Addiction relapse can be a frightening concept for anyone, especially family and friends of a recovering addict. A recovering addict may relapse for a number of reasons. It may be due to some overwhelming stressor, grief or pain. Or an addiction relapse may occur because of some overpowering trigger that transformed into a using thought or reservation (plan to use drugs on a particular day and/or time). But does this mean you’re a failure and that recovery is simply not for you? Are you destined to be an addict forever?
Addiction Relapse is Very Common
Studies suggest that approximately 50% of all individuals in addiction treatment and/or long-term recovery return to heavy use of drugs. 70 to 90% of recovering addicts experience at least one mild to moderate “slip”. See “Relapse – Is it a Part of Recovery?” to learn the difference between a relapse and a slip. Very few people walk out of a top drug rehab facility and never use again, even those with the best intentions.
Men and women in long-term recovery aren’t infallible and there is no cure for the disease of addiction. At best, addiction is sent into remission, much like a cancer or put under lock and key, much like a prisoner. But unlike cancer, an individual in addiction treatment and long-term recovery has control over addiction’s return. This disease of the brain will speak to and try to influence you – making drug use sound appealing if and when you come into contact with certain triggers or trigger thoughts (memories of people, places and things that induce using thoughts). Of course, there are strategies you can employ to reduce the likelihood of a slip or relapse. We encourage you to read “10 Relapse Prevention Tips Especially, the First 90 Days of Recovery” for some excellent strategies to minimize risks of relapse.
Characteristics of Addiction, Similar to Other Diseases
Addiction is very much like other chronic diseases. If patients with a chronic illness such as asthma, diabetes, anxiety/depression or hypertension fail to comply with ongoing treatment, a relapse is likely to occur. Now, don’t be confused. Addiction is a chronic disease of the brain and isn’t synonymous with drug use. Addiction is characterized by a cognitive compulsion and a ubiquitous connection to an “object”, which can either be a substance or an activity. Making the choice to engage and/or indulge in the “object” may feed the disease but isn’t the actual addiction. Many individuals confuse addiction with the actual compulsive behavior of using drugs, which is why those uneducated on the topic of addiction think addiction is a choice. See “Addiction Vs. Using Drugs: Why Addicts Can’t Just Stop using Heroin” and “Proof that Addiction is a Disease and How it Affects the Brain“.
Thus, no matter the chronic disease, each individual must make the choice to adjust his or her own lifestyle and assume responsibility for managing care. See “The Role of Responsibility and Accountability in Recovery”
What Causes a Relapse?
Many recovering drug and/or heroin addicts return to drug use in response to some kind of “stressor”. Stressors can be drug-related cues or triggers that create using thoughts or reservations to use on a particular day/time. Stressors can also be difficult circumstances or traumatic events that induce anger, anxiety, sadness or depression signaling our brain that it’s “ok to use” as a coping mechanism. According to David Sack, M.D.,
“These ‘triggers’ are a byproduct of addiction’s two-stage formation process. In the first stage, the reward functions of the brain are hyper-stimulated—taking drugs makes users feel good, which encourages a repeat performance. In the second stage, repeated overstimulation of the reward centers causes long-term changes in how other areas of the brain function, including areas involved with memory, impulsivity, and decision-making.
A helpful analogy is having a flood in your house. You leave the upstairs bathtub running and depart for the weekend. The water overflows and runs into the hall. Like a waterfall it splashes down the stairs and into the living room. When you return, you find that the walls are soaked, mold is forming, and the wood floors are warped and peeling. Your original problem was that the water wasn’t turned off, but now the floor needs to be ripped up and the walls torn out. Turning off the faucet (detoxing) doesn’t undo the damage caused by the water (drugs) to the rest of your house (brain).”
Can Relapse be Prevented or Is it Unavoidable?
