What Is a Relapse?
Drug addiction is known as a relapsing disease because relapse is common among people in recovery. Repeated drug use can cause changes in the brain that may affect an addicted person’s self-control and ability to resist cravings. Drug relapse prevention is an essential part of the recovery process because people remain at increased risk for many years.
The definition of drug relapse is evolving, thereby complicating efforts to explain it. Researchers debate whether drug relapse is a process or an outcome in and of itself. The origins of the definition of drug relapse come from a medical model that viewed addiction as a disease: a patient returns to a state of sickness after a period of remission. As the definition evolved, it came to encapsulate the process that leads people in recovery to return to their drug abuse.
Drug addiction is a chronic disease that affects millions of people around the world. It is characterized by intense drug cravings and an inability to control drug use despite negative consequences. Not everyone who abuses drugs becomes addicted, but it can happen to anyone, regardless of whether their drug of choice is a prescription medication or an illicit drug. A 2014 national survey on drug abuse reports that 21.5 million Americans over the age of 12 had a substance use disorder in the previous year, corresponding to about 1 in 12 people.
If you continue to use drugs even though it interferes with life at work, school, or at home, you may be struggling with a substance use disorder. Many people first use drugs in their teens— drug use has consistently shown to be highest among people in their late teens and twenties—however, drug addiction can start at any age. Drug use is increasing among people in their 50s and 60s, partly due to the drug-friendly nature of aging Baby Boomers.
- What Is a Relapse?
- Definition of Relapse in Addiction
- What Causes Relapse?
- What Percentage of Drug Addicts Relapse?
- What Percentage of Addicts Stay Clean for Life
- Why Do People Relapse on Drugs?
- Why Do Addicts Relapse When Things Are Good?
- How To Deal With Relapse?
- How Many Times Do Addicts Relapse Before Quitting Successfully?
- Drug and Alcohol Relapse Warning Signs
- Addict Relapse Symptoms
- Addiction Relapse Cycle
- Reclaim Your Life With a Relapse Prevention Treatment
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Definition of Relapse in Addiction
A “lapse” is the first lapse of problem behavior following a quit attempt. A “relapse” is the subsequent lapse of problem behavior that finally returns to a level close to before stopping substance abuse. Another effect of a lapse is that the client could be able to refrain and continue on the path of constructive change, or “prolapse,” after the lapse. To characterize the elements causing relapse, many researchers define relapse as a process rather than a distinct occurrence. 
What Percentage of Addicts Stay Clean for Life?
The first year of recovery is frequently regarded as the most difficult period because the recovering person is still getting used to all the changes that have occurred in their life. Fortunately, relapse risk decreases the longer a person maintains sobriety.
Due to not actively participating in their addiction prevention maintenance, recovering addicts may stop their aftercare programs during these times, increasing their risk of relapse.
Relapse rates for individuals based on a 16-year analysis can be as low as 20%, according to a 2006 study. This finding suggests that relapse rates tend to decline as time goes on. However, active addiction management through relapse prevention plans and aftercare programs like the 12-step program is still necessary. 
Why Do People Relapse on Drugs?
Substance addiction is a chronic disease, meaning it requires ongoing, active management and a long-term commitment to recovery. This is very similar to other chronic illnesses, such as Type I diabetes and hypertension, with very comparable relapse rates.
If your loved one is in recovery, it is important to first recognize that addiction is a disease, not a choice. While all people make choices about whether to use drugs, they do not choose how their body and brain will respond to said drugs. Due to neurological changes, many people battling addiction do not have control over their cravings or behaviors – which is why so many relapses. Substance abuse physically changes the function of a person’s brain, taking over their ability to make decisions and exhibit self-control.
For this reason, the pure desire to get sober is usually not enough to yield a lasting recovery. It is also for this reason that addiction cannot be cured overnight. Long-term treatment and aftercare are needed to stay sober. Fortunately, many treatment programs now focus on relapse prevention as part of their therapy approach. For example, at Turnbridge, we focus on helping clients change deeply-rooted behaviors relating to substance use, and learn healthy ways to cope with everyday triggers.
What Causes Relapse?
Usually, relapse happens when a person is exposed to people, places, things, or emotions that trigger memories of drug and alcohol use. These “relapse triggers” cause intense cravings in the individual, or make the person think they need drugs to cope. Some of the top reasons people relapse include:
- Negative or difficult emotions, such as stress or anxiety. When a person does not know how to properly cope with these challenging emotions, it can quickly lead to relapse. Back to the old ways, they may turn to drugs or alcohol for temporary relief.
