Addiction is a “chronic, relapsing brain disease.”
— National Institute on Drug Abuse
Nobody chooses to relapse.
Just like every other time addiction strikes, relapse does not occur due to a lack of willpower. It does not mean that drug treatment has failed. Rather, relapse is a common part of the recovery process which occurs most frequently in people who do not take part in aftercare.
The relapse rate of addiction disease mirrors those of other chronic illnesses, such as hypertension and diabetes.
Overall, between 40–60% of recovering addicts experience relapse at some point, often within three months of treatment conclusion.
While those numbers may seem discouraging, there are dozens of concrete ways to prevent relapse and improve one’s chances of sustained recovery.
Relapse is a roadblock, but the road is still there. Recovery is always possible — and seeking help is a sign of strength.
Addiction is a medical disease, and relapse is a common part of recovery. Still, people who experience relapse often feel alone and defeated.
If you are feeling this way, please know that you are not alone. Learn about relapse and how to get your life back after it happens.
What Does Relapse Mean?
Relapse is when addiction disease behaviors recur uncontrollably after a period of sobriety.
Addiction is a “primary, chronic disease of brain reward, motivation, memory and related circuitry.”American Society of Addiction Medicine
Sometimes a recovering addict will return to substance abuse on an isolated occasion, then quickly recommit to sobriety. This is not considered a relapse but a slip. It does not have the same ramifications as a full-fledged relapse but should receive medical attention nonetheless. After all, relapse can begin with a single slip.
Regardless of the severity of one’s return to substance abuse, it is crucial to get immediate help.
Why Do Addicts Relapse?
Just like any other chronic disease, addiction requires regular medical attention. Rehab aftercare programs are designed to keep patients motivated towards sobriety. Without this continued care, the brain can become more vulnerable to illness.
“You don’t have to do anything [on your own to cause relapse]. Stop using alcohol and other drugs, but continue to live your life the way you always have. Your disease will do the rest. It will trigger a series of automatic and habitual reactions to life’s problems that will create so much pain and discomfort that a return to chemical use will seem like a positive option.”Relapse guru Terry Gorski
Relapse rates depend largely on the following factors:
Type of Treatment
It is important to receive holistic therapy that not only eliminates addiction behaviors but also treats the causes behind the addiction. In fact, people who undergo intensive treatment (such as residential or outpatient rehab) after detox are 10x less likely to relapse.
Recovery doesn’t happen the moment that formal treatment concludes. According to one study, residential treatment patients who take part in a structured aftercare program relapse at one-third the rate of those who do not.
Co-Occurring Mental Illnesses
The overall addiction relapse rate is much higher than normal in people who suffer from coexisting mental illnesses, such as bipolar disorder or depression. Specialized dual diagnosis treatment is crucial.
Clinical experience shows that support groups help people handle the negative emotions of addiction. A recovering addict who has a strong network of friends, family members, aftercare providers, and support group members is much less likely to relapse than someone who is trying to go it alone.
Duration of Sobriety
Extended abstinence from substance abuse predicts long-term recovery. If someone remains sober for less than one year after treatment, there is a 67% chance they will ultimately relapse. If they stay sober for a full year, that chance drops to 50%. And after five years of sobriety, relapse rates fall to 15%.
Specific Substance Used
Different substances impact the brain in unique ways. For example, the heroin relapse rate is especially high since heroin binds to the brain’s opioid receptors, causing an intensely addictive response. After one year of sobriety from opiates like heroin, there remains an 85% chance of relapse, according to heroin statistics. However, after a year of sobriety, the overall substance addiction relapse rate is less than 50%.
Identifying Alcohol and Drug Relapse Triggers
A trigger is a stimulus that causes someone to experience uncomfortable emotions associated with a prior traumatic event. For example, a car accident survivor may get triggered when they pass the location of their crash. They will feel the same emotions that they felt during the traumatic event, such as fear and panic. Physical symptoms usually show up as well, like muscle tension or increased heart rate and blood flow.
For recovering addicts, addiction triggers can inflict an overwhelming substance craving that manifests physically and mentally. Though specific triggers differ from person to person, the three most common types of relapse triggers are stress, exposure to the substance, and reminders of the substance (including people, places, items, or feelings associated with the substance).
Smelling beer on a friend’s breath may trigger someone recovering from alcohol addiction. A woman used to do heroin on a particular couch in her basement could be triggered by sitting on that couch. A college student in recovery might get triggered by the stress of a relationship breakup or financial problems.
During rehab for drug addiction, those in recovery must work with their therapists to identify their personal triggers. Often a therapist will hone in on an individual’s substance abuse patterns, and figure out what kinds of events trigger temptation or use for that person. From there, the therapist and patient can work together to develop coping skills. Many people fend off triggers and cravings by engaging in relapse prevention activities like going for a walk, exercising, diving into a favorite hobby, or contacting a trusted friend or therapist.
