Signs of Relapse & What to Do

group of people's hands all holding together in support during a narcotics anonymous meeting

January 12, 2023

Clinical Contributors to this story:
James Sherer, M.D.

If you know someone fighting to overcome addiction and you want to help, it’s important to know the warning signs when someone is at risk for a relapse.

Addiction psychiatrist, James Sherer, M.D., shares how to help a loved one in recovery and signs of relapse.

Step 1: Acknowledge that addiction is a disease

“The first fact to accept is that addiction is a disease, not a moral failure or a character flaw. Much like other chronic diseases, addiction cannot be cured but it can be treated and managed successfully,” shares Dr. Sherer.

You also must accept that addiction, or substance use disorder, is a complex disease based upon a mix of biological, environmental and developmental factors. Unfortunately, drug and alcohol use change our brains and make it harder to quit and stay sober.

As a result, relapse is common among those suffering from addiction.  The National Institute on Drug Abuse (NIDA) has found that at least one relapse on the road to recovery is commonplace, and often there are more than one. 

Step 2: Know the signs of relapse

Relapse begins long before someone actually returns to using substances. Except in rare instances, relapse is a three-step process, not a one-time occurrence.  The three stages leading to a relapse are categorized by emotional, mental and physical signs.

Emotional stage

While most people associate a relapse with recognizable physical signs, actually that is the last stage.  The path to relapse usually begins with emotional issues, including:

  • anger
  • moodiness
  • anxiety
  • changes to eating and sleeping behaviors

Compulsive behavior of any type can be a sign of emotional distress as someone fights to remain sober.

Mental stage

In the mental stage, the patient often is involved in an internal struggle between having strong desires to use again and the desire to stay sober.

People who suffer from depression often are in even more danger of relapsing. 

This stage often is also marked by a false sense of self control where the patient starts to believe they can “handle” drugs or alcohol and they begin doubting the efficacy of treatment and not attending treatment sessions. Patients may bargain with themselves about using again, and may seek external validation when they begin to plan their relapse.

Physical stage

The last stage is the physical one, where it becomes evident that the patient has begun to relapse and is exhibiting outward signs of drug and/or alcohol abuse.

Signs of drug or alcohol use can include both physical and behavioral changes, including:

  • Altered consciousness, appearing tired, drowsy or disoriented
  • Slurred speech
  • Memory problems
  • Poor coordination
  • Irritability
  • Difficulty maintaining responsibilities and/or poor performance in work or school
  • Sudden weight change
  • Changes in personal hygiene
  • Financial problems
  • Defensive or aggressive response when asked about substance use

It is imperative to get a patient back into treatment as soon as possible for a successful recovery, preferably during the first stage. The longer an individual continues abusing again, the more difficult it is to regain self- control and sobriety.

Step 3: Getting help

A relapse means there is a need for more and/or different treatment, usually entailing a combination of behavioral therapy counseling and medications, at least initially. Treatment enables a patient to counteract addiction’s disruptive effects on their brain and their behaviors.

It is a long process that can be difficult, and it may entail a number of tries and will be a lifetime commitment, but with the right support, success is possible.

Next Steps & Resources:

  • Meet our source: James Sherer, M.D.
  • James Sherer is the director of the Addiction Medicine Consult Service, a comprehensive inpatient service at Jersey Shore University Medical Center, offering wraparound care to those struggling with addiction who are admitted to the hospital.
  • Hackensack Meridian Health offers comprehensive addiction treatment services. These include inpatient detox and rehab at Blake Recovery Center, Intensive Outpatient Program (IOP) and outpatient services at Blake Recovery Center, Retreat & Recovery At Ramapo Valley, and other locations.
  • To make an appointment with a doctor near you, call 800-822-8905 or visit our website.

The material provided through HealthU is intended to be used as general information only and should not replace the advice of your physician. Always consult your physician for individual care.



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