- Mental health issues. Similar to the above, many people revert to drug use as a means to cope with difficult thoughts or emotions, caused by a mental health disorder like anxiety, depression, or PTSD. Currently, more than 9 million people battle co-occurring mental and substance use disorders – and even more are undiagnosed. All the while, only 7 percent of these people get the appropriate, integrated treatment they deserve. To overcome both substance use and mental disorders, dual diagnosis treatment is needed. Otherwise, there is a greater likelihood that a person will relapse.
- Environmental triggers. Perhaps one of the most obvious causes of relapse is environmental triggers that remind a person of the substance-using days – old haunts where they used to use, an abundance of parties where they used to drink, old haunts, or even seeing someone on the streets smoking a joint can be enough to cause difficult cravings.
- Social triggers go hand-in-hand with environmental relapse triggers. Often, people who relapse do so because of the people they bring back into their lives – People who share their addictive behavior, as well as those who make them feel they need to use or drink (whether that’s through peer pressure or a stressful relationship). Social triggers can be some of the most powerful causes of relapse, which is why it is so important to have a sober social network after treatment, especially in the early stages. A sober support system bolsters a successful recovery.
- Inability to cope, or lack of coping skills. When a person does not know how to handle or cope with, relapse triggers, it positions them at a greater risk for relapse. If your loved one feels like he/she cannot handle stressful situations or pressure from friends, then this may indicate a need for revised treatment. Look for a treatment program that offers behavioral therapies, such as CBT for addiction, that can equip your loved one with the necessary coping skills.
- Loss of motivation. For people in recovery, keeping busy and filling the days with positive, healthy activities is important. That is why, in treatment, clients establish a regime involving exercise, meetings, therapy, volunteer work, meal preparation, mindfulness, and meditation. Outside of medicine, some people may lose sight of the importance of structure and fall back into old habits. They may stop going to meetings, stop going to their job, or stop hanging out with friends. This lack of motivation can lead to relapse and indicates that treatment should be re-engaged. A study from the Current Drug Abuse Reviews found that unemployment increases the risk of relapse after treatment.
Addict Relapse Symptoms
Isolation and loneliness have been linked to relapse. In recovery, people can isolate themselves in a variety of ways. For example, maybe you’ve stopped attending recovery meetings like SMART Recovery, Narcotics Anonymous, or Alcoholics Anonymous. Perhaps you stopped participating in the alumni program at the drug rehab facility you went to. Other indications of isolation include avoiding friends and family, skipping therapy sessions, or avoiding social activities.
- Loss of Self-Care
Self-care is an essential aspect of relapse prevention in most addiction treatment programs. Pay attention if you’ve stopped doing things you know make you feel good so you can resist alcohol and drugs more effectively. Exercise, a healthy diet, and enough sleep are examples of self-care, as are attending individual therapy sessions or continuing with medication-assisted treatment for heroin or opioid addiction.
- Mental Health Decline
According to studies, those who struggle with depression and anxiety are more likely to relapse into addiction. Mental health decline can affect relapse. First, you risk relapsing if you don’t adhere to strategies known to control the symptoms of depression or anxiety, such as therapy and medication. Treatment for mental health symptoms is necessary for people in recovery from co-occurring disorders and avoid the temptation to use alcohol and substances as self-medication.
- Romanticizing Your Active Addiction
Being nostalgic for your previous way of life is a severe relapse warning sign. It can be tempting to overlook the suffering, heartache, loss, and misery of substance abuse when experiencing emotional distress. You might daydream about previous drug use that you found enjoyable or calming and ignore all memories of unpleasant experiences.
- Hanging Out With Friends Who Use
You might begin acting in ways that you are aware cause relapses—for example, catching up with or talking to former friends who are still abusing drugs and alcohol. Another warning sign is hanging out in locations where you previously used drugs or where you might run into old friends.
- Minimizing the Consequences of Relapsing
Going through substance abuse treatment, you are aware that addiction is a disease, and in recovery, there’s no such thing as moderation when using drugs and alcohol. During a relapse, you may start de-emphasizing the danger of “one more drink” or “one more hit.” Playing with fire means having one drink or hit. Additionally, if you’ve been sober for a while, taking drugs like heroin or opioids can put you at high risk for overdosing because you don’t know how much of the drug your body can tolerate.
- Cross Addictions
Cross-addictions happen when one addiction replaces another; however, more research is in need. As an illustration, suppose you were a heroin addict who switched to alcohol or marijuana because you thought it wasn’t as bad. Perhaps you turn to destructive behaviors like compulsive gambling or an eating disorder to cope with life.
