, you need medical attention right away.

What Are the Stages of Relapse?

Relapse does not happen overnight. It gradually develops. There are three stages of relapse – emotional, mental, and physical.

Emotional Relapse

During emotional relapse, you are not thinking about using. Your feelings and habits are beginning to set you up for a relapse. For instance, it looks like isolating, bottling up feelings, skipping peer community meetings, not reaching out, and neglecting food and sleep.

Mental Relapse

In mental relapse, you want to use, and you do not want to use. Your thinking patterns of using become more frequent or more insistent. Other signs may be romanticizing past use, lying, spending time with those you used with, and thinking about how you might do it again.

Physical Relapse

Physical relapse is the return to use. Some divide this into a lapse, the first drink or drug, and a relapse, a return to sustained use. What happens next after the lapse often decides which one you are dealing with.

What Are the Warning Signs of Relapse?

The goal of relapse prevention is to identify it early, so here are the warning signs you need to be wary of:

What to Do After a Relapse?

These steps are for the first day or two.

• Be physically safe. If you used opioids or other substances after a long break, your tolerance has dropped, and overdose risk is real. Ask your doctor about naloxone, and call 9-1-1 for signs of overdose. If you feel physically unwell, get medical care immediately.
• Tell one person you trust. This can be your therapist, your clinical team, a sponsor, or a family member.
• Remove what is within reach. Clear out substances from your vicinity and change plans that put you near them.
• Identify what happened without judgment. Identify what was going on in the days before. It can be stress, cues pertaining to past use (a person, settings, things, moods), and contact with the substance as the most common triggers.
• Go back to your recovery principles and goals. Attend the session, the meeting, or check in with your clinician.

How to Recover From a Relapse?

How to recover from a relapse over the following days and weeks is about planning.

• Review the Level of Care: A short lapse may call for more therapy sessions. A longer relapse may need more structure, such as an intensive outpatient or partial hospitalization program.
• Treat the Underlying Symptoms: One 2023 study of 611 people in treatment found that 3 months after treatment, 40% of those with a co-occurring mental health condition had relapsed, compared with 26% of those without. That is why both are treated together, not one after the other.
• Review Relapse Prevention Planning: Update your warning signs, your high-risk circumstances, and your course of action.
• Rebuild Your Social Support System: Recovery is better with more than one person who knows the real story. Peer community meetings such as Alcoholics Anonymous, Narcotics Anonymous, SMART Recovery, etc can be useful.

Why Do I Keep Relapsing?

If you keep asking why do I keep relapsing – it varies from person to person, but typically, it may be one of these reasons:

• Untreated Mental Health Conditions: Anxiety, depression, trauma, and other conditions raise relapse risk when they go untreated.
• Care Ended Before Time: For instance, detox without therapy and peer community may lead to a return to use.
• Triggers Were Not Identified: If your relapse prevention was not built into your recovery, triggers tied to use may go unidentified and lead to a relapse.
• Cravings Were Not Treated With Medication: For alcohol and opioid use, FDA-approved medications lower relapse risk, such as naltrexone and acamprosate for alcohol, and buprenorphine, methadone, and naltrexone for opioids. If cravings keep winning, ask a prescriber whether medication fits your plan.
• The Abstinence Violation Effect: The abstinence violation effect explains why some lapses stop while others tend to snowball. It is the emotional and mental reaction that follows breaking your recovery, such as guilt, self-blame, and a drop in confidence that you can stay sober. For instance, if you think you blew your recovery and why bother – it becomes a recurring thing.

Change Your Recovery Planning With Skyline

Skyline Recovery Center in Los Angeles offers a partial hospitalization program (PHP) that runs 6 to 8 hours a day, 5 days a week, and an intensive outpatient program (IOP) that runs 3 to 5 hours a day, 3 to 5 days a week. Evening and virtual IOP options, and weekly therapy are also available.

A lapse can be followed by therapy sessions, whereas a relapse may need stepping up to a PHP or IOP, depending on where you are in your recovery.

You do not have to have everything figured out before you reach out to us. You only need to call us and our team will sit with you to understand whether it is a slip/lapse or a relapse to suggest the next step.