There isn’t a definitive rate of relapse among opioid users, although it’s reported that relapse rates may be as high as 70% to 90% for people in the earliest stages of recovery. This doesn’t mean those people suddenly “fail” recovery. Many people eventually regain control and continue their recovery.
Relapses are often simply part of the journey on the way to sustained recovery.
What Is a Relapse?
In the context of drug use and substance use disorder (SUD), a relapse generally refers to a person using drugs after a period of sobriety. In essence, it is a backstep in one’s recovery journey, although it doesn’t necessarily represent a complete reset of recovery progress the way some people who experience relapses feel it does.
The goal is to avoid relapse, as it can potentially be dangerous. Sobriety can make you become more sensitive to drug use, so if you start using again, overdose is much more likely.
Relapse isn’t some moral failure. It’s important not to catastrophize the situation if you relapse, and instead, work to regain control over your drug use. Many people in recovery will experience at least one relapse, and it doesn’t mean recovery is impossible.
Brief relapses are often called slips or lapses, referring to brief breaks in sobriety that don’t necessarily signal a significant change in one’s recovery pattern. For example, if a person recovering from alcohol use disorder binge drinks at a party when normally they have been maintaining their sobriety but then regains control over their alcohol use the next day, that may be called a slip.
This type of use should still be avoided, as it can potentially spiral into a full relapse. But it also emphasizes the fact that drug use doesn’t necessarily represent a major backstep in a person’s recovery in all circumstances.
Key Facts About Opioid Use Disorder & Relapse
Here are some key facts about opioid use disorder and relapse:
- The United States has been in an ongoing opioid misuse epidemic since 1999. Nearly three quarters of overdose deaths in 2020 involved an opioid.
- Heavy opioid use builds up a person’s tolerance to opioids. A period of sobriety can lower that built-up tolerance, meaning that what was once a “normal” amount of use in the past may be fatal if you return to that level of use after sobriety.
- While relapsing can be a major recovery obstacle, the rate of a person diagnosed with a substance use disorder relapsing into unwanted drug use is actually lower than the relapse rates of many other chronic conditions unrelated to addiction, such as asthma.
Why Do People Relapse?
People can relapse for a variety of reasons, with a relapse generally being due to a combination of factors both inside and outside a person’s control. For example, one review of research examined potential biological factors that contribute to SUD. While this type of research is ongoing, there is evidence that high cortisol levels at baseline and when a person is exposed to drug cues (e.g., seeing pictures of drugs) can help gauge a person’s relapse risk.
There is also a genetic element to a person’s risk for substance use disorder. Overall, the review notes promising new technologies that can help this condition, but states that studies into biological markers of addiction relapse risk have been rare.
People who relapse often struggle with depressive symptoms, have a history of trauma and high stress, and experience drug cravings leading up to their relapse. Discussed more later, many relapses occur after a period of poor mental health combined with a person experiencing triggers. These are people, places, things, events, or situations that trigger more intense drug cravings than is typical in their day-to-day life. These triggers make maintaining control over your drug use much more difficult.
How Often Do People in Recovery Relapse?
Relapse rates can vary greatly, and there aren’t many detailed, modern studies on exact relapse rates regarding people in recovery from opioid use disorder. Discussions around relapse rates should generally be broken up by how long a person has been in recovery. People in the early stages of recovery are much more likely to relapse, in part because they haven’t yet built the skills and fully restructured their life to better resist drug use.
The review referenced in the previous section noted reports of relapse rates as high as 65% to 70% in the 90-day period following addiction treatment. This contrasts with the overall relapse rate for substance use disorders, which is often said to be around 40% to 60%.
It should also be noted that a relapse doesn’t mean a person completely drops out of the recovery process or is “reset” in their recovery. Many people relapse, regain control over their drug use, and continue their addiction recovery from about where they were before relapsing.
Reported relapse rates vary significantly enough that it’s hard to paint a picture of what an individual might expect of their own relapse risk. Some sources have put a person’s risk of relapsing within the first year of recovery from an opioid use disorder as high as 90%.
