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Understanding Opiate Addiction Relapse

Relapse is often a part of the recovery process. Many people will relapse on opiates after being discharged from a treatment program or at least once during their recovery.

However, it is possible to recover from a relapse and achieve long-term sobriety.

Information About Relapse

An opiate relapse occurs when you have a period of sobriety followed by a period of resumed substance use.

Unfortunately, opiates have one of the highest rates of relapse of any drug. One study found that many of the 109 people who had admitted themselves to a detox center relapsed at some point afterwards, with a good portion of those who relapsed doing so within the first week.

The study found several risk factors that make some people more prone to early relapse, as well as protective factors that may delay relapse or help individuals avoid a relapse. 1

Risk factors included: 1

  • Being young.
  • Using high doses of opiates prior to detox.
  • Having a history of intravenous drug use.
  • Not having an aftercare plan.

Protective factors included: 1

  • Completing a detox program.
  • Completing at least 6 weeks of inpatient rehab after detox.

Overdose Risks

Relapsing on opiates is particularly dangerous. Throughout the duration of detox and any sustained period of sobriety that follows, people may experience a marked reduction in their tolerance to opiates. Those who relapse may believe that they can handle the same amount of the drug that they used prior to detox. But using the same amount as before can lead to accidental overdose and even death due to respiratory depression. 3,4 

As an American Addiction Centers resource, encourages you to call our admissions navigators if you or a loved one are in danger of relapsing on opioids. We are a phone call away .

Why People Relapse on Opiates

People relapse on opiates for different reasons. Some of the common reasons include:
  • Stress: When people think about stressful events, they often think of losing a job or a death in the family. But stress can also come from positive experiences such as getting a new job or getting married. When a person experiences stress, the brain releases chemicals that may trigger someone in opiate recovery to think about how to relieve the stress. Opiates release feel-good chemicals such as dopamine, which provide an immediate release of stress.
  • Not having a plan: Addiction treatment should include formulating a safety or prevention plan. A plan will help you identify the thoughts, feelings, behaviors, and places that are triggers for your substance use. It will also help you identify things that you can do if you experience a trigger. Include people in your plan you can call if you feel triggered to use. You can refer to this plan whenever you feel at risk for a relapse. Without a plan, you are likely to act on impulse, which will increase the likelihood of a relapse.
  • Being around old friends you used opiates with: Many people have a hard time cutting ties with people they used to abuse drugs with. But most of the friendships that people have when they are addicted revolve around obtaining, using, and recovering from using drugs. For this reason, maintaining associations with these people can quickly lead to a relapse. Work on building a positive support group with other sober people and brainstorm how to ease feelings of loneliness that may come up at some point in your recovery.
  • Believing you can use again once you’ve been sober: Those recovering from opiate addiction often believe that once they have been sober for a while, they are no longer addicted and can use “just a little bit” or “just tonight.” Opiates are one of the most addictive drugs, and they have the highest potential for relapse. This is most likely due to the fact that they stimulate the brain’s reward system with an increased release of dopamine, which creates almost instant feelings of euphoria and pleasure. 2 Believing that you can handle just one dose is a slippery slope that often leads to a full-blown relapse.

How to Recover from an Opiate Relapse

The most important thing to remember if you relapse is that you can just as quickly decide to be sober again. Relapse, especially on opiates, is not uncommon and should be thought of as part of a process, not a failure.

If you’ve relapsed on opiates, here are some ways you can get back on the path of recovery:

