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Addiction Relapse Rates

Joseph Sitarik, DO

Medically reviewed by

Joseph Sitarik, DO

February 28, 2019

Relapse can be one of the scariest things to think about for an individual who is in recovery from addiction. Looking back on the destruction that addiction can cause, combined with the courage and effort it took to achieve sobriety, can sometimes make it feel like an individual would never turn to substances again, but relapses can be very common.

It is not uncommon for individuals recovering from addiction to think they are ‘cured’ for life. This is an easy thing to think when you are fresh out of rehab and armed with a clear mind and the skills to tackle cravings in the future. This, however, is a dangerous way to think. Relapses from drug addiction might be more common than you think.

What Does It Mean When Someone Has A Relapse?

When an individual in recovery from addiction suffers from a relapse, it means that his/her addiction has gone through a recurrence. In other words, the addiction that an individual had previously been in recovery from is back. Addiction is a chronic disease by nature, which means that the cravings, emotional triggers, and coping mechanisms associated with addiction can never truly be ‘cured’.

There are different things in life that may trigger a relapse. Often if an individual suffers the same stressors or triggers that lead them to the addiction in the first place, then they are at a higher risk to suffer a relapse. An individual’s risk of relapse is also higher if their sobriety was the result of quitting ‘cold turkey’, or simply removing the drug from their body and life without addressing the emotional and mental factors that contributed to their addiction.

Having a relapse does not necessarily mean you start back at square one. It can be a devastating realization to witness all of the hard work and dedication you have invested in your recovery seemingly disappear with one mistake, but that does not mean you throw away your months of sobriety.

Relapse can be a way to observe skills that your rehabilitation did not teach you, or triggers that you failed to remove from your life. For example, if an individual relapses after hanging out with a group of friends that were a part of his/her life during the addiction, then it is clear after the relapse that this particular group of people needs to be removed from that individual’s life to properly continue their recovery.

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The Three Stages Of Relapse

Relapse does not happen suddenly, but rather begins weeks or even months before an individual turns back to the drug. There are many people who think that relapse happens at the moment you choose not to say ‘no’ to the drugs in front of you, but in reality it is a process that can progress over a long period of time.

Relapse is often measured in three stages:

Stage 1: Emotional

Stage one is defined by denial. You aren’t actively thinking about using drugs, but your emotions are heightened and distraught. It is common to feel irritated and isolated during this stage. Classic signs of stage one include bottling up emotions, refusing to ask for help, skipping outpatient meetings or events, poor eating and sleeping habits, and poor self care in general.

Stage one is the easiest stage to resist cravings, as well as the easiest stage to practice relapse prevention. If you or a loved one seem to be sitting in stage one, it is important to get a good night’s sleep, eat well, ask for help, and share your feelings with your support network.

Stage 2: Mental

Stage two is often a battle with yourself: part of you wants to use, while the other part knows that is not the answer. Thoughts of using become harder and harder to pull away from during this stage. Symptoms of entering stage two may include thinking about the people, places, and things that were part of your old addiction, hanging out with people who are associated with drugs, lying to loved ones and family members, and most importantly, lying to yourself. Individuals who are going through recovery but ‘innocently’ brainstorm ways to use drugs without getting caught are often struggling with stage two of relapse.

During this stage, it is important to remind yourself of what you could lose if you relapse, and think of how much addiction took from you before. Some techniques for coping with stage two include going for a walk to change the scenery, find things to distract yourself until a craving passes, go to a meeting, or talk to someone you trust about your cravings.

Stage 3: Physical

Stage three is the physical stage where the action of doing the drugs actually takes place. As you can imagine, turning around at stage three is the most difficult of all the stages. By this stage, you have already built up emotional and mental distress for weeks or even months, both of which can prevent you from resisting cravings when they come up.

Stage three is often a difficult time to act upon relapse prevention, can often lead to a relapse, but an immediate change of scenery or calling a sponsor or loved one can help you say no even when the temptation is sitting right in front of you.

What Are Relapse Warning Signs?

