What Are They?
Triggers are social, environmental or emotional situations, scenarios or occasions that remind people in recovery of their past drug or alcohol use. These cues bring about urges that may lead to a lapse or relapse. While triggers do not force a person to use drugs, they increase the likelihood of drug or alcohol use. The National Institute on Drug Abuse (NIDA)
in 2019, between 40-60% of people treated for substance abuse & addiction relapsed at least once and between 30-45% relapsed on multiple occasions. This does not mean however that they cannot be managed and more importantly, beaten! With the right knowledge, an active recovery plan and a relapse prevention plan can help those in recovery keep the warning signs in mind on a day to day basis to ensure that any early signs can be acted upon to prevent a lapse or relapse..
External triggers are people, places, activities and objects that elicit thoughts or cravings associated with substance use. Individuals in recovery can stay away from the dangers of external triggers by developing action plans to avoid triggers that remind them of past drug use. They should also be prepared to fight thoughts and cravings when they are in triggering situations.
Long-term (chronic) drug use creates physical connections in the brain between activities in your daily routines and with your drug or alcohol use from previous occasions when you drank or used. This means that during your daily activities, going to certain places, being around certain individuals may suffer from intense drug or alcohol cravings when exposed to certain cues/triggers. The cravings act as a reflex to external or internal triggers and this response can even affect individuals who have abstained from drugs or alcohol for an extended period of time.
A study by NIDA discovered that cocaine-related images subconsciously prompted the emotional centers of the brains of former users. These underlying stimuli and cues set off a rapid activation of the circuits associated with substance cravings.
The research maintained that subconscious cues are dangerous because they reinforce the patient’s desire to restart using drugs without them being aware of it. Researchers highlighted the importance of avoiding the people, places and things that remind those in recovery activities of their former lifestyle.
People closest to the individual may set off cravings that eventually lead to a relapse. It is perilous for a person in recovery to be around family members that are also actively using addicts. Even peers who abstain from illicit drugs can be dangerous. Offering alcohol to a former addict may trigger feelings that urge the individual to use drugs. People who may influence cravings include:
- Former drug dealers/addicts
- Family members
- Spouses or partners
Friends and family may not understand the consequences of negative behaviors toward people in recovery. These behaviors can make the individuals feel alienated and push them toward feeling more vulnerable towards a lapse or relapse.
High-risk places remind former drug or alcohol users of the times they engaged in substance abuse. Walking or driving through places where they used to drink or consume drugs can spark a memory connected to drug or alcohol use. The high-risk places will be personal/different for everyone but often commonly include:
- Neighborhoods or towns
- A friend’s/associates home
- Bars, clubs or drinking establishments
- A particular road or location
- Former drug-stash locations
- certain buildings
A person can find alternative routes to avoid high-risk places, such as places where they used to meet their dealers or bars where they used to drink.
Objects in an individual’s everyday life may unconsciously induce a craving. Cues such as spoons can trigger memories of drug use in former heroin addicts without them being aware. Numerous objects can spark a drug-related thought, such as:
- Cash or money
- Credit cards
- Empty pill or alcohol bottles
- Marks or stains from previous using/drinking.
- Sunglasses cases or other storage bags, cases
A study by the University of Southampton maintains that exposure to drug-related objects may influence a former addict’s behavior. The brain registers these stimuli and processes them in the same areas involved in drug or alcohol seeking behavior.
People at risk of a relapse should avoid stressful situations that are likely to push them towards wanting to use drugs and alcohol.
While seasonal holidays are a time of celebration for some, they may be a struggle for people in recovery.
Some examples of common situations that many addicts can find difficult are listed below:
- Meeting new people
- Listening to a particular song or genre of music
- Recovery group meetings
- Going out to eat or dance
- Parties or other social gatherings
- Socialising with certain people, especially substance using peers
- Payday or receiving money
- Before or during a date
- Before, during or after sex
- Being alone
- During or after an argument
- Anniversary’s, family gatherings or other annual events
- And others
Things such as Christmas or New Years Eve parties involving alcohol may be tricky for some. Family and friends often tempt those in recovery to consume alcohol because they are under the misconception that one deviation from the treatment plan will not be detrimental.
Patients in rehab or community treatment may consider skipping treatment sessions, meetings or support groups to spend time with their friends and family. A break in their usual routine may leave periods of uncertainty, stress or isolation where patients may be inclined to use substances or drink alcohol.
