Sometimes this involves a one-time drug relapse, but other times it can happen more than once after receiving substance abuse treatment, which is a chronic relapse. Understanding why this is the case can make all the difference in how we understand a SUD for ourselves or others.
One Time or Chronic?
To begin, let’s answer the question, what is a relapse? At its most basic level, a drug relapse occurs when we use or misuse a substance after abstaining from it for a period of time. This type of relapse is not only common among different types of substances (nicotine, alcohol, opioids), but it also is common for more than two-thirds of people who undergo treatment for an SUD. The main reason for this concerns various triggers that can cause a relapse to happen. Take alcohol as an example. Less than 20 percent of treated individuals who have an alcohol-related SUD remain alcohol-free for one year. However, relapse rates get much lower over time, with 60 percent of those who do not relapse in the first year remaining sober for up to five years. Most of those who make it to five years will remain sober indefinitely.
While this trend is encouraging, we should pause because none of these numbers is 100%, meaning that relapse remains a threat. In general, we can summarize that relapse can occur partly because of the people and places we are exposed to. These are the external factors. However, internal factors include how our brain functions, especially after an SUD. A substance use disorder is a brain disease, and this is a massive internal factor that relates to how and why relapse occurs. When dependence on any substance is formed in the brain, it changes how the reward system works, how the brain communicates with the rest of the body, and how we respond emotionally to the external factors mentioned above.
We can understand why substance cravings are much different for people with SUD compared to others. It is because their brains have begun associating those substances’ reward and euphoria. The longer an addiction remains, the stronger this reward system is established in the brain, and the possibility of relapse much easier to understand. Just as addiction is a rewiring of the brain based on an ongoing pattern of substance use, treatment involves healing and rewiring the brain away from the reward system associated with these substances.
Relapsing Dangers
One of the biggest dangers associated with chronic drug relapse is the likelihood of overdosing. The main reason for this is that our brains and levels of tolerance begin to return to normal levels during abstinence. People will often relapse by taking the same amount of the substance (either drugs or alcohol) that they were used to before. This could push them beyond the limits because they are no longer tolerant of this amount, which could cause overdose symptoms that would not have occurred before abstaining. The risk of this is even greater when people attempt to self-detox without professional help or at least a close network of accountability between family and friends.
This also highlights why relapsing is a dangerous scenario for people who do so with illicit drugs. There is never an objective way to know the dosage amount of a particular illicit drug. The drug could be mixed with other substances or marketed as a different drug entirely. Overdosing is very possible in this scenario. But it becomes even more dangerous when people take a smaller dose than before, only to find out that the smaller amount has lethal levels of unsuspecting drugs like fentanyl.
Going Forward in Hope
People should not be discouraged because of the possibility of relapse or if they relapse during recovery. Relapsing is a sign that our bodies are going through changes in the healing process, and treatment is rarely a one-time fix for an SUD when it is understood as a chronic brain disease. We should view treatment as a foundation of knowledge and tools to fight addiction, such as learning about the underlying issues related to addiction, triggers that lead to relapse, coping strategies that work, and supportive relationships for accountability. Together, these tools help people deal with relapses if and when they occur.