Relapses are generally brought on by stressors or triggers in an individual’s life. The weeks, months, and even years following an individual’s initial recovery can result in fragile emotions and willpower, which can quickly lead to relapse under the right conditions. There are, however, some telltale signs that signify you or a loved one might be at risk for relapse:

  • Believing you are cured forever – Addiction recovery is a lifelong process that is more similar to a cancer’s remission than it is a cure to lyme disease. An addiction can flare back up at any time, and believing that your hard-earned sobriety is guaranteed forever can prevent you from spotting the warning signs of a relapse in the future.
  • Glorifying the “old days” of drug use – it is often easier to see reflect on the ‘good times’ that were associated with a past addiction than it is to accept the destruction that it caused in your life. These reflections, however, can be detrimental to your current recovery. Always remember the relationships that were damaged and the opportunities that were lost with addiction, because this is the true reality of addiction.
  • Social disconnect – It is not uncommon for individuals recovering from addiction to feel socially awkward or uncomfortable trying to integrate with those who do not understand what you have been through. This is a normal part of the recovery process however, and a vital one at that. Social disconnect can cause you to feel lonely, depressed, and isolated – all of which can help contribute to a relapse down the road.
  • Living pessimistically – Constant negative or angry thoughts about your life or others is an unhealthy way to deal with the cravings and mood swings associated with addiction. Self-pity is often a side effect that individual’s recovering from addiction may feel, which can again make you feel isolated from other people in your life.
  • Refusing to ask for help – Refusing to ask for help, or refusing to admit that you need help, are both warning signs that the realities of addiction recovery have not sunk in yet. Pride is not a behavior that meshes well with addiction recovery because it can prevent people from getting the help they deserve and need. We all need help sometimes, and it is important to ask for it when you need it.
  • Excusing unhealthy behavior – Examples of unhealthy behavior can include spending copious amounts of money (i.e. transitioning the addiction to other methods), overworking yourself to feel successful or provide a distraction from addiction, obsessing over a significant other or a love interest, etc. Addiction can manifest itself in many ways, and it is vitally important to be able to spot these manifestations and be honest with yourself about why you are participating in unhealthy behaviors in the first place.
  • Increased levels of stress and anxiety –  This is a warning sign that can be largely attributed to the one stated above, as unhealthy behaviors often lead to stress and anxiety. Sensitive emotions like these can leave us vulnerable and open to participating in risky behaviors that can increase the risk of a relapse.

Heroin Relapse Rates

Heroin leads the way when it comes to relapse rates among recovering individuals suffering from addiction. According to a 2002 study performed for the NTORS project (National Treatment Outcomes Research Study), nearly 60% of individuals who successfully completed an addiction treatment program used heroin very soon after. Many of these 60% also resorted to using other illicit drugs after treatment as well.

Heroin is an intensely addictive drug, and it is extremely potent. Heroin’s effects on the brain can be long-lasting and difficult to treat – even with therapy. The same study found that many of the 40% of individuals who did not use heroin after treatment still reported using distraction and avoidance as a coping mechanism when it came to heroin cravings. This signified these individuals had not found a way to move past these thoughts, but rather just a means of ignoring them long enough for the craving to pass.

Prescription Opioid Relapse Rates

Prescription opioid data is sometimes difficult to measure due to the vast variety of medications to study along with the high possibility of an individual suffering from prescription opioid abuse switch to heroin after a period of time. We do know that individuals admitted to a treatment facility for prescription opioid addiction have roughly the same rate of relapse as individuals admitted for heroin addiction. Both drugs affect your brain in similar ways, and both hold a dangerous potential for addiction.

There are some types of drugs that have been created for use in the treatment of opioid addiction. These drugs include Methadone, Buprenorphine, Naltrexone, and other generic brands. These drugs are meant to supplement detox and inpatient rehabilitation to help aid in some of the physical signs of opioid dependence.

Alcohol Relapse Rates

Alcohol has been at the top with heroin when it comes to relapse rates after addiction treatment. As a drug that is legal and easily accessible, it can be easy to slip back into old habits even after successfully completing a residential rehabilitation program. There are, however, medications that have been successful in aiding those trying to recover from alcohol addiction.

