Relapse: A Natural Part of Recovery
Relapse occurs when a person returns to substance use after a period of abstinence. When this happens, it often leaves the individual feeling like a failure or like they don’t have what it takes to stay sober. A feeling of hopelessness can set in quickly, as the perception that they’ll never recover takes hold. However, it is important to understand that not only does relapse happen, it is quite common and, some might say, a natural part of the journey of recovery from addiction. In fact, the Journal of the American Medical Association reports that “among individuals with substance abuse disorders who get treatment, 40% to 60% will relapse within 1 year,”1 and the National Institute on Drug Abuse states “the chronic nature of the disease means that relapsing to drug abuse at some point is not only possible, but likely.”2
Just as individuals with other chronic illnesses such as diabetes or heart disease often have a hard time strictly adhering to a new health regimen, a drug-addicted individual will likely struggle with maintaining sobriety. Staying in recovery involves establishing new habits, a process that is rarely easy for anyone looking to change their behavior.
Think about how you might struggle to adopt a new gym schedule or reduce your social media usage, and you can appreciate how challenging it can be to stay completely abstinent from an addictive substance, especially one associated with significant physical dependence and, at least in the short term, withdrawal.
The bottom line is that recovering from drug or alcohol addiction can be extraordinarily difficult and requires significant lifestyle and behavior change, which commonly includes a few slip-ups along the way.
Why Does It Happen?
Relapse can feel like a failure of willpower, but, in fact, it is far more complicated. Addiction has a major impact on the brain, which is why many organizations that study drug abuse describe it as a brain disease.3 Looking at addiction from this perspective can make it easier to understand the complex nature of addiction and recovery.
Many addictive substances trigger the release of dopamine in the reward centers of the brain which accounts for the experience of significant pleasure, or a “high.” The amount of dopamine released with drug use often far surpasses the amount normally released upon exposure to a natural reward (e.g, eating, exercising, or getting a hug), thus prompting the user to seek more of the drug to get that feeling back.3
This intense pleasure associated with drug use can be fleeting, however. Chronic use of the drug can lead to a phenomenon known as downregulation, which means a decrease in the responsivity of or even the number of dopamine receptors. Over time, the production of dopamine itself might diminish in the presence of consistently elevated drug levels. This translates to a dampening of that person’s ability to experience pleasure not only from their normal dose of the drug but also from healthy, natural rewards. Someone whose brain undergoes these gradual changes may find that seeking and using more and more of the drug takes priority over any of the other activities that previously made them happy because, even though they struggle to attain the high they got in the beginning, taking the drug is still the most effective way to stimulate their brain’s reward center. Without the drug, they may feel dysphoric, or generally dissatisfied with life.3
Moreover, these dopamine-related changes have been associated with lowered activity in the prefrontal cortex, which could lead to increased impulsivity.3 So while to an outsider, a relapse may look like a moral failure, there are numerous physiological factors at play.
Furthermore, some experts posit that the dopaminergic system goes beyond reward and is intrinsically linked to motivation, or ‘‘wanting.” Dopamine gets released not only when you are using it but when you are thinking about getting and using it, and cues in the environment become associated with drug use and initiate the release of dopamine in the brain all on their own. As addiction progresses, parts of the brain associated with automatic behaviors are also impacted. Thus, a relapse is about more than just seeking the experience of pleasure that comes with drug use—thoughts and triggers related to drug use can lead to intense cravings or drug-seeking behaviors even outside of conscious awareness as these processes are occurring in the brain.4,5While to an outsider, a relapse may look like a moral failure, there are numerous physiological factors at play.
Outside of these changes in the brain that help explain why relapse occurs, there are also other psychological and social factors to consider. Someone who abuses drugs may have begun doing so in an attempt to numb troubling feelings and cope with unpleasant or even traumatic life events. They may have done so to self-medicate pain or mental health symptoms. Sobriety forces you to face these things head-on, a process that can be disconcerting, unfamiliar, and sometimes painful. A natural human response may be to go back to what has “worked” in the past.