Internal triggers are more challenging to manage than external triggers. They involve feelings, thoughts or emotions formerly associated with alcohol or substance use. When internal triggers arise, they can lead to questionable behaviors that deter recovery progress. Exposure to these cues may cause individuals to crave and use substances, drink or cause them to slack in their normal recovery routine which may cause a gap or change to occur that means a lapse or relapse becomes a greater possibility.
A study of rats by the University of Michigan found that the rats largely preferred rewards that triggered the brain’s amygdala, part of the limbic system that produces emotions. The researchers also discovered that the rats were inclined to work harder to obtain the reward that triggered the amygdala than the same reward that did not trigger any emotion in the brain.
Researchers deduced that the amygdala played an important role in producing focused and exclusive desire, similar to drug and alcohol addiction. Internal triggers act in reverse, associating these signals to the substances that elicit them.
Emotions that can act as internal triggers may include:
- Feeling criticized, inadequate or overwhelmed
- Celebratory feelings
- Feeling “normal”
- Sexual arousal
Individuals can recognise the feelings that can potentially set off a lapse or relapse by asking themselves these questions:
- How do I feel before using drugs or alcohol?
- How do I want to feel before using substances?
- In the last week, how did I feel when I used or wanted to use substances?
- What can I do to resolve the way I feel without using drugs or alcohol?
It’s important for people in recovery to be aware of the internal triggers they struggle with the most and have a plan in place to seek support when needed.
Many addicts get so used to masking the way they feel so that anytime an uncomfortable feeling arises, they use drugs or alcohol so that those feelings go away. However that could simply be their body reacting normally to the situation but because emotions become dulled or completely smothered, they then seem strange and sometimes overwhelming. That’s why sitting with those feelings with the help of meditation and mindfulness can be a helpful skill to learn and regularly practice.
Stress Increases Vulnerability to Triggers and Relapse
A study from Marquette University pointed out that stress rendered people in recovery more vulnerable to other relapse triggers. Researchers followed the cocainepatterns of stressed and unstressed rats and used a low dose of cocaine as a trigger. The stressed rats’ responses to the trigger mirrored those of people during relapse.
In rats and humans, the hormone corticosterone increases the level of dopamine, a brain chemical that plays a major role in reward-seeking behavior, in the brain in response to stress. Cocaine and several other illicit drugs also boost levels of dopamine. The Marquette researchers stated a stressed animal previously exposed to cocaine will crave the drug because the dopamine surge from cocaine trumps the release of stress-related dopamine.
After removing the corticosterone-producing glands from the rats, researchers observed a lack of relapse behavior after triggering them with low doses of cocaine. In contrast, when they increased the corticosterone levels, unstressed rats showed relapse behaviors when triggered.
What’s The Difference Between A Lapse & A relapse throughout life?
It’s important to know the difference between a lapse and a relapse, two very different situations that can occur in anyone’s recovery.
A lapse, which can also be known as a slip, is a situation where someone has a very brief “slip” where they drink or use, but they stop quickly afterward, normally just involving one incident only, avoiding a full relapse into addiction. Usually, this happens when a person decides to use again but instantly regrets the decision straight away afterwards.
Other names for lapses can be: a failure, failing, slip, error, mistake, blunder, fault, omission, hiccup, slip-up, slide, boo boo or whoopsy.
Some people have a simple lapse, where they use (normally once but not more than twice) but immediately stop and return to recovery and it often strengthens their will to stay clean and sober. Others allow a slip to turn into a full-blown relapse or even a total downward spiral with no escape in sight and ending up back in full blown active addiction.
The word relapse actually stems from the Latin meaning: to slip back. This is used as a designation for someone who has been sober or clean and fell back into their previous active substance abuse/addiction.
Their length of sobriety and abstinence can vary from a week to a month or even several years and has no defined timeframe. The basis of a relapse is when someone who was in recovery for any amount of time returns to their old ways and old substance abuse/addiction habits. In some cases, substance use in relapses can actually increase from the amount previously used/abused which not only makes the overall situation worse but also puts them at a high risk of overdose and death.
Typically, a slip is extremely short-lived and does not take away from someone’s motivation to stay clean or sober and recover from their addictions. In fact, it can often fuel their decision to get back on track and stay there. Knowing that a slip is easily possible if their eyes are taken off the ball for even a second. However if the right tools, effort and support are in place and are ongoing then the addict can and will get back on their feet in their recovery and avoid making the same mistake twice.
It is important to understand that not everyone in recovery experiences a relapse. However, it is a topic that everyone should be aware and mindful of so that if a lapse or full blown relapse does occur, then you’ll know what to do about it and that it doesn’t mean you’ve failed or given up. It simply means that you can get back on the “horse” and carry on in your recovery. Fortunately recovery isn’t like an exam where you simply have two options, pass or fail. In recovery you simply do or don’t do.
