Do not use again alone tonight. Your tolerance dropped during the break, so the amount that used to be ordinary is not what your body can take now. After that: tell one person today, keep your next appointment, and get back to the ordinary routine tomorrow morning rather than on Monday. Four steps, in that order.
The safety part comes first
This is the thing almost nothing written about relapse tells you, and it is the reason the day after a clean stretch is the most dangerous day.
The World Health Organization is explicit: all opioid dependent patients who have withdrawn from opioids ["should be advised that they are at increased risk of overdose due to reduced opioid tolerance"](https://www.ncbi.nlm.nih.gov/books/NBK310652/). The NHS says the same in one line: ["Detox lowers your tolerance to heroin. This means your risk of overdosing is higher if you take heroin or other drugs, such as benzodiazapines, after detoxing."](https://www.nhs.uk/live-well/addiction-support/heroin-get-help/)
Any gap counts, not only a formal detox. A fortnight, a hospital stay, a stretch inside.
So, tonight:
- **Never use alone.** If something goes wrong, someone has to already be in the room.
- **Assume your old amount is too much.** Whatever you used to take, that is not the reference point any more.
- **Have naloxone in the house** if opioids are anywhere in the picture, and make sure someone knows where it is and how to use it. [Naloxone and keeping yourself alive](/guides/drugs/naloxone-and-keeping-yourself-alive) covers how to get a kit.
- **Know the signs of an opioid overdose.** WHO lists ["pinpoint pupils, unconsciousness, difficulties with breathing"](https://www.who.int/news-room/fact-sheets/detail/opioid-overdose). If you see them in somebody, call 999.
If alcohol is part of this and you had gone back to drinking daily and heavily, do not stop that suddenly either. UK guidelines warn that reducing too quickly ["can lead to severe complications and can even be fatal"](https://www.gov.uk/guidance/clinical-guidelines-for-alcohol-treatment/8-harm-reduction). Ring a GP or your service.
The four steps
**1. Stop this episode.** The most expensive belief available is that the week is already ruined so the rest of it is free. It is not free. One night and a three-week return are different problems, and the only thing between them is the next few hours. Eat, drink water, sleep, and do not go back out.
**2. Tell one person today.** Same day, short message, no essay. "I used on Saturday. I'm still doing this." Going quiet is what turns one night into a month, because the secret has to be maintained and maintaining it takes all the energy you needed for the actual problem. If there is nobody yet, [telling someone about your drug use](/guides/drugs/telling-someone-about-your-drug-use) is the harder starting point, and a helpline works tonight.
**3. Ring your keyworker or GP, and do not vanish.** The National Institute on Drug Abuse describes a return to use as ["often part of the treatment and recovery process"](https://nida.nih.gov/publications/drugfacts/treatment-approaches-drug-addiction), and UK services plan for it. Two specific things matter here. Do not stop taking a prescribed substitute medicine because you feel you no longer deserve it. And if you have been out of contact for a while, ring anyway. Being embarrassed is not a reason to be untreated.
**4. Do the next ordinary thing.** Not a grand restart. Get up at the usual time, eat, go to work, keep the appointment. Recovery is built mostly from unremarkable days, and the quickest way back into one is to have one.
What not to do
**Do not write off the attempt.** Six weeks did not stop having happened because of Saturday. You are not back at the beginning. You are somebody with six weeks of practice who had a bad night, which is a materially different position.
**Do not build a bigger plan out of guilt.** Ninety days, a total ban on socialising and a new regime, decided at four in the morning. Oversized plans collapse inside a week and take the small working ones with them.
**Do not restock.** The single most consequential decision in the next twenty-four hours is whether there is any left in the flat tomorrow. Get rid of it now, while you still want to.
**Do not go quiet on the person you told.** Silence takes away exactly what telling them bought you.
The shame loop, and why it is a practical problem
The reason to deal with shame here is not kindness. It is that shame reliably produces the next episode.