Also, as stated above, recovery is associated with significant lifestyle and environmental changes. They often involve avoiding exposure to old triggering environments and limiting contact with substance-using friends. Someone in recovery, especially if they’re just starting out, might feel isolated, missing their old life, and lonely. An individual suffering from these negative feelings may begin to romanticize their drug use, remembering only the “good” moments. They may return to social activities and groups where drug use was a normal part of daily life. The addicted brain will say, “I can handle it,” but in reality, when feelings of isolation, struggle, and loneliness are in place, being surrounded by environmental and social triggers can make drug use seem irresistible.
Finally, rehab programs provide a protective, substance-free environment where recovery is given sole focus. The transition away from a completely abstinent therapeutic environment back into daily life can be a difficult one. If a good plan isn’t in place to assist in the transition and provide adequate support, the individual may be more susceptible to relapse.
Learning from Relapse
Recovery is a learning process and sometimes it is through making mistakes that people discover what they need to be aware of to navigate their own recovery path. It has often been through an experience of relapse that recovering individuals have learned the following lessons:
- They can no longer spend time in their old environments or with their old friends.
- The ideas that they could moderate their substance use or have “just one” were false.
- They struggle with underlying mental health issues that must be addressed in order to stay sober.
- They need to return to treatment or reevaluate the type of treatment that is right for them.
It is important to remember that although relapse is common, it can still be very dangerous (sometimes deadly) since after a period of abstinence your body is no longer used to the same level of alcohol or drugs.
Recovery is possible and a relapse should not undermine your hope for the future.Also, even though relapse is something that often happens on the path to recovery, it is not a necessary component. Thus, it is best to have a relapse prevention plan in place and do everything you can to avoid relapsing. If it happens, it will be helpful to remind yourself that you are not a failure and that relapse is a common roadblock for many people who’ve walked the road to long-term recovery. It won’t help to beat yourself up over it and, in fact, doing so can actually be very harmful. Dr. G. Alan Marlatt, former director of the Addictive Behaviors Research Center at the University of Washington, coined the term “abstinence violation effect” to describe how the self-degradation that can occur after a slip-up can actually lead to a full relapse.6 So what’s the difference? Many addiction experts distinguish between a “lapse” and a “relapse”—a one-time substance use vs. a full slip back into problematic drug use. If you’ve had a lapse, be gentle with yourself; berating yourself or telling yourself you don’t deserve recovery only serves to make a full relapse more likely.
If you have suffered a full relapse, just realize it is common, get back on track, and take what you have learned and use it to inform your future actions. A relapse does not mean you have failed, but rather that you need to return to treatment or make some adjustments in your treatment plan or lifestyle. Recovery is possible, and a relapse should not undermine your hope for the future.
- Slomski A. (2014). Mindfulness-Based Intervention and Substance Abuse Relapse. Journal of the American Medical Association, 311(24):2472.
- National Institute on Drug Abuse. (2014). Drugs, Brains, and Behavior: The Science of Addiction.
- Volkow, N. D., Wang, G.-J., Fowler, J. S., Tomasi, D., Telang, F., & Baler, R. (2010). Addiction: Decreased reward sensitivity and increased expectation sensitivity conspire to overwhelm the brain’s control circuit. BioEssays : News and Reviews in Molecular, Cellular and Developmental Biology, 32(9), 748–755.
- Everitt, B.J. & Robbins, T.W. (2013). From the ventral to the dorsal striatum: devolving views of their roles in drug addiction. Biobehav. Rev., 37, 1946-1954.
- Littrell, J. (2011). How Addiction Happens, How Change Happens, and What Social Workers Need to Know to Be Effective Facilitators of Change. Journal of Evidence-Based Social Work, 8(5), 469-486.
- Marlatt, G. A. (1985). Relapse prevention: Theoretical rationale and overview of the model. In G. Alan Marlatt and J. R. Gordon (Eds.) Relapse prevention: Maintenance strategies in the treatment of addictive behavior (pp. 3–70). New York, NY: Guilford Press.