Stages of Relapse
Substance abuse relapse doesn’t happen overnight. It is a multi-stage process that begins internally and eventually manifests as external behaviors. Usually, weeks or months pass between the emotional start of relapse and the first time an addict returns to physical use.
Relapse begins subtly, often due to a trigger. During the emotional stage of relapse, a person experiences emotional distress and interpersonal difficulties and exhibits isolating behaviors. They may start skipping drug and alcohol support group meetings or refusing to participate when they do attend. The primary indicator of this stage is poor self-care.
This is when the cravings hit hard. The pain from the emotional stage has become so tremendous that returning to drugs appears to be a viable method of alleviation. People who are in the mental stage of relapse may imagine returning to locations where they used to use or contacting people with whom they used. They may even act on these imaginings. They lie to themselves and others about their current struggles and glamorize their past usage. A common belief is that the recovering addict can control their addiction. They may think, “Now that I’m not using all the time, I know how to have just a little bit, then stop.”
This stage of relapse is when substance use occurs. It begins with a slip and then progresses into full, uncontrollable use.
Relapse Prevention Plans
As is the case with other chronic diseases, early detection is critical. Seek help the moment you notice signs of relapse. The earlier you catch relapse, the better your chances of bouncing back quickly.
While it is good for those in recovery to hold themselves personally accountable, it is far more effective to take part in structured treatment with a mental health professional. A therapist who specializes in treating substance abuse disorder can create a relapse prevention plan, which offers a concrete path to sustained sobriety. Getting a plan that’s unique to you is one of the benefits of individual counseling.
Relapse prevention plans should be individualized and focused on holistic recovery. That is, they should offer realistic coping strategies based on the recovering addict’s unique needs. Most plans incorporate lifestyle changes, evidence-based therapies, alternative therapies, and medication management.
Lifestyle Changes in Relapse Prevention Plans
Consistent self-care is of primary importance in recovery. For some, this may mean nightly bubble baths. For others, it may mean daily journaling to keep track of emotions. An effective plan also considers proper diet, exercise, and rest to be important parts of self-care in recovery.
Social pressure is one of the primary reasons for relapse. Thus, many people need to completely overhaul their social circle, despite any hurt feelings brought on by this major lifestyle change.
Evidence-Based Relapse Prevention
Evidence-based treatments are those that have been scientifically tested and proven effective. Though treatments differ according to each patient’s needs, Cognitive Behavioral Therapy (CBT) has proven especially useful when working to prevent relapse. The goal is total abstinence from substance use through analysis of high-risk situations and the subsequent development of coping strategies.
During a CBT session, your therapist may guide you gently back into your past, where the two of you will explore specific positive emotions and experiences. You will work together to replace your current negative thoughts and behaviors with positive ones. In doing so, that cognitive shift can lead to positive actions. Repeatedly performing this process can successfully change behaviors.
Alternative Therapies in Relapse Prevention
Alternative therapies rely on anecdotal reports rather than scientific evidence to show their effectiveness. For example, clinical experience has shown time and time again that art therapy is a helpful tool in substance abuse disorder treatment. During an art therapy session, the therapist will guide the patient through a process of releasing emotions through creating art.
Other examples of alternative therapies include healing addiction with yoga, listening to music, playing sports, spending time outdoors, among other enjoyable activities.
Group Therapy in Relapse Prevention
After medical detox and rehab, many people rely on 12 step programs such as Alcoholics Anonymous or more formal group therapy sessions arranged by their aftercare provider. Continued support is crucial for lifelong relapse prevention — and millions of people regularly attend addiction support group meetings for decades after treatment.
Medications to Treat Alcoholism and Drug Addiction
Clinicians may use medications in relapse prevention plans when necessary. Some pharmaceutical remedies can help correct the long-term changes that have taken place in addicted person’s brain.
Each of these recovery and detox medications should supplement regular therapy:
Doctors prescribe this as part of aversion therapy to prevent alcohol relapse. Antabuse users become very ill if they drink any alcohol.
This has a similar mechanism as Antabuse, but comes with fewer side effects. Doctors prescribe this to prevent alcoholic relapse by reducing cravings for alcohol. Opiate users also benefit from this medication and experience longer periods of sobriety while using it.
This anti-craving medication helps normalize the brain’s glutamate system, which is involved in alcohol cravings.
Perhaps the most renowned of all drug treatment medications, methadone helps people who are recovering from heroin and opiate addiction to manage their cravings.
Other medications — Clonidine, Librium, Lorazepam, Midazolam, Triazolam, Valium and Wellbutrin all have other uses but can assist in addiction recovery.
Are You Dealing with Relapse?
If you are experiencing symptoms of addiction relapse, you are not alone. Remember that addiction is a chronic, relapsing disease that requires continued medical attention. Now is the time to seek help.