Your brain’s reward center is altered by addiction. According to research, the brain’s reward center develops strong associations with the locations, people, and circumstances connected to prior drug and alcohol abuse. Mere sight can trigger strong compulsions. You should expect some cravings and urges if you’ve reached the point where you either actively seek out relapse triggers or don’t try to avoid them. It’s time to get help because this is a barrier between you and recovery.
- Making a Plan to Relapse
You avoid relapse warning signs and intend to use drugs and alcohol when you are on the verge of mental or physical relapse. You might be saying to yourself, “I can handle this. It will only happen once”, and planning the specifics of your alcohol and drug relapse, such as when, how, and with whom it will occur. You still have time to alter your course.
- Slip or Full-Blown Relapse
Addiction specialists refer to relapse into substance use as slipping or relapsing. It might appear as though a slip just happened. An unexpected occurrence like the death of a loved one may set it off, loss of employment, or other triggers. An occasional slip usually leaves you feeling guilty and wanting to resume sobriety. A long-term relapse into drug or alcohol abuse is referred to as this. If you relapse, you may, for a while, lose interest in quitting drinking and fall back into your old habits. 
Addiction Relapse Cycle
Through recovery, people can give up their addiction and transition to a healthy lifestyle. Recovery, however, can take months, years, or even decades.
Even if they understand and recognize the cycle, addicts sometimes struggle to break free. They need to get help and want to make changes in their lives. What is the cycle of addiction and relapse, then?
The addiction cycle consists of 6 different stages:
- Initial use
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A Journal of American Medical Association study shows that relapse rates for all substance use disorders (e.g. alcohol, heroin) are 40 to 60%. Relapse rates vary by drug of choice, stage of disease, co-occurring, and process disorders. Therefore, this 40-60% relapse rate is not a valid predictor of an individual’s long-term recovery.
What this rate does show us though, is that relapse is not a given. If 40 to 60% of patients in recovery from alcohol or substance use disorder relapse, 40 to 60% of people in long-term recovery will not relapse. However, because substance use disorder is a chronic disease, what is true about relapse and recovery is that there is always a potential for relapse – even after many decades – which is why it’s important to continue to manage your disease daily.
Cocaine Addiction Relapse
Cocaine relapse statistics indicate that relapsing on cocaine is relatively common. According to research, approximately 24% of people relapse back to weekly cocaine use within a year following treatment. Another 18% of people end up returning for treatment following a relapse. Cocaine relapse rates are typically higher among those with more severe addictive problems and those who attend addiction treatment for shorter periods.
There are many reasons why a person may experience a cocaine relapse. Stress plays a large role in addiction relapse and may initiate cravings for the drug. As stress can increase the frequency with which cravings arise, a person may be more likely to give in to cravings, especially if they are not actively using other coping skills.
Heroin Addiction Relapse Rate
Heroin is an incredibly powerful substance that can trigger addiction with just one or a few uses. That’s because heroin floods the system with dopamine (many users describe this as the “rush”), which creates an intense sense of euphoria, pleasure, and even serenity (often called “nodding”). Chronic use of heroin creates tolerance. That means once the individual attempts to reduce or abstain from use, he or she experiences distressing withdrawal symptoms.
These symptoms may include severe body aches and pains, intense cravings, depression and anxiety, and flu-like reactions. To avoid these withdrawal symptoms, many people continue using opioids- even if they want to stop. It is important to know that relapse does not always have a clear, defined trigger.
While some people may start using due to environmental or physical situations, others may relapse due to emotional states or other co-occurring conditions. Many people fall into a vicious cycle of chronic relapse. They may be able to accomplish several short periods of sobriety, but they struggle to sustain long-term recovery.
Unfortunately, there is limited research on the specific heroin relapse rates in America. One study found that 72-88% of individuals receiving inpatient rehab treatment relapsed within 12-36 months. However, a six-month controlled study focusing on long-term aftercare and clinical services showed a 32-70% relapse rate. One study examining women who spent longer than six months in treatment found that upwards of 70% of participants remained sober 6-12 months in posttreatment measures.
Meth Addiction Relapse Rate
There has been much research dedicated to the crisis of substance use disorders, and according to an NCBI study, around 61% of recovered methamphetamine users experience relapse within the first year after undergoing addiction recovery treatment. The high percentage of relapse makes many who think about treatment feel the struggle toward recovery is not worth it because they are afraid to fall on the wrong side of that percentage.
