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Understanding Addiction Relapse

Relapse rates vary depending on the substance being abused, but most run fairly high. Understanding that addiction is a chronic problem can help you to stay in treatment and better handle temptation.

Addiction relapse is generally considered to be the return to substance use after a period of abstinence. However, according to James Garbutt, MD, professor of psychiatry at the University of North Carolina in Chapel Hill and a researcher at the Bowles Center for Alcohol Studies, “Relapse has different definitions. Some would say that it is a return to any amount of substance use, while others would say it is a return to heavy use. The medical profession states that a relapse is a return to destructive or heavier use.”

It’s an important distinction: If you drink one beer on one occasion, you have had a lapse. But if you are abusing regularly or your alcohol or drug abuse is causing negative consequences in any area of your life, you are having a relapse and need professional help.

Addiction Relapse: Why Does It Happen?

“Relapse can occur because an addictive disorder is a chronic disorder. As there is no cure, there is always the potential for relapse,” notes Stephen Gilman, MD, an addiction specialist in New York City. “Anyone can relapse.”

Dr. Garbutt agrees, “Addiction is a chronic illness, and like any other chronic illness, it must be managed over time.”

Addiction Relapse: How Common Is It?

Your risk of relapse depends on the substance used, Dr. Gilman says. For example, he notes, “There is a high rate of relapse for opiate addiction. At one year after stopping opiates, there is an 85 percent chance of relapse.” Fortunately, new drugs are being researched that show promise in reducing the rate of opiate addiction relapse.

With other substances, the rate of relapse varies widely. Alcohol relapse depends on the individual, but can range from 30 percent to 70 percent. According to Garbutt, the rate also depends on whether the person is in treatment.

Addiction Relapse: What Are the Risk Factors?

“There are many risk factors for relapse and they vary from person to person,” Dr. Gilman says. A powerful need to stimulate reward centers within the brain can be the trigger point for an addict who is used to getting a certain drug. Both external and internal factors can create the urge to use drugs or alcohol again.

Internal risk factors include a persistently negative mood, feeling stressed or depressed, a genetic predisposition to or family history of addiction, and/or co-existing psychiatric problems like attention deficit disorder, depression, and anxiety disorders.

Mental illness can greatly increase the risk of addiction relapse if left untreated. If other mental health disorders are present, the relapse rate is “significantly higher,” says Garbutt. “People with bipolar disorder and schizophrenia are at a much greater risk of alcohol addiction relapse. As many as 50 percent of those with bipolar disorder also have an alcohol or drug addiction.”

While significant external psychological or social stressors can play a part in bringing on a relapse, external or environmental risk factors can be as simple as being at a restaurant where other people are drinking, explains Garbutt. Even happy events can be risk factors, such as weddings, New Year’s Eve parties, and other holiday celebrations.

Not surprisingly, unhappy events can trigger a relapse as well. “Risk factors are very much individualized,” Gilman says. “When addicts are overwhelmed by external triggers, such as losing a job, problems with their spouse, or even bad weather for a couple of days, they can relapse.” Health-related issues, academic problems, and difficulties with friends or family are all potential risk factors for a relapse.

Addiction Relapse: How to Resist the Urge

A person who is tempted to drink or use drugs again should go back into treatment immediately, Garbutt recommends. “In treatment, you can learn to manage negative emotions and your particular triggers for abuse.”

Drug and alcohol treatment is critical to learning coping skills that can help you manage relapses. Your therapist may suggest you try constructive activities, like taking a walk, talking with someone you trust, reading, meditating, or exercising instead of using again. “If you do one of these activities for a period of time, you can move into a different state of mind and the addiction urge can pass,” explains Garbutt.

If you or a loved one has had a problem with substance abuse in the past, surround yourself with supportive friends and family and rely on guidance and advice from a substance abuse therapist to help reduce your risk of relapsing. And if you do relapse at any point, the best advice is to seek treatment immediately, before the relapse spirals out of control.

Author: Linda Foster, MA Medically reviewed by Niya Jones, MD, MPH


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