The Stages of Relapse
Triggers for addictive behavior do not initiate immediate use.
When people in recovery succumb to triggers, their brains create reasons to use substances or alcohol despite knowing that they must remain abstinent. This ongoing fight increases their vulnerability to cravings, which may result in a potential lapse/relapse.
Former drug or alcohol users are in denial during emotional relapse, but they do not have thoughts of using. They are ashamed of the last time they lapsed and may have developed negative behaviors to cope with their thoughts. This state of mind is dangerous because it encourages bad health practices that can eventually lead to a full-blown relapse. Signs of an emotional relapse may include:
- Holding back emotions
- Avoiding AA, NA, CA meetings
- Being reserved at meetings
- Focusing on other people’s problems
- Bad eating and sleeping habits
During therapy for people experiencing emotional relapse, patients are encouraged to identify their denial and focus on self-care.
Mental lapse, or relapse justification, is the continuous fight between wanting to use and knowing you should not use. Individuals often underestimate the dangers of situations and fall into the trap of single-time use. They give themselves permission to use substances in a controlled way, but the frequency of use generally increases until they fully relapse. Signs of a mental relapse may include:
- Drug or alcohol cravings
- Thoughts about people, places and things associated with former use
- Glamorising former use of substances
- Plotting to better control substance use
- Actively seeking relapse opportunities
- Planning a relapse (intentionally or unintentionally)
Education on coping skills can help people manage thoughts of using.
A physical relapse occurs when someone starts using again. It is the culmination of an emotional relapse and a mental relapse. Physical relapses are one of the most challenging stages of lapse to overcome. In many cases, users cave to drug or alcohol use during a window of opportunity and falsely believe it will cause no harm.
External triggers are easier to identify and manage than internal ones. Substance addiction treatment aims to help individuals recognise the early warning signs of relapse and develop healthy coping skills to thwart a potential lapse/relapse.
Managing External Triggers
Triggers that happen outside of the individual are not necessarily beyond control. There are multiple reminders of substance use in a former drug or alcohol user’s life, including people, places and things. Asking the right questions and taking the correct steps can enable people in recovery to healthily transition to their normal life without risking a lapse/relapse.
Recovering individuals can carry out personal exercises where they make a list of the people, places and things that remind them of their substance using life. Asking certain questions about external triggers can help prevent a lapse/relapse.
Some questions to ask can include:
Eliminating Drugs & Paraphernalia
- Do you think an upcoming event or situation will prompt substance cravings?
- Are you currently in a situation that triggers cravings? Can you leave?
- Are you stuck in a situation that forces you to think about substance use?
- Were you recently in a situation that sparked a thought about using substances?
- What drugs do you have around your house or in your car?
- What paraphernalia did you use with your drugs?
- What objects did you use when you took drugs and consumed alcohol?
- Do you have a non-using family member or friend who can purge your home from objects that remind you of your former life?
- How soon can you arrange for your family or friend to rid your home of drugs and related objects?
Avoiding Substance Users
- With whom did you use substances?
- Who were your former suppliers?
- Do you have their phone number saved?
- What steps can you take to stop contact with your dealers and substance-using peers?
- Do you have family members or lovers who are substance users?
- How should you approach the situation if they are still using?
Avoiding High-Risk Areas
- What neighborhoods, streets, houses or other locations do you associate with drugs or alcohol use?
- Do you encounter these daily, while going to work, on a jog or on the way to treatment?
- Can you avoid high-risk areas?
- How do you plan to avoid these areas?
- What can you say to refuse drugs and leave the situation when someone pressures you?
Managing Internal Triggers
Individuals develop new thoughts, feelings and behaviors while using substances. These may include shutting family off, denying issues or justifying substance use. Healthier practices need to replace these negative internal processes in order to help people succeed in their path to a substance-free life.
Users in recovery can ask themselves some questions to help them understand their internal thoughts and feelings.These questions include:
- How did I shut off my feelings?
- What are the benefits and risks of shutting off from friends and family?
- How can I change this?
- How did I change my thoughts to avoid reality?
- Did avoiding reality help?
- How can I change that behavior?
- Do I engage in specific behaviors to avoid difficult circumstances?
- What are the advantages and disadvantages of these behaviors?
- What types of behaviors would be healthier?
The earlier people in recovery can identify and successfully respond to triggers, the greater their chances of prolonged abstinence, success and happiness.