What happens in the few moments before a relapse?

It’s 12:05am. Your salary arrived five minutes ago, and now it’s gone. You’re sitting in the same room, holding the same phone, but everything feels different. 312 spins in 5 minutes. There were more than three months since you last gambled. Three months of rebuilding trust, sleeping a little better, beginning to believe that perhaps life could feel like yours again.

“I don’t know why I did it,” you say. “It just happened.”

I think we need to listen carefully to that sentence, because somewhere inside it is a person trying to understand how they could do something they so desperately wanted to avoid.

So, what happened?

In his now rather famous book, Behave, Robert Sapolsky approaches behaviour by travelling backwards. What was happening in the brain a second before the action? What happened in the seconds and minutes before that, in the world around the person and within their body? Then further back, through experiences and circumstances that shaped how this particular moment would be received. His invitation is to understand behaviour through its history, across different timescales.

Let’s take that invitation and return to our story.

Your phone lights up. The salary notification appears.

For someone else, this might mean rent, groceries, a small sigh of relief. For you, perhaps payday has repeatedly been followed by gambling, and that notification carries a history. Before you have put the feeling into words, it may already be drawing your attention towards something familiar.

Research involving people experiencing gambling harm shows that gambling cues can provoke craving and engage brain regions involved in motivation and reward. Applying this to our scenario, payday could function as a learned cue, although we cannot know what happened in this person’s brain from their story alone.

To understand this better we need to enter the wonderful world of neurotransmitters and their role into deciding neurological processes occurring before a behaviour.

Neurotransmitters are chemical messengers that neurons (nerve cells) use to communicate with each other and with other types of cells in the body. They are released from one neuron and travel across a small gap called a synapse to bind to receptors on the next neuron, influencing whether that neuron will activate and send its own signal. Neurotransmitters play a critical role in regulating various functions in the body, including mood, memory, muscle contraction, and the body's response to stress. Essentially, they are the key to how our brain and nervous system manage everything from emotions to physical movement.

They respond to what happens in our inner and in the outer environment in the seconds to minutes before we act in a way or another. They act like on and off switches for our intentions.

From all the neurotransmitters, there is one that plays a more significant role in the development and maintenance of addictive behaviours more than any other: Dopamine and its continuous tango with the brain’s reward and anti-rewards systems.

I believe that dopamine deserves a better introduction than “the pleasure chemical” as is so often described as.  Dopamine contributes to many aspects of learning and motivation, including the pull towards something associated with reward. Berridge and Robinson’s distinction between wanting and liking helps explain why someone can feel powerfully drawn towards a behaviour they no longer enjoy. That pull can coexist with a sincere wish to stop.

But dopamine is also not just about reward. Actually, dopamine is more about the anticipation of the reward and building motivation to chase that potential reward. What is really interesting about it is that you are more likely to get a dopamine kick if “maybe” you’ll get a reward. Is the anticipation of possibly discovering a treasure. And it can go even a step further, as if you switch from just going with “maybe”, incredibly powerful though that is, to going with “almost”, you get to a whole new level.  The better you do that the more people will press a lever/use a drug/stare at a screen till they’ll drop or lose everything.

Every time you get a totally unexpected reward from out of nowhere (like it happens when you have a win) you can be sure that there will activation of dopamine reward pathways in your brain.  Your brain remembers that as something that they need to look for, redirect your attention and intention and motivate you towards it again. And again… and again.

Understanding this intricate dance between reward, motivation, and behaviour may hold the key to helping those who find themselves on the verge of relapsing.

In our particular scenario, you encounter a cue associated with past addictive behaviours, that is getting your salary, which activated the dopamine pathways and predicted (thus directed your action) towards a behaviour that was previously associated with getting your salary. The brain sees it as a bonus (energy saving) if we repeat what we’re already used with in certain situations.

Perhaps what comes next is an image of a previous win. Or perhaps gambling promises a few minutes away from something you cannot bear to feel.

“I’ll only have a look.”

We should be curious about that sentence too. What is the person expecting gambling to do for them, right now?

Studies following people through everyday life find that cravings predict subsequent gambling episodes, and that expectations of enjoyment or excitement can interact with craving. These are changes in likelihood, not a precise way of telling exactly when an urge becomes an intention.

Once play begins, the experience brings further encouragement to continue. Near-misses can recruit reward-related circuitry and increase motivation to gamble, even though the person has lost. The feeling of being close can be persuasive without making the next win any closer.

Does this mean that by the time we notice what is happening, everything has already been decided?

We need to be careful here. Experiments examining simple movements show that preparation in the brain does not always make an action inevitable; people can sometimes cancel movements after that preparation has begun. But these experiments cannot give us a precise stopping window for gambling or settle the question of freedom of choice.

What they leave open is the possibility of interruption. In practice, we can work towards that at several points.

Before payday, we can help someone arrange protections while they have time to think: self-exclusion, blocking software, bank gambling blocks, and an agreed plan for essential payments. NICE includes blocking tools and managing exposure to triggers among approaches to reducing relapse risk. These protections give the person’s intention to recover a practical presence in the moment when it may be hardest to hold onto.

Victor Frankl said that between stimulus and response, there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom. And that space is at times believed to be as short as 90 seconds. So, when the notification arrives, we have very little time to make decisions, which is why a rehearsed response might help: “If I notice myself wanting to open a gambling site, I put the phone down, leave the room and contact the person we’ve agreed.”

That is a concrete action we can practise together. Planning has promise, but gambling research is mixed; an if–then sentence should sit within broader support, without becoming another test the person can supposedly fail.

When the urge is already there, we can help the person recognise it: the restless hands, the narrowing attention, the thought returning again and again. Urge surfing involves noticing those sensations as they change, without immediately acting on them. A small gambling study found reduced craving after brief coping activities, but it had no control group, so we should offer these tools with hope and honest limits. There is no guaranteed number of breaths after which an urge disappears.

For professionals, this means slowing the story down together. What happened before the first deposit? What did gambling seem to offer? Where could we make support easier to reach?

And even if the first bet has happened, help still matters. We can support stopping, address immediate safety and make returning to care straightforward. NICE explicitly recognises both the distress of relapse and the importance of reducing shame and providing rapid re-entry to treatment.

At 12:05am, the person needs to know that those three months of recovery still belong to them.

They need to know that they have more power than they think to take back control.

And, when they are ready, they can return to reflect upon that midnight moment in, with curiosity to understand what happened and care to prepare for the next difficult moment.

Because understanding how a behaviour became possible also helps us ask what might make a different next step possible.