Heroin Relapse is Common
Anyone can develop a heroin addiction—it’s not limited to a specific demographic—but once you develop an addiction, it can be difficult to overcome.
Heroin addiction is very powerful and, because of its interaction with opioid receptors and reinforcing influence on your brain’s reward centers, results in such profound feelings of euphoria and pleasure that it sometimes feels impossible to quit 1. Even after someone has successfully completed a treatment program, they may continue to struggle with cravings and thoughts about using. Sometimes, the rise in intensity of these cravings and thoughts leads to a heroin relapse.
The National Institute on Drug Abuse reports that 2.1% of adults aged 26 and older have used heroin at least once in their lifetime 2. Anyone can develop a heroin addiction—it’s not limited to a specific demographic—but once you develop an addiction, it can be difficult to overcome, and the heroin relapse rate is often high.
One study examined heroin relapse rates among participants who were discharged after successfully completing an opiate detox program. Of them, 91% reported a relapse, 59% of which occurred within 1 week of discharge. Earlier relapse was associated with younger age, heavy use before treatment, a history of injecting, and not following up with aftercare 3.
Despite the high heroin addiction relapse rate, many people don’t realize that relapse is often considered part of the recovery process. Given that, how is relapsed defined?
What Is a Relapse?
Heroin relapse is defined as the resumption of heroin use after a period of abstinence. It frequently occurs in connection with strong cravings or as a response to a stressor.
According to the National Institute on Drug Abuse, people struggling with addiction often experience one or more relapses over the course of their recovery journey. Many schools of thought adhere to the concept of addiction as a chronic, relapsing disease, which means that drug addiction—and the desire to relapse—is an issue that a person may struggle with for the rest of their life 4.
The book Relapse and Recovery in Addictions also states that addiction is a disease and that relapse is an unrelenting part of recovery 5. It also presents the idea that relapse is a part of a larger learning process that may ultimately lead to abstinence in that each relapse gives a person clues into areas that can be strengthened to prevent future relapses.
Although it can take multiple relapses before a person is truly able to remain abstinent, a strong aftercare program is an essential component to staying on the path to recovery.
Why Do People Relapse on Heroin?
Substance abuse expert Terence Gorski believes that relapse is a progressive issue resulting from a compounding series of behaviors, thoughts, and problems. In other words, the triggers and problems that led to an addiction don’t simply disappear when a person gets clean 6. Each problem that occurs during recovery is a relapse warning sign, which, after a while, becomes too much to handle. The person feels that life has become unmanageable, and the only solution is to start using again.
A person struggling isn’t necessarily thinking about using, but their emotions may be setting the stage for relapse.
An alternative perspective on the relapse process views it as having three phases: emotional, mental, and physical 7:
- During the emotional phase, a person isn’t necessarily thinking about using, but their emotions may be setting the stage for relapse. They might feel isolated, stop going to meetings, or develop poor eating and sleeping patterns.
- In the mental phase, they experience internal conflict: part of them wants to use, but part of them knows how destructive their addiction was.
- And finally, during the physical phase, a person starts using again when the pull of the addiction becomes too strong to resist.
Relapse Warning Signs
Some common warning signs of heroin relapse include 6,7:
- Experiencing a distressing event.
- Denying a need for help.
- Leaning on other compulsive behaviors, such as overeating or oversleeping.
- Becoming overly emotional instead of relying on your intellect to keep you sober.
- Acting and feeling out of control in your day-to-day life, such as at work or in relationships.
- Thinking negative or dysfunctional thoughts, such as “I’ll never be able to stay clean.”
- Not having supportive family or a helpful social network.
- Not following up with aftercare.
- Stopping attendance at 12-step groups or individual counseling.
- Experiencing intense physical cravings.
- Using “just once,” which can lead to a cycle of uncontrolled use.
What to Do When You Relapse on Heroin
If you should experience a heroin addiction relapse 7:
- Stay calm. Don’t beat yourself up. Remember that relapse is a part of recovery and that you’re not the first person ever to relapse.
- Take action right away. Don’t let days or weeks go by before you reach out for help.