The sequence is familiar. You use, you feel disgusted, the disgust is unbearable, and the fastest available way to stop feeling it is the thing that caused it. Two days later the story has changed from "I had a bad Saturday" to "I am the sort of person who cannot do this", and the second story is far harder to come back from than the Saturday was.
What breaks it is boring specificity. It was one night. It started at about eight. You had not eaten. You had money in your pocket and you walked the usual way home. Those are facts you can change. "I am hopeless" is not a fact and cannot be acted on.
Then, in a day or two, look at the route
Not tonight. When you are steadier, spend ten minutes on what actually happened rather than on what it says about you. Where were you, what hour was it, who was there, what had you eaten, what were you feeling in the ten minutes before, and where did the money come from?
That is the same four columns as [the people, places and hours that pull you back](/guides/drugs/mapping-your-using-triggers), and a single night's data is genuinely useful. Nine times out of ten it points at a route that was still open, which is a twenty-minute fix rather than a character rebuild. [Cutting off the supply](/guides/drugs/cutting-off-your-dealer-and-your-supply) is that list.
One night or something bigger
Be honest about which of these you are in, because the responses differ.
**One episode after a good stretch.** The four steps above are the whole answer.
**A return to regular use over a fortnight.** That is not a slip. Go back to the start of the process rather than trying to grind on from where you are: ring the service, say exactly what you are using now, and let them reassess you. Nobody will be annoyed. It is what services are for.
**Repeated short attempts, weeks apart, ending the same way each time.** That usually means something structural is missing rather than that you are failing. Most often it is medication, a person, or an unfilled fortnight. Say that out loud to a clinician instead of running the same month again.
Who to ring tonight
FRANK is 0300 123 6600, 24 hours. Narcotics Anonymous UK is 0300 999 1212 between 10am and midnight. Cocaine Anonymous UK is 0800 612 0225. SMART Recovery UK is 0330 053 6022. Samaritans is 116 123 at any hour, and you do not have to be in crisis to ring.
We Are With You runs free local services across England and Scotland plus a webchat with trained recovery workers, and its own advice where there is an immediate risk to life is to call 999.
Common questions
**Does one slip mean I have to start again from zero?** Only if the counter is helping you. For some people the day count is useful structure and for others it turns one night into a reason to abandon a month. If yours does the second, count differently: days this month, or clear evenings out of thirty.
**Why is using after a break more dangerous?** Tolerance falls while you are not using. WHO advises everyone who has withdrawn from opioids that they are at increased risk of overdose for that reason, and the NHS says detox lowers tolerance so the risk of overdosing is higher afterwards. Your old amount is not a safe reference point.
**Should I tell my keyworker I used?** Yes, and it changes nothing about how you will be treated. It changes what they can offer, which is the point. Services expect it and plan for it.
**Will I be thrown off my prescription?** Ask the service directly what their policy is rather than assuming the worst and disappearing, which is the outcome that actually harms you. Do not stop taking a prescribed medicine on your own because you feel undeserving.
**How do I stop the spiral at three in the morning?** Do not try to settle anything at three in the morning, because nothing decided then is reliable. Eat, drink water, go back to bed, and write the four columns in daylight. Ring Samaritans on 116 123 if the night is genuinely bad.
Sources
- [WHO, clinical guidelines for withdrawal management](https://www.ncbi.nlm.nih.gov/books/NBK310652/), for increased overdose risk after opioid withdrawal because of reduced tolerance.
- [NHS, Heroin: get help](https://www.nhs.uk/live-well/addiction-support/heroin-get-help/), for detox lowering tolerance and raising overdose risk afterwards.
- [WHO, opioid overdose fact sheet](https://www.who.int/news-room/fact-sheets/detail/opioid-overdose), for the signs of an opioid overdose.
- [NIDA, treatment approaches for drug addiction](https://nida.nih.gov/publications/drugfacts/treatment-approaches-drug-addiction), for a return to use being often part of the treatment and recovery process.
