WarningRelapse Warning Signs and What to Do. How to spot a relapse building early, and what to do to stay safe if use happens.

Many people in recovery and many clinicians describe relapse in three broad stages. These are not strict rules, and people move through them in different ways. Still, they help explain why a return to use can feel sudden when it was actually weeks in the making.

• Emotional stage: the person is not thinking about using yet, but old feelings and habits are coming back. Stress builds up. Sleep and eating slip. They pull away from people and stop sharing how they feel.
• Mental stage: part of the person wants to use and part does not. They think about old times, picture using, or start planning how they could get away with it just once.
• Physical stage: the person actually drinks or uses.

The good news is that the early stages give everyone time to act. The sooner a warning sign is noticed, the easier it is to change course.

Watch for changes in mood, routine and connection. A single rough week is normal. Several signs at once, for more than a few days, deserve attention.

• Skipping meetings, therapy, check-ins or other parts of the recovery plan
• Isolating, keeping secrets or getting defensive about small questions
• Poor sleep, skipped meals or letting basic self-care go
• More irritability, anxiety, low mood or feeling numb
• Talking about old using days with fondness
• Spending time with old using friends or in old places
• Thinking they can handle just one, or that they were never that bad
• Sudden money problems or missing time that is hard to explain

People in recovery can use this list on themselves, too. Honest self-checks, written down once a week, make patterns easier to see.

A common shorthand is HALT: hungry, angry, lonely, tired. Any one of these lowers defenses. Other high-risk times include:

• Big life changes, good or bad, such as a new job, a breakup, a move or a loss
• Holidays, birthdays, weddings and other events with alcohol
• Conflict at home or at work
• Pain, illness or a new prescription
• Feeling bored, or feeling so confident that the plan seems unnecessary
• The weeks right after leaving treatment, when structure drops away

If the person you care about has recently finished treatment, our guide After Treatment: Planning the First 90 Days at Home covers how to build structure for that period.

It is natural to feel scared or angry. But shame tends to push people further into hiding. The goal is to keep the door open so the person can be honest.

• Pick a calm time. Avoid a talk when anyone is drunk, high or upset.
• Name what you see, not what you fear. For example: I noticed you have missed your last two sessions, and I am worried.
• Ask, then listen. Let the person explain before you respond.
• Point to the plan. Ask what step from their plan would help right now.
• Take care of yourself. Families need support too, whatever the person decides.

Avoid threats you will not follow through on, and avoid trying to police every move. Clear, steady boundaries work better. Our guide Support for Families goes deeper, and Blackburn Recovery Services runs a free virtual family support group every two weeks that is open to any family.

The best plans are short, specific and written by the person in recovery, ideally with help from a therapist, case manager or sponsor. Share a copy with one or two trusted people.

• Personal warning signs: the three to five signs that show up first for this person
• Triggers: people, places, feelings and times that raise risk
• Coping steps: what to do in the moment, such as call someone, leave, eat, rest or go to a meeting
• People to call: names and numbers, in order, including the care team
• Daily basics: sleep, meals, movement, and recovery activities
• What happens if use occurs: who to tell, how to stay safe, and how to get back into care

Review the plan every month or two. What works early in recovery may need to change later.

After a period without using, the body loses tolerance. An amount the person used to take can now cause an overdose. This is one of the most dangerous times, especially with opioids. Street drugs may also contain fentanyl, even when the person does not expect it.

• If opioids may be involved, keep naloxone (Narcan) on hand and know how to use it. It is sold over the counter at many pharmacies.
• Do not use alone, and do not mix substances.
• If someone will not wake up, is breathing slowly or not at all, or has blue lips, call 911 and give naloxone if you have it.
• Stopping alcohol or benzodiazepines suddenly after heavy use can be medically dangerous. Talk to a doctor before stopping.
• Call the care team as soon as you can: therapist, prescriber, case manager or sponsor.

For families: stay as calm as you can. Focus on safety tonight and next steps tomorrow. Arguments about why it happened can wait.

A return to use is useful information. It shows where the plan needs more support. That might mean more frequent therapy, a medication review, a change in level of care, or a short medically supervised detox. Our guide on outpatient detox at home explains when that can be safe.

Three kinds of support often help most:

• Case management: a case manager keeps the plan on track, coordinates providers and helps the person and family through the next steps. Learn more about how this differs from other options in Case management, mentoring or therapy.
• Monitoring: regular, random testing gives early, objective information and can rebuild trust. See How drug and alcohol monitoring works. Blackburn Monitoring shares results in real time with consent.
• Therapy and psychiatric care: therapy helps with the stress, feelings and patterns under the use. Psychiatric care can address depression, anxiety or other conditions that raise risk. Blackburn Clinical Services offers both.

• NIDA: Treatment and Recovery
• CDC: Stop Overdose
• CDC: Lifesaving Naloxone
• FDA: Information about Naloxone and Nalmefene
• 988 Suicide and Crisis Lifeline

Not sure which kind of help fits? Our Where to start page walks through the options. You can also call us at (888) 305-5422 or email info@theblackburngroup.org. Families can find more on our families page.

If you or someone you love is thinking about suicide or is in crisis, call or text 988 to reach the 988 Suicide and Crisis Lifeline. In an emergency, call 911.

Related help in Los Angeles: Help for families in Los Angeles, Aftercare planning in Los Angeles. Or call (888) 305-5422.

• After Treatment: The First 90 Days
• Fentanyl and Naloxone
• How Drug and Alcohol Monitoring Works

All guides →