- Reach out to a trusted and supportive friend, family member, or sponsor.
- Commit to regularly attending 12-step meetings. For example, you might aim for 90 meetings in 90 days.
- Begin (or resume) individual counseling.
- Engage in positive activities that take your mind off using. You might consider exercise, getting out of the house and spending time in nature, reading, or seeing a movie.
- Avoid negative or all-or-nothing thinking. This might include thoughts such as, “I can’t handle life without using,” or “Life is no fun if I don’t use.”
- Enter a professional substance abuse treatment program.
Going to Treatment After a Relapse
After a relapse, it’s often wise to consider reentering a treatment program. Your support system, which might include your therapist, psychiatrist, family, friends, or sponsor, may decide that treatment is the smartest and most helpful way for you to get back on track. Yet despite their best intentions, you might feel some resistance to this idea.
Some of the more common emotional and mental blocks to reentering treatment after a heroin relapse can include 7:
- Feeling like a failure. Instead of viewing relapse as a failure, try to see your relapse as a small detour on your recovery journey that will end up teaching you more about what you need to stay sober.
- Fear. You might be fearful of being judged or not measuring up, or even of success. Participating in cognitive therapy in a treatment program can help you learn to replace these fearful thoughts with more positive and realistic thought patterns.
- Thinking that recovery isn’t “fun.” While you might think that staying clean isn’t a good time, it might help to realize that redefining your view of “fun” could help you stay sober. Keep in mind that your expectations play an important role here. Research has shown that if people think something won’t be fun, it usually isn’t. On the flip side, if they expect it to be fun, it usually is.
- Not wanting to face your demons. Everyone has problems, but not everyone has the courage to face them. Entering treatment can provide you an opportunity to further work on the issues that first led to your addiction and eventually contributed to relapse.
How to Create an Effective Relapse Prevention Plan
Having a heroin relapse prevention plan can provide you the tools you need to stay sober. A well-thought-out plan can help you identify and manage the signs of heroin relapse before things get worse. You can implement some of the elements of a relapse prevention plan on your own, while others are performed during treatment.
The main components of an effective relapse prevention plan—which can be especially helpful if you have just experienced a relapse—include 8:
- Stabilization. Starting with period of sobriety is essential. Preventing another relapse can’t be effective if you’re high or drunk.
- Assessment. Treatment staff work with you to identify past and present problems that led to your relapse. They take a detailed family history and ask questions about your previous history of treatment and drug use to help tailor your relapse prevention plan.
- Relapse education. Participating in 12-step groups can help you learn how to manage the relapse process. You will also receive relapse education during treatment.
- Warning sign identification. Learning to recognize the triggers and problems that cause you to want to use.
- Warning sign management. Learning what to do when warning signs occur.
- Recovery planning. Start or continue to attend groups like Narcotics Anonymous (NA) on a regular basis to work through the 12 steps of recovery.
- Inventory training. This type of training involves thinking about situations that may trigger a relapse. In the morning, take a moment to think about how to handle the warning signs you might encounter during your day, and then in the evening, review your progress and reflect on any problems you faced.
- Family involvement. If it’s possible, encourage family members to attend NA meetings so they know how best to support you.
- Follow up. Your triggers and responses may change over time, so it’s crucial to update your relapse prevention plan periodically: every month for the first three months of recovery; quarterly for the first two years; and then on an annual basis thereafter.
- National Institute on Drug Abuse. (2017). Heroin.
- National Institute on Drug Abuse. (2016). Heroin: Statistics and Trends.
- Smyth, B.P., Barry, J., Keenan, E., and Ducray, K. (2010). Lapse and relapse following inpatient treatment of opiate dependence. Irish Medical Journal, 103(6), 176–179.
- National Institute on Drug Abuse. (2017). What is a relapse?
- New England Journal of Medicine. (2002). Book review: Relapse and Recovery in Addictions.
- Gorski, T. (2001). Understanding Relapse.
- Melemis, S. (2015). Relapse Prevention and the Five Rules of Recovery. Yale Journal of Biology and Medicine, 88(3), 325–332.
- Gorski, T. (2003). How To Develop A RP Plan.