Unlike other chronic diseases however, addiction works strictly at a cognitive level and while urges and compulsions can be so strong that it feels like there is no other choice but to engage in drug use, resisting the urge to relapse and making the choice to remain in recovery is possible. For the addict experiencing the compulsions in the moment, resisting doesn’t feel like a real possibility and the desire to resist definitely disappears.
For a recovering addict, especially one who has been in recovery for years doesn’t experience an urge and compulsion that powerful immediately. Addiction gradually regains strength if we choose to let it. The compulsion to use drugs will increase or lessen based on what we take into our mind and how we process it. The below stages is what a recovering addict will go through.
1. A recovering addict will come into contact with a stressor. This can be a difficult situation, a trigger, a traumatic event, a memory (trigger thought), etc.
2. The stressor will evoke negative emotion such as anxiety, depression, sadness or anger. For an addict (active or in recovery), the compulsion to use becomes instinct, although it should be a lot weaker for someone in recovery).
3. The mind will quickly page through to its coping mechanisms to find a good fit. At this stage, the mind is actively considering any and all coping strategies and weighing out the pros and cons. If drug use has become a consideration, the addict’s mind will dwell on the consideration and the compulsion (in stage 2) becomes stronger. For an active addict, using heroin or another drug of choice became the coping strategy for everything. A recovering addict has hopefully learned and developed other coping mechanisms to employ. I’ve linked to it above, but this is a good time to view “10 Relapse Prevention Tips Especially, the First 90 Days of Recovery“, some of which apply here.
4. A recovering addict will employ the coping mechanism of choice. If drug use became the coping mechanism of choice, a recovering addict relapses. If the recovering addict made a conscious choice and decision, and was able to shove that consideration out of their brain while considering coping mechanisms, relapse does not occur.
How the Brain Reacts to Drug Use and Develops Triggers
Modern brain imaging shows that drug use alters the connections between the ventral tegmental area (part of the reward center of the brain) and memory hubs in the brain (which includes the hippocampus). Thus, for men and women suffering from addiction, triggers become hardwired in the brain as part of the collateral brain damage of addiction. This is why addicts are highly reactive to people, laces or things associated with previous drug use and why Kill the Heroin Epidemic Nationwide and top addiction treatment centers and programs constantly recommend knowing and avoiding your triggers at all cost. See “Knowing and Avoiding Triggers During Heroin Addiction Treatment and Recovery“.
When is Relapse Most Likely to Occur?
While relapse is a choice recovering addicts make based on reactions to stimuli, it is more common for individuals to relapse during the first 90 days. It takes a significant amount of time for the brain to heal and repair itself from the damage and rewiring that occurred during years of perpetual drug use. In many cases, cravings get worse before they get better. For instance, it may be more difficult not to relapse at 60 days than at 6 days. At 90 days however, the chance of successful long-term abstinence increases, especially with proper addiction treatment.
Creating Positive Triggers for Recovery
The word “trigger” is typically used to define a person, place or thing that induces thoughts or memories of drug use. However, in the same way addiction can create triggers, recovery can create positive triggers. I wish there was another technical word to describe the difference, but for now, we’ll just call it a recovery trigger. But the concept and reality that recovery triggers are created is one of the reasons it’s suggested to stay longer than 30 days at a top addiction treatment center / drug rehab facility. For instance, regular attendance of group therapy, 12 step meetings, SMART Recovery, etc. are likely to result in cue-induced learning related to recovery. For example, if an addict repeatedly hears that they should immediately call another sober person when they experience cravings, the individual eventually starts to visualize performing that action in the event a craving occurs. This cue-induced pattern of behavior generates a recovery trigger.
A Relapse Is Only Failure if You Stop Trying
As we discussed above, a relapse is very common for addicts in long-term recovery. However, those who relapse should not consider it a failure. Instead, get back up, shake it off, eradicate any guilt or shame you’re feeling. Don’t let others get you down. And get right back on the road to recovery. Relapse shouldn’t be taken lightly but people can and do recover from it.
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