Understanding and Avoiding a Relapse into Addiction

For people in recovery, the thought of relapse can be terrifying. But it often produces other complicated feelings as well: some may be tempted by the charms of using again, others may feel deep shame about their own relapse, and still more will consider relapse an existential threat, precipitated by unknown and mysterious forces. But relapse is both observable and preventable, and a person can safeguard their recovery by looking for the warning signs, being aware of its possibility and attending to their personal needs.

Ultimately, relapse is a part of many people's story, and it doesn't prevent anyone from finding long-term sobriety. But staying watchful for a potential relapse is vital because it comes with the inherent risk of overdose or even death, and a person who experiences relapse should consider their treatment options carefully to give themselves the best chance at re-entering recovery.

In this article, we'll discuss the most common causes of relapse, why relapse comes with such a high risk of overdose, and how to find long-term sobriety upon relapsing, most particularly related to opioids.

How common are relapses?

According to the National Institute of Drug Abuse, "Relapse rates for addiction resemble those of other chronic diseases such as diabetes, hypertension, and asthma."1 In numbers, the statistics indicate that anywhere from 40 to 60 percent of people with addiction will experience a relapse.

Some people may look at those numbers and ask, "Why bother with treatment or sobriety if nearly half of people in recovery will relapse at some point?" But that philosophy toward treatment and recovery completely misses the mark. The other half of people who don't relapse have found long-term sobriety and the coincident health and happiness that come with it. And abstinence isn't the only measure of success: those who do relapse still have the resources, support system and coping tools from treatment that will allow them to enter into recovery whenever they feel ready.

What causes relapse?

Look at recovery as a spectrum, where one end is relapse and the other is a thoughtful program full of self-care, selflessness and growth-oriented activities. The concept and process of relapse, then, becomes a little easier to imagine: it's not a binary where someone is either sober or relapsing, but instead a series of continual movements in either direction as a person reacts gracefully to recovery's blessings and challenges, or partakes in increasingly dysfunctional thoughts and behaviors.

Relapse is total dysfunction, where a person has continually engaged in a pattern of thoughts or behaviors that destabilizes recovery and makes the use of alcohol or other drugs appealing. To this person, a return to addiction makes sense because they've been internalizing, listening to and agreeing with the logic of addiction.

How can a person prevent relapse and stay sober?

In treatment, patients learn to identify any high-risk situations and the warning signs of relapse, and create relapse prevention plans they can apply to dangerous situations, triggers and other life stressors. Patients are also taught the disease model of addiction, which states that addiction is both chronic and progressive. In other words, it's a lifetime diagnosis, so patients have to carefully maintain their recovery using different coping skills, support networks and self-care routines. By using those important techniques, people in recovery will adeptly maneuver any threat of relapse.

How can I tell if a loved one relapsed?

Obviously, if someone is under the influence of alcohol, opioids or other drugs, the visible effects of those drugs are pretty good indicators for relapse. However, it's important to keep in mind that many people with substance use disorders are exceptionally good at hiding their use from those around them.

Unfortunately, if a person is new to recovery, those active effects of alcohol, opioids or other drugs are often the only symptoms that outsiders can rely on to determine whether relapse has occurred because the transition into a new recovery lifestyle may not have taken full effect.

For people with longer-term recovery, outsiders can see more clearly the behavioral changes and warning signs that coincide with relapse, like someone suddenly disappearing from their home-group Twelve Step meeting. For a fuller list of behavioral changes, see the warning signs listed below.

What are the warning signs of a relapse?

Those who are in greatest danger of relapse will notice some or many of the behavioral changes listed below:

• Changing priorities, where recovery becomes unimportant
• Compulsive behaviors
• Magical thinking
• Isolation
• Destabilized emotions
• Withdrawal from support groups
• Restlessness
• Irritability
• General discontent

Which drugs have the highest relapse rates?

Users of all drugs are susceptible to relapse, and a person who engages in dysfunctional thoughts or behaviors will be vulnerable to relapse, regardless of their primary drug of choice. Rationalization, minimization and other dysfunctional patterns of thought are not restricted to any one drug. A person may convince themselves that THC is natural and is, therefore, safe. Or they may comfort themselves with the thought that Ativan is a different type of depressant than alcohol and can be used safely. The moral of the story: every drug of abuse will hijack the reward pathways in the brain, and relapse is a threat to anyone in recovery from addiction.

Research shows that alcohol and opioids have the highest rates of relapse, with some studies indicating a relapse rate for alcohol as high as 80 percent during the first year after treatment. Similarly, some studies suggest a relapse rate for opioids as high as 80 to 95 percent during the first year after treatment. Other substances with notoriously high relapse rates are stimulants and benzodiazepines.

For everyone who's sober, but especially for people who use those drugs, it's important to understand the triggers associated with use, and to have a relapse prevention plan in place that will nullify any cravings.

Why is opioid relapse and overdose so dangerous compared to other drug overdoses?

When comparing an opioid relapse with other drug relapses and overdoses, it's important to understand a few things. First is the rate at which opioid tolerance builds, which increases very rapidly when compared with other drugs. So a person is quickly forced to take more and more of the drug to achieve the same effects. Then, when that person becomes sober and experiences withdrawal, their body and their tolerance levels react accordingly, pushing their tolerance closer to normal. When a person then relapses on opioids, they take the same increased amount of opioids as they had before and the body isn't ready to process that amount of drugs.

On top of that, the widespread surge in fentanyl's inclusion and mixture within other opioids has created a nightmare scenario for opioid overdoses and overdose deaths. Fentanyl is a synthetic opioid—human-made and often lab-grown—that's 80 to 100 times more powerful than morphine and is among the leading causes of overdose deaths in America. Combine those two scenarios together, and you get a small, but informative picture of the opioid crisis in America.

How to spot an opioid overdose

You will recognize the signs of an opioid overdose by looking for the following:

• Pinpoint pupils
• Unconsciousness
• Respiratory depression (slow breathing)
• Pale or clammy face
• Bluish skin, lips and fingernails among lighter-skin people
• Grayish or ashen skin, lips and fingernails among darker-skin people
• Vomiting
• Loss of consciousness

If you notice any of these signs or symptoms, call 911 immediately, try to wake the person, check for breathing, administer Naloxone if possible and stay with the person until medical help arrives. If you are friend or family to someone with an opioid use disorder, it would be a good idea to keep Naloxone on hand for if and when an overdose occurs.

How to deal with relapse

If someone you know has relapsed, consider the following steps:

1. Assess for intoxication, overdose, withdrawal or suicidal thoughts, and remove any children from a dangerous situation.
2. Remove the person, if possible, from their current environment and away from any substances.
3. Inform any counselors or therapists of the person's relapse, with or without a signed release of information.
4. Communicate to the person who relapsed your feelings and concerns for them.
5. Offer any necessary help, and support their admission into a treatment or medical facility.
6. Reach out to your support system and ask for help.

If you relapsed, understand this: recovery is a long story that often features relapse, and one that often results in long-term recovery. You can learn from this and strengthen your relapse-prevention plan, you can re-admit yourself to a treatment facility or seek clinical help for the first time, and you can always, always build long-term recovery.

If you or someone you know is struggling to maintain sobriety, please reach out to Hazelden Betty Ford for answers and help at 1-866-831-5700. You don't need to manage the situation alone. Substance use disorders of all varieties are common and treatable, and there is no shame in needing help with addiction. We're here for you.