  • Stop using opiates immediately. Opiates create rapid tolerance, which means that it is easy to escalate your dose in a short period of time. Even a week of relapse could require detox and treatment again.
  • Don’t beat yourself up. Instead, try to think about the sequence of events that led to the relapse and the feelings you had after the relapse. Write down any thoughts, feelings, behaviors, people, places, or events that may have triggered your desire to use opiates again. Were you bored? Were you having problems with your job, family, or friends? Also think about how you obtained opiates and whether your actions may have affected someone else. Think about the feelings you had once the opiates wore off. All of this will help you better understand why you relapsed as well as help you understand some risk factors for future relapse.
  • Contact someone in your support system. It’s very difficult to recover alone. Having a friend, a support group, a sponsor, or a therapist you can call to help you process your feelings can help prevent you from using opiates for a longer period of time. You can dig into the reasons why you relapsed and reduce the likelihood of doing so in the future.
  • Think about seeking further addiction treatment. The level of treatment required will depend on how long your relapse lasted. If you “slipped” and took opiates for one day, then a short-term course of intensive treatment or a series of individual therapy visits may help you avoid another relapse. If you were using for several weeks or months, however, you probably need to admit yourself to an inpatient treatment facility that can help you detox, offer a more intensive level of care, and potentially treat any medical issues related to sustained opiate use.
  • Speak to a professional about underlying issues that may have led to a relapse. Many people who are dealing with substance abuse have also endured some sort of trauma or are dealing with another mental health issue, such as depression. If you have an undiagnosed mental illness or trauma, it may require medication and therapy.
  • Speak to a professional about using medication-assisted therapy. Methadone and buprenorphine can lessen cravings, and they can help those recovering from opiate addiction feel less depressed, more engaged in their family and occupational lives, and less likely to commit crimes. 3 However, these drugs do come with risks, so speak to a professional and then weigh the pros and cons. If you are already on medication or previously took it, it can be re-initiated or adjusted.
  • Develop a relapse prevention plan. A relapse prevention plan outlines some or all of the following based on your needs:
    • Follow-up care (therapy, support groups, a sober living program if necessary, etc.).
    • Mental, physical, and emotional triggers to relapse.
    • Activities such as hobbies, exercise, or meditation to help you heal from substance use and manage cravings.
    • Coping skills to use when you feel triggered to use opiates (cognitive reframing, challenging thoughts, thought-stopping, distraction, urge surfing, etc.).
    • People you can contact when you need support to stay sober.

Warnings Signs

To avoid a future opiate relapse, it can also be helpful to learn the warning signs that you might be headed toward an opiate relapse. These include:

  • Experiencing stress. As mentioned above, stress (good or bad) can drive people in recovery back to using. If you are stressed, find ways to cope such as exercising, getting enough sleep, eating a healthy diet, and doing activities that you enjoy. You can also call a friend, family member, or sponsor when you’re stressed or work with a therapist on stress-reduction techniques.
  • Hanging around friends who drink or use drugs. Spending time around people who are still using can be a major temptation to use again. It can be extremely difficult to be around drugs in early recovery and not use.
  • Thinking you can use just once or use a different drug. Some people who have been in addiction recovery for a period of time begin to think that they can go back to occasional use, or that they can use a different drug that wasn’t their drug of choice. Although some people are able to do this, many recovering opiate users cannot and end up going back to addictive behaviors.
  • Stopping attendance at 12-step or group therapy meetings. It’s hard to stay sober without some form of support. That’s why many people continue going to 12-step meetings for years after they leave a formal program. If you do decide to stop going to 12-step meetings, make sure you have some other kind of support lined up.
  • Isolating yourself. Spending too much time alone, or even too much time working or studying, can lead to feelings of loneliness and depression. Take time to socialize or at least call friends and family members to stay connected to others.
  • Dealing with a crisis. A crisis, such as the death of a loved one, losing a job, or getting divorced, can be a trigger for relapse. If you’re going through a major life event, reach out to others for support when you need it or see a therapist.
  • Romanticizing past opiate use. If you find yourself thinking about the “good old days” of using and thinking about how good it would feel to use heroin or another opiate again, stop yourself and consult your relapse prevention plan.

How to Reframe

For many, addiction is a chronic and relapsing condition. Many people who are on the road to recovery will relapse many times throughout their lives, and many may relapse soon after being discharged from treatment programs if they don’t have the proper support in place.

Don’t beat yourself up because you relapsed. Just as you were able to remain sober before, you will be able to achieve sobriety again. Each relapse can help you learn more about yourself and grow as an individual. The key is to accept that relapse will always be a possibility throughout your journey to long-term sobriety.

Relapsing doesn’t mean you failed. You just have to start caring for yourself in a way that curbs any future relapse and get back to self-care immediately if you do relapse.

Find a Recovery Program

If you are in recovery from opiate addiction or abuse and feel like you are at risk of relapse, please contact one of our representatives at who can provide information about supportive treatment options.

[1]. Smyth, B.P., Barry, J., Keenan, E., & Ducray, K. (2010). Lapse and relapse following inpatient treatment of opiate dependence. Irish medical journal, 103(6):176-79.

[2]. Kosten, T. (2002). The Neurobiology of Opioid Dependence: Implications for Treatment. Science and Practice Perspectives 1(1):13-20.

[3]. Harvard Medical School. (2009). Treating opiate addiction, part I: Detoxification and maintenance.

[4]. U.S. National Library of Medicine. (2013). Opiate and opioid withdrawal.