Are Some People More At Risk For Relapse Than Others?

Drugs and alcohol change the brain’s chemistry, which for many, can result in substance use disorder (SUD). These major changes to the brain’s functionality are challenging to overcome, so addiction “is considered a ‘relapsing’ disease,” according to the National Institute on Drug Abuse. Relapse occurs if a person returns to using drugs or drinking alcohol after a time of abstinence. NIDA also states that relapse is common but it “doesn’t mean that treatment doesn’t work.” Relapse, for many, is part of the ongoing struggle to lead a sober lifestyle.

What Factors Can Trigger a Relapse?

Various triggers can tempt a person to seek out drugs or alcohol after a period of sobriety. Some of the most common triggers include:

  • Stress
  • Emotions
  • Familiar places
  • People
  • Lack of activity
  • Holidays and special occasions

Stress

  • Stress can manifest as headaches, anxiety, insomnia, or other physical and psychological symptoms that are uncomfortable. When stress builds and remains unresolved, using a substance that “helps take the edge off” is tempting.

Emotions

  • Deeply felt negative emotions such as anger, grief, or jealousy can trigger substance use in order “to calm down.” Even extreme joy or happiness can trigger previous habits through the impulse to celebrate or “party.”

Familiar Places

  • Returning to familiar places can also trigger relapse behavior. Whether the location is the exact same spot where a person previously used substances or is simply similar doesn’t matter. Even sights, sounds, and smells can bring back old cravings.

People

  • Visiting former friends who also used drugs or alcohol can create the temptation to relapse. Also, certain family members or friends who create stress or strong emotions can stir up unresolved issues and contribute to relapse.

Lack of Activity

  • Staying busy with fun and exciting activities is critical for leading a sober lifestyle. Boredom and frustration are common triggers that can lead to a relapse into harmful behaviors.

Holidays and Special Occasions

  • Holidays, birthdays, weddings, and funerals frequently involve alcohol could contribute to a relapse.

Who is At Risk for Relapse?

Not everyone in recovery will relapse, even when faced with potential triggers. So, why are some people more at risk than others? People who have recently completed addiction treatment are more likely to relapse than those who have successfully maintained a sober lifestyle for a year or more. This is because it takes time and practice to establish a sober lifestyle and implement coping skills learned during recovery. Also, mental illness and SUD often co-occur. Frequent bouts of anxiety, depression, and other mental challenges can often contribute to a relapse, even if treated with medications prescribed by a medical professional. While anyone recovering from addiction faces some risk of relapse, the person’s substance of choice can also influence their chances of slipping back into old habits. The more addictive a drug or the longer the person has struggled with addiction influences their possibility of recovery.

Cocaine

  • Cocaine is highly addictive. Some reports state that nearly 45% of recovered cocaine users relapse to regular use within one year. One reason cocaine is difficult to quit is because of the changes it causes in specific areas of the brain. The NIH cites research from the University of California in San Diego, which “found that a cocaine-addicted person’s chance of managing 1 year of abstinence correlates with activity levels in these impaired motivational and decision-making brain areas.” Luckily, this research may lead to improved treatment plans for people who show signs of neurological issues in these areas of the brain.

Opioids

  • Relapse after treatment for opioids is also common. In addition to the typical relapse triggers, age and drug dosage influence the outcome. Younger users who use higher doses of an opioid are more likely to use the drug again. A complicating factor of opioid relapse is the potential of an overdose. Once clean from the drug, a person’s tolerance drops. If they then take a dosage at the level of their previous addiction, they can suffer an accidental overdose or death by respiratory failure.

“Dry Drunks”

  • For some, although they maintain abstinence from alcohol or drugs, they continue their risky behaviors and associations. The term “dry drunk” is a slang term that refers to former alcoholics who have refrained from drinking but still make impulsive decisions. Health care professionals acknowledge these individuals have a high potential for relapse. Even though a former alcoholic maintains a sober lifestyle, if they have not resolved the underlying issues that led to dependency, they remain vulnerable to temptation and relapse.

