Relapse occurs when someone returns to substance use after a period of abstinence. It is a common setback among people recovering from addiction. In fact, many individuals in recovery experience more than one relapse in their lives.
According to the National Institute on Drug Abuse, between 40 and 60 percent of people recovering from drug addiction relapse. These recurrence rates are similar to those of other chronic diseases, including Type 1 diabetes and hypertension.
Staying sober takes time, practice and commitment, and a relapse does not mean treatment has failed. Addiction is a brain disorder that causes people to engage in compulsive drug use despite knowing the physical, legal and social consequences.
People in recovery from this disease may return to heavy drug or alcohol use. A number of factors can cause people to relapse, but long-term recovery is possible for those dedicated to living healthy, sober lives.
Completing rehab does not guarantee sobriety. After leaving substance abuse treatment, people often return to environments where they once used drugs. Certain people, places and things from a person’s past can bring about memories of substance use, which can induce urges that may lead to relapse.
The risk for relapse can be influenced by the duration of addiction. For example, a person in recovery from long-term alcoholism has a higher risk for relapsing than someone who seeks treatment for an alcohol addiction that has lasted less than a year.
A number of factors can increase the likelihood of relapse, including succumbing to triggers or failing to seek aftercare services upon completion of addiction treatment.
Triggers are thoughts, feelings, sensations, situations and relationships that cause someone to drink or use drugs after a period of abstinence. For example, driving past a familiar drinking establishment, such as a bar or restaurant, may generate cravings in some people in recovery.
Triggers can arise when people feel sad or attend a social function where alcohol is available. Other triggers include stress, lack of sleep and various physical illnesses.
Communicating with individuals who engage in substance abuse is a common trigger for individuals in recovery. Friends who do drugs or drink heavily might also pressure people to engage in substance use after addiction treatment.
A 2014 study published in the journal Patient Preference and Adherence examined reasons for relapse among former smokers. Researchers found that common triggers such as stress and environmental factors contributed to relapse. Pleasure from smoking was another commonly cited reason for relapse.
Many people who complete rehab do not adhere to their treatment plan. They may think treatment cured their disease, but relapse can still occur. Taking proper steps to remain drug-free can increase a person’s chances of maintaining sobriety during recovery.
Aftercare services provide extended care after rehab. These services include psychotherapy, 12-step education and other prevention programs that help people avoid triggers that commonly lead to relapse. Many treatment centers encourage clients to engage in aftercare services.
These programs may also include sober housing, which are substance-free homes for people in recovery. These environments allow residents to support one another in abstaining from drug or alcohol use.
Sober homes have proved to be effective aftercare services. A 2006 study published in the American Journal of Public Health compared the effectiveness of Oxford House participation in Illinois with participation in traditional aftercare services in the state. Oxford House is a nonprofit that provides a network of democratically run sober homes in the U.S. and several other countries. The homes are led by peers in recovery from addiction who elect officers that serve six-month terms.
In the study, researchers randomly assigned 150 people who completed treatment to an Oxford House or a traditional aftercare program, such as outpatient treatment or a self-help group. After 24 months, the Oxford House residents showed significantly lower substance use rates than those who participated in standard aftercare. Incarceration rates were also much lower among Oxford House residents.
Access to a strong support system is important for preventing relapse. Family, friends, recovery coaches and peer mentors can provide immediate support and encouragement to people experiencing challenging times.
Several internal or external factors can cause a relapse that delays recovery from drug or alcohol addiction.
Physical or mental exhaustion can lead to fatigue, which can affect everyday tasks. Too much stress can create urges to numb physical or psychological pain with drugs or alcohol.
Depression is a mental health disorder that often co-occurs with addiction. Depressive thoughts can cause people to oversleep, lose interest in hobbies or have difficulty focusing. People experiencing depression in recovery may be tempted to use drugs to find relief.
In addition to psychological issues such as depression, physical pain is associated with relapse. A 2016 study published in the journal Drug and Alcohol Dependence found that decreases in pain levels may lower the risk for alcohol relapse.
Many people in recovery are dishonest about feelings such as anger and resentment. As a result, they may make excuses for not accomplishing tasks, or they may become more easily frustrated with others. These feelings can steer someone back to substance abuse.
People in recovery may be disappointed that they can no longer attend parties or go to the bar with friends. Feeling sorry for oneself or dwelling on negative circumstances can be dangerous because these thoughts can lead to relapse.
A 2011 study published in Current Drug Abuse Reviews found that unemployment increases the risk of relapse after rehab treatment. Researchers found that risky drinking, which includes binge drinking or heavy alcohol use, is more common among the unemployed. They also found that unemployment is a risk factor for substance use and addiction.
Recovery takes time. Further treatment may be needed after an initial stay in rehab to help people reach long-term sobriety. During recovery, individuals should attend counseling or 12-step meetings, such as Alcoholics Anonymous or Narcotics Anonymous.
A 2014 study published in JAMA Psychiatry found that mindfulness-based relapse prevention programs may reduce relapse rates. These programs combine mindfulness activities such as sitting meditation with traditional relapse prevention skills, such as recognizing triggers.
Researchers involved in the study examined 286 people who successfully completed initial addiction treatment at a private, nonprofit facility between October 2009 and July 2012.
Participants entered mindfulness-based relapse prevention programming, cognitive-behavioral relapse prevention programming or standard aftercare treatment that included 12-step programs and psychoeducation. They were monitored for 12 months.
According to the results, people in mindfulness-based relapse prevention and cognitive-behavioral relapse prevention programs showed a much lower risk for relapsing to drug use or heavy drinking than those in traditional aftercare treatment.
A variety of factors can cause someone in recovery to relapse. However, engaging in aftercare services such as 12-step programs or halfway houses can reinforce strategies to stay sober. Individuals who experience chronic stress or feelings of depression should seek further assistance to avoid relapse.