Understanding Opioid Relapse

Relapse is a normal part of the recovery process from addiction, which has relapse rates that are similar to those of other chronic, relapsing diseases.^{2, 4} Relapse does not mean that a person’s recovery has failed.²

The Surgeon General’s Report on Alcohol, Drugs, and Health shows that substance use disorders (SUDs) have relapse rates of 40 to 60%, which is similar to the rates for other chronic diseases, such as diabetes (20-50%), hypertension (50-70%), and asthma (50-70%).⁴

If you have been in recovery for opioid addiction or are considering entering treatment, it may be helpful to understand opioid relapse to help prevent challenges when you encounter triggers to use during recovery.

What Does Relapse Mean?

Relapse occurs when a person who stopped using opioids returns to regular use.^{3, 9} In the context of opioid addiction, relapse occurs when a person with OUD who has been in remission (i.e., the disappearance of signs and symptoms of addiction) develops signs and symptoms of addiction again, according to the Substance Abuse and Mental Health Services Administration.¹ Opioid addiction relapse can take place over time, can be interrupted, and does not always last a long time.¹

Relapse from certain substances, such as opioids, can be more dangerous than with other substances.^{2, 3} This is because your tolerance level goes down after a period of abstinence.^{2, 3} If you resume using opioids at your previous level of use, you can experience an overdose, which can be deadly.^{2, 3}

How Does Relapse Happen?

Brain changes that occur due to chronic substance use persist for a long time after a person has stopped using a substance.⁴ These brain changes can lead to cravings, which can be difficult to withstand and lead to repeated relapse.^{4, 5} Cravings are strong urges to use a substance and key contributors to relapse.¹

Cravings can be triggered by different cues, such as seeing friends you used drugs with, being in places where you used opioids, or seeing people selling drugs.¹ People can continue to have a high risk of relapse for years after they’ve been abstinent.⁴

Warning Signs and Risk Factors of Opioid Relapse

Relapse is a process that doesn’t occur all at once. A lapse is a return to substance use, and relapse is continuing to use the substance after the first lapse.⁶ Early warning signs of opioid relapse can include:^{6, 7}

• Thinking about using opioids.
• Imagining what it would be like to use opioids again.
• Not seeking support when you need it.
• Reassociating with people who use opioids or other substances.
• Resuming previous behaviors involved in your previous substance use.
• Avoiding taking opioid addiction treatment medications, if you were prescribed them.

It’s important to be aware of the warning signs and risk factors for opioid relapse so that you are prepared and know what to expect; this can help you better understand what to do to prevent opioid relapse following treatment.⁶

Risk factors can include general psychosocial (psychological and social) factors, as well as specific behavioral, internal, or external factors that can arise in daily life.⁶ You may not be able to influence or control all these factors, but you can choose how to respond and whether to engage in unhelpful or negative behaviors.

Psychosocial risk factors may include:^{6, 7}

• Not believing that you can stay sober.
• Not realizing the negative consequences of substance use and thinking using opioids will bring you the desired outcome, such as pain relief or reduced anxiety.
• Having low motivation to stay sober or to make positive life changes.
• Having poor coping and relapse prevention skills, especially in risky or high-stress situations.
• Low mood.
• Poor social support.
• Cravings.

Behavioral factors can include:⁶

• Keeping in touch with people who use or sell opioids.
• Being around drug paraphernalia.
• Going to places where you used to use opioids.
• Socially isolating yourself or spending more time alone.
• Avoiding people in your recovery support network.

Internal risk factors can include:⁶

• Feeling hungry, angry, lonely, or tired (HALT) and not attending to your needs.
• Being bored.
• Not taking care of issues related to your physical or mental health.

External risk factors can include:⁶

• Spending time in areas where opioids are easily available.
• Being exposed to opioids or people who use them in your work or living environment.

How to Prevent Opioid Relapse

Opioid relapse may occur more easily if people don’t fully understand what the recovery process involves.⁶ People sometimes assume they can simply stop using opioids and return to their normal lives; however, recovery is a lifelong process.^{6, 8} Relapse can occur at any time, even after many years of making behavioral changes.⁸

People may also believe that going to detox is enough to stay abstinent and avoid relapse; however, detox alone may not be sufficient to promote long-term abstinence.⁹ While detox is an important first step in recovery that can help you stop using opioids, it’s also important to continue treatment that includes continuing care and relapse prevention plan.^{6, 9}

A relapse prevention plan is a written plan put in place to help you prevent relapse.⁶ It is developed in conjunction with your treatment provider and may contain the following elements:⁶

• The contact information for people in your recovery support system.
• A list of your specific triggers to use opioids.
• A list of healthy strategies and actions to take if you feel the urge to take opioids (such as going for a walk or calling your sponsor).

There are numerous relapse prevention strategies, and it’s important to find what works for you including:

• Engaging in ongoing individual counseling.⁶
• Attending mutual support groups.⁶
• Ask yourself if you feel HALT triggers and identify and address the underlying need.⁶
• Checking in with your support system.⁶
• Practicing self-acceptance and allowing the cravings or urges to be there without resisting or fighting them, but also without acting them out.⁶
• Practicing meditation or taking a mindfulness-based relapse prevention course, which is based on cultivating non-judgmental awareness of thoughts and urges.^{6, 10}
• Engaging in a substitution activity, such as exercising, hobbies, or another activity you enjoy.¹⁰

Using FDA-approved medications can be an important way of preventing or minimizing cravings and may help to protect against opioid relapse.² This can include the use of buprenorphine, methadone, or naltrexone as a part of ongoing OUD treatment and maintenance plan.^{1, 6} These medications are designed to reduce cravings, help you stay in treatment, and protect against relapse.^{2, 6}

If you’ve experienced a relapse, getting support is an important step in getting back to your recovery. American Addiction Centers (AAC) can help you find the treatment that can help you return to a drug-free lifestyle. Contact us today at to learn more about treatment options for relapse and recovery from opioid use.