When choosing a rehab program, be skeptical of any organization that purports to have 100% success rates or claims to have an “addiction cure.” At The Recovery Village, we recognize addiction is a medical disease. While addiction cannot be cured, it can and must be managed. We approach substance abuse disorder with compassion, experience, and medical expertise.
Located in peaceful Umatilla, Florida, The Recovery Village lies just north of Orlando, between Tampa and Jacksonville. Our campus was thoughtfully planned to offer a sense of serenity and well-being — the perfect atmosphere for recovery. Clients in our residential drug rehab program enjoy hotel-like accommodations, complete with fluffy towels, soft sheets, and daily cleaning services. Stay fit at our on-site gym or outdoor basketball court. Lounge poolside beneath the warm Florida sun and swaying palm trees. Relax in our private courtyard, stroll through our green gardens, or reflect by the koi pond.
You want your life back — we can help. Our addiction advisors are always available to speak with you on the phone and answer any questions you may have about treatment. If you need help sorting out your level of recovery insurance, we are here for you. We work with most major insurance companies and can communicate directly with your provider on your behalf. If you simply need a listening ear, we are available for that too.
Your moment is now — take the first step by getting in touch.
“DrugFacts: Heroin.” National Institute on Drug Abuse (NIDA), National Institutes of Health, Oct. 2014, www.drugabuse.gov/publications/drugfacts/heroin. Accessed 28 Oct. 2016.
“Drug-Free Housing for Substance Abusers Leaving Detox Linked to Fewer Relapses.” Johns Hopkins Medicine, 27 Feb. 2012, www.hopkinsmedicine.org/news/media/releases/drug_free_housing_for_substance_abusers_leaving_detox_linked_to_fewer_relapses. Accessed 28 Oct. 2016.
Foster, Linda. “Understanding Addiction Relapse – Addiction Center.” EverydayHealth.com, 28 Dec. 2012, www.everydayhealth.com/addiction/understanding-addiction-relapse.aspx. Accessed 28 Oct. 2016.
Gorski, Terence T. “Does Relapse Mean Treatment Failure?” Information About Terry Gorski, GORSKI-CENAPS Web Publications, 24 May 2001, www.tgorski.com/gorski_articles/does_relapse__mean_treatment_failure_010524.htm. Accessed 28 Oct. 2016.
“How Effective is Drug Addiction Treatment?” National Institute on Drug Abuse (NIDA), National Institutes of Health, Dec. 2012, www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/how-effective-drug-addiction-treatment. Accessed 28 Oct. 2016.
Melemis, Steven M. “Focus: Addiction: Relapse Prevention and the Five Rules of Recovery.” PubMed Central (PMC), National Institutes of Health, 3 Sept. 2015, www.ncbi.nlm.nih.gov/pmc/articles/PMC4553654/. Accessed 28 Oct. 2016.
Ozbay, Fatih., et al. “Social Support and Resilience to Stress.” PubMed Central (PMC), National Institutes of Health, May 2007, www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/. Accessed 28 Oct. 2016.
Reynolds, Marcia. “5 Steps for Managing Your Emotional Triggers.” Psychology Today, 8 July 2015, www.psychologytoday.com/blog/wander-woman/201507/5-steps-managing-your-emotional-triggers. Accessed 28 Oct. 2016.
Sannibale, C., et al. “Aftercare Attendance and Post-treatment Functioning of Severely Substance Dependent Residential Treatment Clients.” National Center for Biotechnology Information, National Institutes of Health, June 2003, www.ncbi.nlm.nih.gov/pubmed/12850905. Accessed 28 Oct. 2016.
“The Science of Drug Abuse and Addiction: The Basics.” National Institute on Drug Abuse (NIDA), National Institutes of Health, Sept. 2014, www.drugabuse.gov/publications/media-guide/science-drug-abuse-addiction-basics. Accessed 28 Oct. 2016.
“Treatment and Recovery.” National Institute on Drug Abuse (NIDA), National Institutes of Health, July 2014, www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery. Accessed 28 Oct. 2016.
“Treatment Episode Data Set (TEDS) 1994-2004.” Substance Abuse and Mental Health Services Administration, Department of Health and Human Services, July 2006, wwwdasis.samhsa.gov/teds04/tedsad2k4web.pdf. Accessed 27 Oct. 2016.
Ringquist, Linda. “Addiction Relapse.” News & Analysis on Healthcare, Policy, Marketing & Global Health, HealthWorks Collective, 8 June 2013, www.healthworkscollective.com/linda-ringquist/106716/relapse-revolving-door. Accessed 2 Nov. 2016.
Anderson, S.T. (2005). Relapse Prevention: An examination of relapse issues includes consideration of the relevance of this issue, an historical perspective, a survey of existing knowledge on the subject, and ideas counter to disease concept beliefs. Journal of Addictive Disorders. Retrieved from http://www.breining.edu.