A study highlighted in a 1992 issue of JAMA outlined the success rate of using Naltrexone in the treatment of alcoholism. The study contained two groups – one was given Naltrexone and the other was given a placebo replacement for the drug. Neither group know if they had been given the actual drug or not. The placebo group had a relapse rate of 54.3% after a 12-week treatment program, while only 23% of the group that was actually given Naloxone relapsed.

Benzodiazepine Relapse Rates

On average, benzodiazepine addiction shows a far less prevalent rate of relapse than heroin or cocaine. While studies on benzodiazepine addiction and relapse were few and far between, one study performed in the UK published for the British Journal of Addiction showed that after following 50 consecutive patients through supervised withdrawal followed by residing in a clinical pharmacological unit, only 3 showed signs of a relapse. It should be noted that other participants showed varying levels of recovery, and poor recovery could lead to a relapse down the road.

Benzodiazepines are sometimes used to aid in other types of addiction recovery because of their calming effects on anxiety and insomnia. Addiction treatment utilizing benzodiazepines as an aid is usually done in small doses and under close clinical supervision. This type of therapy should always be administered by a professional, and does hold a risk for dependency on benzodiazepines.

Cocaine/Crack Relapse Rates

Cocaine use is known to cause emotional distress and small changes in the brain after prolonged use. This can be somewhat responsible for the rate of relapse among cocaine users even after completing a residential rehabilitation program. While cocaine is not necessarily the most potent or addictive drug available, it still holds a relapse rate that is worth talking about.

According to a study published in a 1999 issue of JAMA, cocaine holds a relapse rate of 23.5%. The study was conducted with 1,605 cocaine dependent patients who attended various rehabilitation programs across the country. Of these 1,605 patients, 377 reported using cocaine in the year following their discharge. Another 289 of these patients reported being admitted into another rehabilitation program within a year of their discharge.

Methamphetamine Relapse Rates

While methamphetamine (meth) use has not made headlines as much since the opioid epidemic has hit the United States, it is still a war that rages today. Meth use is associated with a myriad of lethal outcomes, including immediate heart failure as well as heart, kidney, and lung disease down the road.

Meth is also a highly addictive drug. A study published in Volume 32 of the Journal of Psychoactive Drugs showed a 50% relapse rate among individuals treated for methamphetamine addiction. The study contained 98 participants that attended a rehabilitation program from 1995-1997 within the Los Angeles city limits. These participants were interviewed three years after they completed their treatment, where more than half reported using meth again since discharge from rehab. 36% reported using within six months of successfully completing a rehab program.

Relapse Prevention

Relapse prevention is intended to predict an outcome that could happen, and preventing it from having the proper conditions to happen. The three stages of a relapse can be extremely valuable in relapse prevention because they can help outline how at risk an individual may be for relapsing. The point of identifying what relapse stage an individual is currently in can provide a better guideline for what steps need to be taken.

Relapse prevention is not saying ‘no’ when the drug is in front of you, it is taking care of yourself to prevent the development of a relapse. Relapse develops overtime, it does not happen immediately. If a relapse is caught during the first stage, it is much easier to control then when after the cravings take over. A support network should be utilized when any stage of relapse has been detected, as they can help get you through the difficult times.

Lower Your Risk Of A Relapse With The Right Rehab

Relapse can be a scary thing to think about, but with the right support network in place and utilizing the best modalities and coping mechanisms from residential rehab can help prepare you for the worst days.

If you believe rehab could benefit your recovery, or if you have recently suffered a relapse and are looking for the right treatment program to get you back on track, give us a call today. Our addiction treatment specialists are waiting to take your call around the clock, and it is always 100% confidential. Let us help you continue your journey to recovery.

Current Psychiatry Reports - The Role of Stress in Addiction Relapse

Journal of Addictive Diseases - Will the Methamphetamine Problem Go Away?

Society for the Study of Addiction (SSA) - Factors Associated With Abstinence, Lapse or Relapse to Heroin Use After Residential Treatment: Protective Effect of Coping Responses

Journal of Psychoactive Drugs - Predictors of Relapse After Treatment for Methamphetamine Use

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