What Is a Relapse? What to Do Next and How to Get Back Into Care

Maybe you used again after treatment, and you are sitting with the shame of it. Or maybe you just found out that someone you love, someone who worked hard to get sober, is drinking or using again. Both moments feel like everything fell apart. They are also more common than most people realize, and what you do over the next day or two matters more than how you got here.

Relapse does not erase what treatment built. This guide starts with what to do right now, then explains what relapse is, how it usually unfolds in stages, and how to get back into care at Freeman Recovery Center in Tennessee without starting from zero.

What to Do in the First 24 to 48 Hours After a Relapse

The first priority is safety, not guilt. According to the National Institute on Drug Abuse (NIDA), relapse is a normal part of recovery, but for some drugs it can be very dangerous, even deadly. After a stretch without using, the body is no longer adapted to the amount a person used before. Going back to that old amount can cause an overdose.

That risk is not theoretical. A small 2003 study in the BMJ followed 137 people after inpatient opioid detox and found that the overdose deaths in the following year clustered among people who had completed detox and lost their tolerance (Strang and colleagues, 2003). The authors said the finding needed to be replicated, but it lines up with what NIDA describes.

If someone may be overdosing or is in immediate danger, call 911. If opioids are involved, naloxone can reverse an overdose. The FDA approved Narcan nasal spray for over-the-counter, nonprescription sale in March 2023, so families can keep it at home.

Stopping again can carry its own risks. MedlinePlus describes alcohol withdrawal as a serious condition that may quickly become life-threatening. If you were drinking often and recently stopped, get medical care for alcohol withdrawal right away, and call 911 or go to an emergency room for seizures, fever, severe confusion, hallucinations or an irregular heartbeat.

Once everyone is safe, these steps help over the next day or two:

• Tell one person. A sponsor, counselor, sober friend or family member. Keeping it secret tends to make the next use easier.
• Put distance between yourself and the substance. Get rid of what is in the house, and step away from the people and places tied to using.
• Call your treatment team or Freeman Recovery Center. NIDA says a relapse means a person needs to speak with their doctor to resume treatment, modify it, or try another treatment.
• Write down what happened. What was going on in the days before? That becomes useful information for your next plan, not evidence against yourself.
• Be honest about how much and how long. The answer shapes which level of care makes sense next, and our guide to knowing when you need rehab can help you think it through.

If Someone You Love Just Relapsed

Keep the first conversation about safety and next steps, not blame. Watch for signs of overdose, keep naloxone close if opioids are involved, and offer to make the call to a treatment team together. Anger and fear are normal, and they can wait until the person is safe.

If your loved one is not ready to go back, our guide on how to get someone into rehab walks through what to say, what to do if they refuse, and what Tennessee law allows.

What Is a Relapse?

In addiction, a relapse is a return to drug or alcohol use after an attempt to stop. That is how NIDA defines it, and it applies whether someone had been sober for a week or a decade.

Relapse is often talked about as a single moment, but it usually is not one. In a 2015 review in the Yale Journal of Biology and Medicine, physician Steven Melemis describes relapse as a gradual process with distinct stages, and says the goal of treatment is to help people recognize the early stages, when the chances of success are greatest.

Lapse vs Relapse

Some researchers split physical relapse into two parts: a lapse, meaning the first drink or drug use, and a relapse, meaning a return to uncontrolled use. Melemis cautions against leaning too hard on that line. One use can quickly lead to uncontrolled use, and it usually brings back obsessive thinking about using. A lapse is still a reason to call your treatment team.

Is Relapse a Normal Part of Recovery?

For some people, yes. NIDA explains that because addiction is a chronic condition, relapse can be part of the process, and relapse rates for substance use disorders are similar to those for other chronic illnesses. NIDA puts the rate at 40 to 60%, compared with 50 to 70% for high blood pressure and asthma, based on a 2000 review in JAMA.

That comparison matters. Nobody tells a person with high blood pressure that treatment failed because their numbers went back up. Their care team adjusts the plan. NIDA describes relapse the same way: a sign that treatment needs to be resumed, modified or replaced, not proof that it did not work.

Common does not mean safe, though. The overdose risk described above is the reason to act quickly, even when a relapse feels small.

Why Relapse Happens

Relapse rarely comes out of nowhere. Melemis points to poor self-care as the common thread in early relapse and suggests a simple check called HALT: are you hungry, angry, lonely or tired? Any one of those can make old coping habits start to feel reasonable again.

He also describes how hard it is for people to recognize their own high-risk situations, and how often relapse starts with bargaining, such as deciding it would be fine to use on a holiday or a trip, or that switching to a different substance does not count. Our guide to building a relapse prevention plan covers triggers and how to plan around them.

The Three Stages of Relapse: Emotional, Mental and Physical

Melemis describes relapse in three stages. The earlier a person recognizes which one they are in, the better the chance of stopping the slide.

Emotional Relapse

In emotional relapse, a person is not thinking about using. They may remember their last relapse clearly and have no intention of repeating it. But they are bottling up emotions, pulling away from people, skipping meetings or going without sharing, focusing on other people’s problems, and eating and sleeping poorly. Melemis calls poor self-care the common denominator of this stage and notes that denial is a big part of it, which is one reason family members often notice the changes first.