The relapse rate strictly by numbers does not account for any comorbidities or dual diagnosis with substance use disorder participants of a given study have. For example, if a methamphetamine addiction is mixed with medical or mental health disorders, those individuals may find themselves struggling more or having to push themselves harder to maintain their commitment. This is why it is extremely important to treat all co-occurring conditions simultaneously when treating addiction.
Relapse Alcohol Addiction
Over 30% of people who attempt to stop drinking relapse in their first year of sobriety. However, while the first years can be the hardest, the relapse rate does go down over time: in one study, 21.4% of recovering alcoholics relapsed in their second year in recovery, but only 9.6% relapsed in years three through five, and only 7.2% relapsed after five years in recovery. This means, that more than 70% of people struggling with alcohol abuse will relapse at some point.
The longer an alcoholic stays sober, the better their chances are for long-term sobriety. Overall, among people sober for five years, the chances of relapsing are less than 15%, according to Psychology Today.
However, it is important to realize that the threat of relapse is always present. For this reason, a recovering alcoholic should stay involved in aftercare options like Alcoholics Anonymous to stay focused on sobriety.
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Drug and Alcohol Relapse Warning Signs
Current research suggests that relapse is a gradual process wherein a person in recovery returns to his or her drug abuse. This means relapse can begin weeks or even months before an individual first takes a drug again. A good relapse prevention program helps individuals identify those early signs of relapse and develop tools and techniques for coping to stop relapse early in the process. Researchers believe this significantly reduces a person’s risk of returning to drug addiction.
Drug relapse warning signs can be broken down into three categories: emotional, mental, and physical. During an emotional relapse, individuals are not consciously thinking about using but are setting themselves up for it. They remember what relapse feels like and are in denial about the possibility of it happening again.
During a mental relapse, individuals think about using drugs again, but they are at war with themselves. Part of them wants to use it, and part of them doesn’t. Eventually, this internal struggle wears them down. Physical relapse is when an individual finally returns to drug use. Some clinicians divide this phase into lapse (initial drug use) and relapse (returning to uncontrolled using). Either way, this final stage is the hardest to come back from.
Drug addiction relapse prevention requires identifying the following warning signs:
- Isolating oneself
- Not going to treatment or meetings
- Going to meetings but not sharing
- Bottling up emotions
- Poor eating and sleeping habits
- Not taking care of self mentally or physically
- Relaxing self-imposed rules
- Drug cravings
- Thinking about people and places associated with past drug use
- Romanticizing past drug use
- Minimizing consequences
- Bargaining with self
- Lying to others
- Thinking about how to better control drug use next time
- Planning a relapse or looking for opportunities
- Using drugs “just once”
- Returning to uncontrolled use
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How To Deal With Relapse?
After a drug relapse, life can feel like a lot to handle. Developing an effective recovery plan can help prevent future relapses. This means developing a plan to take care of yourself physically and emotionally. It should involve small achievable goals, like staying sober, eating right, and taking time out for yourself.
After a relapse, you need to go back to the basics. Even if you have relapsed after years of sobriety, the basic tools for sobriety are where you need to start. The following are some of the tasks that will help you return to a sober life:
- Understand the stages of relapse
- Learn to deal with negative thoughts and feelings
- Break ties with friends who are using
- Develop healthy alternatives to using
- Visualize yourself as a sober person
- Accept that you have an addiction
- Be honest with yourself and others
- Develop coping skills for cravings
- Become active in support groups for addiction
- Practice emotional and physical self-care
How Many Times Do Addicts Relapse Before Quitting Successfully?
A study found that The average (median) American who once struggled with alcohol or drug use no longer required only two serious attempts to solve their problem, and the number of serious recovery attempts ranged from 0-100. The average number of recovery attempts before resolving a substance use disorder may be much lower than most people would have thought. This might surprise many people. Arguably, the cultural representation of how substance problems resolve is infused with the stereotyped notion that such issues constitute “chronically relapsing brain diseases,” Success in changing substance use is perceived to involve seemingly endless tries. 
Why Do Addicts Relapse When Things Are Good?
Rehab for substance abuse and addiction is generally regarded as a positive step. But even with all the advantages of rehab and sobriety, some people continue to wonder why addicts relapse when things go well. Relapse rates can vary depending on factors like disease stage and drug usage. As a result, these drug addiction relapse rates are a poor indicator of a person’s potential for sustained recovery. No matter how far along your recovery, relapse is always possible because substance-related disorders are chronic illnesses. 
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 Buena Vista Recovery. (2021). WHY DO ADDICTS RELAPSE EVEN IF THINGS ARE GOOD?.