Is Drug Relapse Dangerous?

Relapses back to drug or alcohol use can be dangerous. Although opioids and cocaine have the highest risks associated with relapse, any drug or alcohol could cause various complications. As the body heals and recovers from substance use, tolerance levels decrease. If a relapse happens, regardless of the drug, a person needs less of that substance to recreate the desired effect.

Can Drug Relapse Be Prevented?

Yes, but it takes dedication and commitment. To prevent relapse, individuals must become deeply aware of their emotions, mental state, and physical signs. The Yale Journal of Biology and Medicine (YJBM) identifies three phases of relapsing: emotional, mental, and physical.

1. Emotional Phase

  • A common trigger to relapsing is allowing negative emotions to continue unchecked. Bottling up anger, grief, and disappointment is unhealthy for everyone, but for someone in recovery from a SUD, these emotions especially require healthy outlets. If drinking or using drugs was the person’s coping mechanism before recovery, they must develop new strategies. Common approaches to help with emotional triggers include talking to a trusted friend, journaling, exercising, and reaching out to a sponsor or support group.

2. Mental Phase

  • Negative thoughts are natural. They may stem from a bad mood, something going wrong during the day, or everyday anxiety. During the mental phase of relapse, individuals argue with themselves about whether or not they should return to substance use.

Breaking this negativity cycle can help prevent relapses. By learning strategies and coping skills to overcome negative thoughts, people in recovery can better resist the temptation to return to their substance of choice to relax, calm down, or take the edge off. To help break the negativity cycle, try exercising to increase the endorphins that help us feel better, seek out a sponsor or support group, or remove yourself from negative environments.

3. Physical Phase

  • The most challenging phase of relapse is managing cravings experienced in the body or brain. If you give in to cravings and relapse, remember that doesn’t mean you’re automatically returning to addictive behaviors. Seek out professional assistance to get back on track.

The Five Rules of Recovery

The YJBM article presents five rules of recovery:

  1. Change your life
  2. Honesty
  3. Seek help
  4. Practice self-care
  5. Don’t bend the rules

1. Change Your Life

  • Recovery demands change. The key elements to change are negative patterns of thinking and behavior, avoiding the individuals, groups, hang-outs, and things previously associated with substance use, and actively following the five rules of recovery.

2. Honesty

  • A lifestyle involving addiction invariably includes deceit. Learning honesty takes time. First and foremost, people in recovery must be honest with themselves. They must also be frank with those most involved in their recovery: health care practitioners trusted friends and family, and support groups. As confidence builds, honesty can extend to healing past injuries caused to others by lying.

3. Seek Help

  • Attempting recovery alone has a low probability of success and a high likelihood of stress and anxiety. No matter where in the recovery stage you are, seek professional help to maintain a sober lifestyle.

4. Practice Self-Care

  • Practicing self-care is not selfish, it’s necessary. As the YJBM states, “poor self-care often precedes drug or alcohol use.” Learning to take time for reflection, meditation, exercise, and sober activities that bring joy will mitigate the chance for relapse.

5. Don’t Bend the Rules

  • This rule serves as a reminder that there is no bargaining or compromising with addiction. There are no loopholes. The YJBM classifies people in recovery into two categories: “non-users and denied users.” Non-users recognize that using is no longer an option, so their odds of relapsing will be smaller. Denied users, however, will have a higher risk for relapse because they believe they can use drugs or alcohol again at some point in their lives. Unfortunately, because of this mindset, “many people have relapsed this way 5, 10, or 15 years after recovery.” For this reason, the rules of recovery are not rules that can be broken.

Recovery from a Substance Use Disorder takes time, and even after you achieve abstinence, a sober lifestyle takes dedication and commitment to maintain. It’s natural to encounter situations and people that will tempt old patterns and habits to recur. If this happens, do not despair; relapse is often a part of the recovery and learning process. Various factors influence the likelihood a person will relapse. Knowing the three phases of relapse and sticking to the five rules of recovery can help reduce these risks.

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