The essential definition of relapse is when symptoms of a medical condition begin to return and get worse after a period of improvement or maintenance. When discussing a substance use disorder or addiction, the term applies to a return of cravings, impulse control problems involving the substance, and ingestion of the substance. The recovering addict is unable to control their behavior around the substance or seeks it out.
Although relapse can be difficult to deal with, and lead the recovering person to feel disappointed in themselves, it is currently an expected part of the recovery process. Addiction is a chronic illness, like diabetes or multiple sclerosis, and addiction treatment is part of the process to improving symptoms and helping the individual live a normal, healthy life. Therapy and medications are considered an integral part of this treatment process, much like with other chronic illnesses.
The Role of Relapse in Addiction Recovery
Because addiction has previously been considered a failure of willpower, people who relapse might believe that they are defeated or have failed. This is not true. Addiction changes brain chemistry, and sometimes brain shape, and treatment is a long-term process of changing the brain back as much as possible. According to the National Institute on Drug Abuse (NIDA), between 40 and 60 percent of people recovering from an addiction relapse after treatment. However, these relapse rates are actually similar to relapses of other chronic conditions, including diabetes, hypertension, and asthma.
Relapse into addictive behaviors is a two-step process. The first step involves hyperstimulation of the reward centers in the brain, which have been changed because of how intoxicating substances can interact with this system and control or release dopamine, serotonin, and other neurotransmitters. In the second stage, the overstimulated neurons impact other areas of the brain involving behavior and memory. The reward system can trigger sensations of pleasure when a person visits a place where they took drugs, when they go to an event that leads them to remember taking drugs, or when they see an object or person that reminds them of taking drugs. The reward system releases enough dopamine to trigger other parts of the brain to engage in seeking more dopamine release, which is associated with intoxicating substances.
These changes to memory, reward systems, and other brain structures can remain in place for years. Studies show that the majority of relapse occurs right after a rehabilitation program ends. For example, a study of recovering heroin users found that 91 percent of study participants relapsed after treatment, and 59 percent of those were within the first week after leaving the program. However, relapse can occur even years after leaving a rehabilitation program. This is part of the recovery process, and it only means that the person should seek help from their therapist and medical professionals.
Drug addiction treatment programs take relapse into consideration during the course of treatment. There are many different approaches to treating and preventing relapse, which can be considered when choosing a treatment program to enter. Reducing the likelihood of relapse is very important, but learning how to manage relapse when it occurs is equally important on the journey of recovery.
Triggers for Relapse and How Treatment Can Help
There are several reasons people overcoming an addiction relapse, and understanding these helps mitigate the risk of relapse.
- Drug-related reminders: Being around drugs, having drug-related dreams, discussing drugs, or watching others take drugs are just a few of the cues that can trigger cravings and drug-seeking behaviors in people who are going through recovery.
- Negative moods: Depression, anxiety, stress, and anger can all trigger cravings for drugs, since the brain’s reward system is still used to taking an intoxicating substance to release dopamine and balance these negative feelings.
- Celebrations: Good times like holiday parties or social events can involve intoxicating substances, and they can also trigger cravings or drug-seeking behaviors to increase the brain’s flow of dopamine.
- Trying the intoxicating substance again or taking another intoxicating substance: Even small amounts of a substance of addiction can lead to cravings for more of the substance and further drug-seeking behaviors. This is why it is important for people to discuss their struggles with addiction with their doctor when they receive prescription medications and avoid any intoxicating substance.
- Addiction is a chronic illness that will require consistent management and monitoring.
- Therapy can help with coping skills, including ways to manage cravings and stress.
- Continued engagement in 12-Step meetings or peer support groups can provide ongoing social support.
- Periodic visits with therapists, treatment specialists, or a sponsor can manage potential issues with relapse.
- Continued care programs like drug testing can also monitor potential relapses.
Each person in treatment and recovery has a slightly different chance of relapse. Factors involved include the length of time the person struggled with their addiction, what type of substance they used, and if they have any co-occurring disorders, such as bipolar disorder or polydrug abuse.
Avoiding a Relapse with Understanding
Medical researchers have compiled a list of warning signs that could lead to relapse. These include:
- Feeling fearful of a potential relapse, but not discussing this fear
- Denying fear of relapse
- Detoxing or being abstinent from drugs, but not going through further recovery treatment
- Leaving a treatment program before 90 days
- Avoiding discussion of triggers or anxiety during treatment
- Being isolated physically, emotionally, or socially
- Experiencing a mental health issue, such as anxiety or depression
- Focusing on the past
- Focusing on work or obligations without taking time for fun activities or exercise
- Failing to relate to others in the treatment program
- An unstructured or even chaotic daily experience
- Friends or family members using intoxicating substances
- Fantasizing about ingesting intoxicating substances
- Feeling angry, resentful, sad, or guilty, and not discussing this in therapy sessions or during treatment
- A belief that one should be happy all the time
- Unable to find ways to have fun while sober
- Failure to remove intoxicating substances from the home or other personal environments
- Bouncing from one crisis situation to another, such as housing issues, work stress, or family problems
- Lacking self-confidence to move forward
These psychological symptoms should be addressed in therapy.
Other aspects of treatment can help to prevent relapse. Using medications like buprenorphine, antidepressants, or over-the-counter pain medications can manage withdrawal symptoms, but should only be used under direct medical supervision.
Family and friends, as well as treatment professionals, should encourage the person to remain in treatment for the full 90 days recommended by NIDA. Although some treatment centers offer shorter stays, these have not been shown to be effective for most people.
Therapists in both individual and group therapy should work with the person on what stresses and triggers may be encountered when they leave treatment and work on methods to deal with these. A few types of therapy that involve this type of strategizing and management include:
- Cognitive Behavioral Therapy: This specifically helps clients recognize triggering scenarios, avoid them, and cope with the feelings that come up.
- Contingency Management: This uses positive reinforcement like non-substance rewards for maintaining abstinence from drugs, attending meetings and therapy sessions, and taking any prescription medications as needed.
- Motivational Enhancement Therapy: This develops strategies that rapidly invoke internal motivations to seek treatment in the event of a relapse.
- Family Therapy: Family and close friends work together with the person in recovery and a therapist to learn signs of relapse and strategies to help the person in recovery in the event of a relapse.
Managing a Relapse When It Happens
When a person relapses after addiction treatment, it is important for them to re-enter a program as soon as possible. It is also important for treatment programs to emphasize that this is a possibility, and it is not a sign of failure. Recovery is a lifelong effort, and family, friends, and treatment professionals must all be part of an ongoing support network encouraging the continued work of recovery.