Common Contributors to Relapse
A 2017 study looking into contributing factors to relapses to alcohol use disorder or opioid use disorder found some factors that can contribute to a greater risk of relapse, including these:
- A low feeling of self-efficacy (the ability to resist drug use on one’s own)
- Strong drug cravings
- Poor family support
- A desire for a better mood
It’s also to understand how common triggers contribute to a person’s relapse risk. These include the following:
- Entering environments you associate with drug use and consider use to be normal while there
- Seeing people or situations that make you think engaging in drug use may be enjoyable or that remind you of a time when your drug use was enjoyable
- Being in situations where you believe drug access and use will be easier than normal
- Focusing on thinking about drugs, drug use, or your lack of drug use
- Using a small amount of drugs, which can often prime you to want more and experience much stronger cravings
- Stress, anxiety, or traumatic events
Responding to Your Opioid Relapse
If you do relapse to opioid misuse, it’s important that you don’t suddenly give up on your recovery, as that makes further drug use much more likely and may cause you to potentially engage in worse and more dangerous drug use than you otherwise intended to. Instead, stop using drugs the moment you find you are able and then seek help from someone you trust who won’t encourage further drug use.
As soon as possible, contact an addiction treatment professional, ideally the ones you have already been working with as part of your treatment. Tell them about what happened, so they can help you craft a plan to deal with the relapse.
While using drugs, do not engage in the same level of drug use as you had been using before you quit. As mentioned earlier, your tolerance for opioids has likely significantly lowered during your recovery journey. What was once an amount of drugs that caused a desirable high may now be dangerous or even fatal.
Additionally, do not engage in polydrug use, where you mix other drugs with opioids. This significantly increases your risk of complications, and combining substances in this way is much more likely to lead to overdose, including fatal overdose.
Recovery from opioid use disorder is best done with the help of medical professionals. Again, the first step you should take once you admit you have a problem is talking to an addiction treatment professional about your path forward.
If you’ve already been in recovery and relapse, it’s important to be honest with the professionals you’re working with. They need to know what you’re dealing with, especially because some medications for opioid use disorder may react poorly if you have traces of opioids still in your system.
If you feel you’re in crisis and at serious risk of a fatal overdose as a result of your relapse or losing control over your drug use, consider checking into an inpatient addiction treatment facility. These programs can provide dedicated treatments and make access to drugs more difficult. This can help people in crisis build up the skills and willpower to better resist drugs once they leave. After that point, transition to an outpatient treatment program can occur.
How to Prevent Future Relapses
If you want to prevent future relapses, it’s important to get therapy focused on building up skills to resist drug use. You’ll also learn how to avoid or redirect thoughts that might make your risk of drug use higher. This is generally done through cognitive behavioral therapy, although other types of therapy and counseling can help. For example, family therapy can help you and your family repair your relationship and build a supportive network around you.
Another important part of preventing relapses, which will often be covered in therapy and counseling, is identifying and avoiding your triggers for opioid use when possible and also preparing to experience them if they’re inevitable.
For example, think about situations, people, or places that remind you of opioid use and that seem likely to increase the chances you’ll consider using opioids. Whenever possible, you should generally skip out on things that will potentially trigger drug cravings even if it means missing social events like parties that you might ordinarily have thought were fun.
Reviewed By: Peter Manza, PhD
- Opioid Facts and Statistics. Department of Health and Human Services. https://www.hhs.gov/opioids/statistics/index.html. December 2022. Accessed February 2023.
- Drugs, Brains, and Behavior: The Science of Addiction. National Institute on Drug Abuse. https://nida.nih.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery. July 2020. Accessed November 2022.
- New Findings on Biological Factors Predicting Addiction Relapse Vulnerability. Current Psychiatry Reports. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3674771. October 2011. Accessed November 2022.
- A Comparative Study of Factors Associated with Relapse in Alcohol Dependence and Opioid Dependence. Indian Journal of Psychological Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5688890/. September 2017. Accessed November 2022.
- The 6 Triggers of Craving. Psychology Today. https://www.psychologytoday.com/us/blog/science-choice/201802/the-6-triggers-craving. February 2018. Accessed November 2022.
- Module 5: Assessing and Addressing Opioid Use Disorder (OUD). Centers for Disease Control and Prevention. Accessed November 2022.
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