Despite resistance from some professionals in the field of substance abuse and addiction treatment, the term “relapse” began to be out of favor as early as 2021. Coincidentally, that was just about the time that punitive abstinence also began to be out of favor, largely because it doesn’t work. “Relapse” carries with all the stigma of the words “addiction” and “abuse.”
If someone goes back to the oncologist with symptoms of cancer after a period of remission, then no one would ever say that the person relapsed. The same should apply when someone experiences a substance use disorder. The National Institutes of Health makes the point of not using this kind of stigmatizing language. Therefore, the term “return to use” is now the acceptable phrase when describing someone whose symptoms of substance use disorder recur.
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What is Relapse in Addiction Recovery?
Once people start treatment, a return to use—commonly known as addiction relapse—occurs when they use their substance of choice in a manner not prescribed by a doctor. As Paquette et al. pointed out, the modern trend in the treatment of substance use disorder is not solely focused on punitive abstinence or even achieving long-term sobriety as the primary goal. Instead, the focus is on harm reduction and improving overall well-being. Staying alive remains the No. 1 goal for people seeking treatment for substance use disorder, often involving medication-assisted treatment to manage addictive behaviors effectively.
In some cases, a return to use means resuming the use of the original substance. For example, let’s consider Jane, who has an opioid use disorder and previously used heroin. As part of her treatment plan, instead of aiming for complete sobriety during an extended period of abstinence, her doctor might prescribe methadone as a long-term strategy to manage her opioid dependence—similar to how individuals with chronic diseases like hypertension use medication to manage their condition. If Jane reverts to using heroin instead of the prescribed methadone, it would be considered a return to use.
People relapse for various reasons, and returning to use is a common occurrence during recovery, particularly with certain substances. It should not be seen as a failure or a lack of willpower but rather as a symptom of the complex nature of addiction. Just like other chronic diseases, addiction is a relapsing condition influenced by numerous risk factors, including environmental triggers, stress, and co-occurring mental health disorders.
While the goal of treatment is to minimize and prevent return to use, it is essential to recognize that relapse can occur in the same way cancer or other chronic conditions might reoccur. Understanding the complexities of addiction and addressing underlying mental health disorders can help individuals develop healthier coping mechanisms and reduce the likelihood of relapse over time.
How Common is Relapse?
Considering all substance use disorders, the rate of relapse is between 40% and 60%. Opioid use disorder has the highest rate of relapse without medication-assisted treatment: 90%. With medication-assisted treatment, that rate drops to a low of 40%. Other substances have varying rates of return to use.
Additionally, your specific case could include parameters that increase or decrease your likelihood of returning to use. For example, if you have a co-occurring mental health diagnosis, then your risk of relapse will be correspondingly higher than that of someone without such a diagnosis. If you misuse multiple substances, then your rate of return to use will also be higher than that of people who don’t misuse multiple substances.
| Substance | Relapse Rate (%) | Notes |
| General Substance Use Disorders | 40–60% | Overall relapse rate across all substance use disorders. |
| Alcohol | 70% | Professional treatment and support groups aid in reducing relapse risk. |
| Opioids (without MAT) | Up to 90% | Highest relapse rate without medication-assisted treatment (MAT). |
| Opioids (with MAT) | Approximately 40% | MAT significantly reduces the rate of return to use. |
| Heroin | 78.20% | High relapse rates due to severe withdrawal symptoms and cravings. |
| Cocaine | 61.90% | Behavioral therapies and coping strategies are critical for recovery. |
| Methamphetamine | 52.20% | Strong psychological dependence contributes to high relapse rates. |
Why Do People Relapse?
Most commonly, the reasons for return to use involve triggers associated with either the substance that the person uses or the use itself. Let’s say that John uses cocaine. He started using it because he felt down all the time, and the cocaine gave him energy and helped him focus when he couldn’t concentrate. He normally used cocaine when at home. Further, let’s say that he had a couch that was blue in color.
At some point during his SUD, John decides to seek treatment. He successfully completes an inpatient program at a treatment facility and is progressing in his recovery journey. He goes to visit a friend, however, and that friend also has a blue couch. That couch could serve as a trigger to returning to use. Or, let’s say that he loses out on a promotion at work for whatever reason. That gets him down. Being down sparked his initial drug use, so being down again could also be a trigger. If John experiences both triggers at the same time, then the chances of him returning to use would be much higher than they would be normally.
