Relapse begins with changes in attitudes, feelings and behaviors. A change in attitude is one in which the recovering person no longer feels that participating in a recovery program is necessary or a change in the daily routine or life situation that signals a potentially stressful life event.
- Elevated stress, as seen by overreactivity to life events.
- Reactivation of denial, particularly as related to stress, as seen when the recovering person is stressed but refuses to talk about it or denies its existence. This behavior is of great concern because of its similarity to denial of drug addiction or abuse.
- A recurrence of postacute withdrawal symptoms, which are especially likely to occur at times of stress. They are dangerous because the recovering person may turn toward drugs or alcohol for relief.
- Behavior change. The recovering person begins to act differently, often after a period of stress, as signaled by a change in attitude or daily routine.
- Social breakdown. The social structure the recovering person has developed begins to change. For example, he/she no longer meets with his/her sober friends, or he/she becomes seclusive and withdrawn from his/her family.
- Loss of structure. The daily routine that the recovering person has constructed in the recovery program is altered. For example, he/she sleeps too late or skips meals.
- Loss of judgment. The recovering person has difficulty making decisions or makes decisions that are very unwise. There may be signs of emotional numbing or overreactivity.
- Loss of control. The recovering person begins to make irrational choices and is unable to interrupt or alter them.
- Loss of options. The recovering person feels stressed and believes that the only choices are to resume drug use or to undergo extreme emotional or physical collapse.
- Relapse in which substance use is resumed.
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