Mental Relapse

In mental relapse, there is a fight going on. Part of the person wants to use and part of them does not. Signs include cravings, thinking about the people, places and things tied to past use, minimizing or glamorizing past use, bargaining, lying, scheming to control use, and looking for or planning an opportunity to use. Occasional thoughts of using can happen in recovery. Melemis says the warning sign is when those thoughts become more frequent or more insistent.

Physical Relapse

Physical relapse is using again. This is where the first section of this guide applies: safety first, then a call to your treatment team. For a longer list of early warning signs, see our guide to recognizing the signs of relapse.

How Relapse Prevention Works

Relapse prevention is built on the idea that relapse can be caught early. Melemis names cognitive therapy and mind-body relaxation as its main tools, used to build healthier ways of coping. Cognitive therapy helps people notice the thinking that leads toward use, like bargaining or glamorizing the past, and answer it before it turns into a decision.

He also sums up most relapses with five rules of recovery: change your life, be completely honest, ask for help, practice self-care, and do not bend the rules. They sound simple. In practice, each one takes work, and most of that work happens in therapy, in group sessions and in aftercare. If you are not sure which approach fits you, our guide on what kind of therapy is best for you breaks down the options.

How a Treatment Team Decides the Right Level of Care After a Relapse

Going back to treatment after a relapse does not mean starting over at the beginning. One widely used framework is The ASAM Criteria from the American Society of Addiction Medicine, which guide a multidimensional assessment of biomedical, psychological and social factors. Those dimensions inform the level of care a team recommends and the treatment plan that follows.

In plain terms, the team looks at the whole picture: how much and how recently you used, whether withdrawal could be dangerous, your physical and mental health, and what support you have at home. A short lapse after months of steady recovery can call for something very different from weeks of heavy use.

At Freeman Recovery Center, care runs along a continuum:

• Detox and residential care at the Burns campus. Medically monitored detox and residential treatment, with a nurse on site 24/7 and a physician on call.
• PHP and IOP at the Dickson location. A partial hospitalization program and an intensive outpatient program, including evening IOP options.
• Standard outpatient care at Dickson, with telehealth sessions as part of outpatient treatment.
• Aftercare and alumni support once formal treatment ends.

The treatment team makes each move between levels with the client, not for them. Clients can be admitted directly to PHP or IOP without detox when that is clinically appropriate, so someone coming back after a short lapse may not need to start at detox. If psychiatric care or medication management becomes part of the plan, those services are provided by Freeman Health Partners.

Coming Back to Freeman Recovery Center After a Relapse

If you have been through treatment before, coming back can feel like admitting defeat. It is not. It is exactly what NIDA describes as the right response to a relapse: resuming, adjusting or changing treatment.

Freeman Recovery Center offers same-day admissions and a free, confidential assessment. One call to (615) 645-3677 starts the process, and the assessment is where the team works out the right level of care for where you are now, not where you were the first time. You can read how it works on our admissions page.

Most PHP and IOP clients live in Freeman Recovery Center recovery housing, and vans run between the housing, the Burns campus and the Dickson clinic, so getting to care each day is taken care of. You can see both locations on our facilities page.

You will also be working with people who get it. More than half of Freeman Recovery Center’s staff are in recovery themselves. For anyone who wants faith to be part of their recovery, Arise is an optional Christ-centered track. Freeman Recovery Center is Joint Commission accredited and licensed by the Tennessee Department of Mental Health and Substance Abuse Services.

Before you come back, you can verify your coverage so there are no surprises. Then call (615) 645-3677. You can call for yourself, or with someone you love sitting beside you.

Frequently Asked Questions

What Is the Difference Between a Lapse and a Relapse?

Some researchers use “lapse” for the first drink or drug use and “relapse” for a return to uncontrolled use. Either one is a reason to call your treatment team, since a single use can quickly lead to more.

Is Relapse a Part of Recovery?

For some people, yes. NIDA puts relapse rates for substance use disorders at 40 to 60%, similar to other chronic illnesses, based on a 2000 review in JAMA. That makes relapse common, but not safe, because lost tolerance raises the risk of overdose.

What Are the 3 Stages of Relapse?

Emotional relapse, when emotions and habits start setting up a relapse; mental relapse, when part of you wants to use; and physical relapse, when use begins again.

What Should You Do When Someone Relapses?

Make sure they are safe first. Call 911 for any sign of overdose, and keep naloxone nearby if opioids are involved. Then talk calmly, without blame, and offer to call a treatment team together.

Can I Go Back to Freeman Recovery Center After a Relapse?

Yes. Freeman Recovery Center offers same-day admissions and a free, confidential assessment, and the team decides the right level of care with you. If you want to know what to expect, our guide to what rehab is like covers what to expect. Call (615) 645-3677 to start.

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This content is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. If you or someone you know is in immediate danger, call 911. For crisis support, call or text 988 to reach the 988 Suicide & Crisis Lifeline. For treatment referrals and information, call the SAMHSA National Helpline at 1-800-662-HELP (4357), which is free, confidential, and available 24/7.