A substance use disorder (SUD) is a complex condition with far-reaching consequences. Its effects can be emotional, social, physical, and biological. Often referred to as chronic, SUD may feature relapse, with rates estimated at approximately 40 to 60 percent. While SUD may not always be cured, it is treatable and it can be successfully managed. People with SUD can regain a fulfilling life. Additionally, with sufficient strategies in place, it is entirely possible to spot red flags and prevent relapse altogether.
What Is A Substance Use Disorder?
Commonly referred to as addiction or alcoholism, and formerly called substance abuse and substance dependence by clinicians, the condition is now called Substance Use Disorder (SUD) as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). The Substance Abuse and Mental Health Services Administration (SAMHSA) provide a range of resources and factual information about substance use and mental health.
SAMHSA explains that a substance use disorder is a complex condition that occurs with recurrent use of drugs and alcohol. Varying in severity — mild, moderate, or severe — substance use disorders can cause significant clinical and functional impairment in terms of health, disability, and failure to meet day-to-day responsibilities at home, work, or school.
What Is Relapse?
Relapse simply means a return to substance use after a period of abstinence. It is important to note that due to the chronic nature of the disease, relapse is not just a possibility — it’s a likelihood. However, relapse is not a sign of failure: rather, it’s a common feature of the disorder.
The National Institute on Drug Abuse (NIH) estimates relapse rates to be between 40 and 60 percent. These rates are similar to relapse rates in other chronic disorders such as diabetes, hypertension, and asthma — all of which, like SUD, have both physiological and behavioral components.
SUD can be a result of a prior trauma and/or ineffective coping strategies in dealing with life’s stressors. It can take time to uncover those issues, process them, and recover from them. Treatment of chronic disease requires changing deep-seated behaviors and developing effective coping strategies for the challenges that occur in life. Those strategies include developing the ability to self-regulate emotions, thoughts, and behaviors, as well as building a supportive network of relationships with trusted professionals and people in recovery. It didn’t take a brief moment to develop SUD, so it will take more than a few moments to recover and develop new behaviors and coping mechanisms.
Common Causes Of Relapse
While causes of relapse can vary from person to person — with different stressors presenting as triggers — it is known that SUD biologically changes the brain chemistry, how pleasure is experienced, the ability to override impulse control and rational decision-making, and the regulation of mood. It is because of the repeated nature of drug and alcohol use that the brain chemistry is altered and neural pathways are changed. This is why withdrawal symptoms are experienced, why cravings occur, and the reason that people who suffer from SUD return to the drug to stop these unpleasant withdrawal symptoms.
Neuroscientists have proven that those with SUD have lower levels of dopamine receptors — responsible for reward-motivated behavior, i.e. pleasure — in the brain. This means that people with SUD are less sensitive to and motivated by rewards and may find the world dull, once again making them prone to seek out drugs (or even food) to enhance their everyday life — and to provide pleasure.
Lowered dopamine receptors continue long after drug use has stopped, which is why the risk of relapse continues well into recovery. This also explains why people gain weight in recovery: the brain transfers the addiction by seeking pleasure in less harmful substances like high-carbohydrate foods.
What’s more, fewer dopamine receptors has been linked to lower activity in the prefrontal cortex, which impairs the ability to think critically and exercise restraint. This means that SUD, or even overeating certain foods, is not a moral failing, rather the brain is biologically altered by the disorder rendering the person unable to make rational decisions.
Knowing this information informs treatment strategies and can help develop effective means to watch out for warning signs. That said, relapse can still occur. It is important to acknowledge that relapse is not a failed recovery: rather, relapse can be used to adjust treatment plans and recovery tools and strategies.
Relapse Warning Signs
While most people’s experience will differ in terms of what caused the use of substances to numb out, often leading to SUD, there are some common themes and triggers. Here are some potential red flags to watch out for:
Not Completing Treatment
People in treatment will often be encouraged to stay and complete the prescribed course of treatment. It takes time to learn new coping strategies, which is why the length of stay in a treatment center is typically 30 to 90 days. Learning these strategies outside of the home environment is easier, but they take time to implement at home; that’s why secondary support is available. Leaving treatment early removes this support and the ability to fully utilize the potential tools and strategies that could prevent relapse.
This is perhaps the most common trigger for elevated levels of anxiety, feeling agitated, and an increased desire to escape. Work, home environment, strained relationships, and competing priorities all can cause stress. This emphasizes the need for coping strategies, effective planning, and ensuring there isn’t too much on your plate.
Certain people, places, things, and moods may trigger a euphoric recall of using drugs and alcohol. Being around friends who are using, or visiting a bar, can potentially cause relapse because temptation is much closer and there can be peer pressure. This is why the common phrase “change your playground” is used in support groups and treatment centers.
Side effects to medication can be unpleasant and upset general well-being. It’s important to keep on top of these and stay in close contact with a primary care doctor.
It is entirely possible to prevent relapse, or to use the relapse as a sign that treatment needs to be adjusted. These are useful tools that are most commonly used to manage continued recovery:
- Asking for help when needed
- A supportive network of friends that you regularly check in with
- Nutritious food
- Avoiding triggering people and environments
- Regularly visiting a primary care doctor
- Effectively managing any co-existing disorders
- Taking medication as advised
- Restorative activities, such as yoga, float tanks, or meditation
- Limiting or avoiding caffeine
- Regularly attending support groups
- Regular exercise
- Creative activities
About The Expert
Writer and wellness coach, Olivia Pennelle (Liv), is in long-term recovery. Olivia passionately believes in a fluid and holistic approach to recovery. Her popular site Liv’s Recovery Kitchen is a resource for people in all types of recovery to live well—providing delicious recipes, insightful interviews, some of her featured articles, and tools to live well. You will find Olivia featured as an expert writer in leading recovery and mental health publications. She also provides tailored coaching packages and delivers wellness workshops. Olivia is located and living in Portland, OR.