A Relapse Doesn’t Mean Recovery Failed, Says Behavioral Health Expert

For many people living with anxiety, depression or trauma, substance use doesn’t begin as a crisis. It begins as relief. A drink, a pill or another substance can offer a quick break from a nervous system that feels constantly overloaded or a numbness that’s hard to shake. Over time, though, that relief can fade, and the substance that once seemed like a solution can start intensifying the very symptoms a person was trying to escape.

Breaking that cycle is difficult, in part because substance use and mental health conditions tend to feed each other. That’s why many clinicians now treat them together through what’s known as integrated care, bringing psychiatric care, therapy, medical management and addiction counseling into one treatment plan.

The Educated Patient spoke with Bonnie J. Mitchell, DBH, LPCC, clinical director at The Mental Health and Stabilization Center of Sacramento, about how self-medication takes hold, what happens in the brain with regular use, why treating co-occurring conditions together matters and how people can stay in recovery after a setback.

You've treated a lot of people who started using substances to cope with anxiety, depression or trauma. What does that pattern typically look like in the beginning, and at what point does it usually stop working the way it once did?

Bonnie J. Mitchell, DBH, LPCC: The beginning of substance use often starts as a relief of the symptoms. Someone who is living with unmanaged anxiety, severe depression or active trauma responses often has a baseline state of chronic nervous system overload or deep emotional numbness. Self-medication can look more like a solution than a crisis. It works almost instantly by offering a short window of calm or escape. Over time, the person is no longer taking the substance to feel relief; instead, they are taking it just to get back to their original baseline. This shift happens when physical dependence sets in and the brain adapts to the frequent presence of the substance. Clinically, I would call it “neurobiological tolerance.”

You often see substance use worsen the exact symptoms someone was originally trying to escape. Can you walk us through why that happens — what's going on with anxiety, depression or trauma responses over time with regular use?

BM: Many substances flood the brain's reward pathway with dopamine. In response to this flooding, the brain downregulates dopamine receptors to protect itself. Then this leaves the person with a reduced capacity to experience pleasure naturally.

Eventually, the person experiences deeper depressive episodes when sober. Regular substance use keeps the nervous system trapped in a cycle of avoidance while lowering the threshold for panic and trauma triggers. When the drug wears off and the body adapts to tolerance, the brain compensates by suppressing GABA and surging glutamate. This cycle creates severe physiological rebound anxiety, making the baseline anxiety far more intense than before.

Self-medicating can become a hard cycle to break. What makes it so difficult, and what's usually the turning point for someone who starts to recognize they're stuck in it?

BM: Breaking the cycle of self-medicating requires navigating both physical dependence and psychological patterns. Substance use creates an immediate relief by altering a person’s brain chemistry. When the substance wears off and the original symptoms return, they are intensified.

The negative consequences occur hours or days later by taking a physical toll on the body with a so-called crash that induces depression and anxiety. Their brain naturally prioritizes immediate relief over delayed discomfort. A primary turning point I have witnessed with my patients is when the self-medicating behavior stops delivering relief and begins causing more distress than the original symptom. I see them realize that the "solution" has become the main source of suffering and breaks the illusion of control.

You treat co-occurring mental health and substance use conditions together rather than separately. Why does that integrated approach matter, and what tends to go wrong when only one side gets addressed?

BM: Addressing co-occurring mental health conditions and substance use disorders at the same time is known as integrated treatment and is the clinical standard of care because these conditions do not exist alone. They form a connected feedback loop where each drives the other. Treating them together allows me and other health care providers to address the root causes of the problem while simultaneously building stabilization strategies in real time.

When a patient understands how their mental health fuels their urge to use substances, they can build integrated coping mechanisms instead of managing two separate issues. Integrated care brings psychiatric care, therapy, medical management and addiction counseling under one cohesive treatment plan. This eliminates conflicting medical advice, dangerous drug interactions and fragmented therapy goals.

In the past, treatment systems forced patients to achieve sobriety before receiving mental health care or vice versa. Without active psychiatric support, the unmanaged mental health symptoms quickly become intolerable. Relapse becomes a predictable mechanism for immediate survival and relief.

You've said recovery is rarely a straight line. For someone in the middle of a setback right now, what would you want them to understand about that, and what helps people stay in the process instead of giving up on it?

BM: I would want my patient to understand that I consider a setback as data, not defeat. A lapse or relapse reveals valuable information about their current ecosystem. It highlights where an underlying symptom spiked, where a coping tool was overwhelmed or where a gap in their support network appeared. It shows where their treatment plan needs adjusting.

I would encourage them to represent immediate honesty with a safe support network because isolation fuels setbacks. Reaching out quickly to a therapist, medical provider, sponsor or trusted loved one strips away the secrecy and shame that keep people stuck. Looking closely at the 24 to 48 hours leading up to the setback helps pinpoint what happened. A setback indicates that your existing strategies were outmatched by something specific. Staying in the process means adapting and adding new coping tools, modifying medication under professional guidance or increasing support frequency.