In all cases, not having a support system of family, friends, and other community members can lead to return to use. People in recovery can often feel alone or as if they don’t matter to the people who matter to them. This can be especially difficult in cases where people’s brain chemistry is fundamentally altered, making them into a different person than they were before the SUD began. Heroin is one of the substances where this frequently happens.
Preventing Relapse
First, it must be said that there is no 100% method of preventing return to use. SUD is a lifelong condition that requires active vigilance to keep at bay. There are, however, a few things that people and their care teams can do to help prevent return to use.
- Building a Support System: Being appreciated helps. Having family, friends, and other strong people around you when you have SUD can be a great help in staying focused on recovery. Those extra people can not only provide the hugs and other encouragement that are crucial to maintaining emotional health but also look out for warning signs of possible return to use and hold the person accountable.
- Therapy: Most often, cognitive behavioral therapy (CBT) is the tool of choice for helping to control SUD. Other forms of therapy, however, can form an integral part of an overall treatment plan. Trauma is very often a big part of why someone starts using a substance, and it can also be a hindrance to recovery. In these cases, eye movement desensitization and reprocessing (EMDR) can be extremely effective in reducing the effect of the trauma. EMDR doesn’t treat the SUD itself, however. It reduces the possible effect of the trauma as a trigger.
- Coping Strategies: One of the aims of successful therapy is to teach people how to cope with their triggers and their ongoing SUD no matter how long it has been in remission. Common examples of coping mechanisms include:• Practicing mindfulness • Taking up a hobby or hobbies • Starting a workout regimen • Volunteering • Learning to trust others to help you
Of course, you and your therapist could come up with any number of other strategies to handle both your SUD and your triggers. Your case could preclude some of the normal coping mechanisms. For example, you could have chronic pain that interferes with your ability to exercise. You might also have trouble trusting people because the ones closest to you could have enabled your SUD rather than helping you combat it. In any case, the professionals who are involved in your ongoing recovery can work with both you and your loved ones and friends to craft a treatment program that is best for your continued success.
Speaking of Professionals …
Substance Use Disorder (SUD) treatment and monitoring during the recovery process isn’t a job for amateurs or laypeople. Effective treatment requires highly qualified medical professionals, such as doctors, nurse practitioners, and licensed mental health professionals, with expertise in addiction therapy. Detoxing from substances, especially in cases of alcohol addiction or drug addiction, can be life-threatening. The withdrawal process, if not properly managed, can pose severe risks, making it essential to seek care from a professional treatment center equipped to handle such complexities.
For example, detoxing from alcohol can be particularly dangerous. If a person has struggled with alcohol use disorder for an extended period, the risk of developing delirium tremens—a severe form of withdrawal—is high. The National Institute on Drug Abuse notes that professional oversight during medical detox is crucial to prevent complications. Even with expert care, delirium tremens has a mortality rate of approximately 5%. Symptoms such as severe dehydration, nausea, and diarrhea require careful medical intervention, including IV fluid administration, which should only be done by trained professionals. Without proper support, individuals face an increased risk of complications that could hinder their journey toward long-term recovery.
In addition to medical care, therapy plays a critical role in relapse prevention. Evidence-based approaches such as cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT), and motivational enhancement therapy help individuals manage their cravings and develop healthier coping mechanisms. Engaging in support groups, such as 12-step programs, group therapy, alcoholics anonymous (AA) can provide an added layer of accountability and encouragement during the critical first year of recovery.
Finding the right therapist is equally important. While credentials and experience are essential, the therapeutic relationship is built on trust and compatibility. The right therapist will offer guidance on available alcohol treatment and drug rehab options, ensuring individuals receive the appropriate care tailored to their needs.
Ultimately, the path to recovery is not a one-size-fits-all process. Seeking help from experienced professionals in a reputable treatment center can make all the difference in overcoming addiction and achieving sustainable, healthy living.
Conclusion
At ReCreate Life Counseling, our holistic approach to addiction recovery focuses on treating the entire person, not just their substance use. Our customized treatment options, including outpatient and inpatient care, group and individual therapy, and comprehensive aftercare support, help clients re-create their lives free from addiction.
Whether you are in the early stages of your recovery or seeking support to avoid relapse, we are here to help. Contact us today to explore our tailored rehab program and start your journey toward a healthier future.
Published on: 2025-01-19
Updated on: 2025-01-19
