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Opiate Relapse

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Opiate abuse and addiction has become an epidemic with a vast impact on the health and welfare of individuals and societies worldwide 1. The statistics provided by the National Institute on Drug Abuse offer a snapshot of the epidemic that helps to emphasize just how significant its effect is 1.

  • The United States is one of the largest global consumers of opiates, representing almost 100% of the Vicodin (a medication containing hydrocodone) market and 81% of the Percocet (an oxycodone painkiller) market.
  • In 2013, 207 million opiate prescriptions were written in the U.S. alone.
  • It is estimated that anywhere from 26 to 36 million people worldwide abuse opiates. Of that, 2.1 million are U.S. residents.
  • It is believed that at least 14% of pregnant women will be prescribed opiates during their pregnancy.
  • Between 2000 and 2009, babies born with neonatal abstinence syndrome—a condition resulting from prenatal opioid exposure—rose by 300%.
  • In 2012, more than 5% of the population older than 12 had used an opiate medication for non-medical reasons.
  • In 2010, opiate medications represented 82.8% of the total deaths caused by unintentional overdose.

Chances of addiction relapse are higher than those for any other drug addiction, with one study reporting that as many as 91% of those in recovery will experience a relapse 2. The study also found that at least 59% of those who had an opiate relapse would do so within the first week of sobriety, and 80% would relapse within a month after discharging from a detox program 2.

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What Is a Relapse?

Relapse occurs when a person returns to drug use after a period of abstinence 3. Addiction to any substance or activity is considered by many a chronic illness that inherently holds the potential for relapse 3. 

It is not uncommon for those on the road to recovery to relapse at least once. Many view relapse as a significant, yet not insurmountable, stumbling block. It’s all part of the recovery process, and should relapse occur, it need not fuel the idea that the person in recovery is a failure, or that treatment efforts have been unsuccessful. A relapse can help you identify triggers that you didn’t know existed and be the impetus to learn helpful techniques you didn’t previously know. In fact, the steps that you take to address a relapse can help you become stronger in your sobriety than you were before.

Why Do People Relapse on Opiates?

Opiates activate the mesolimbic system of the brain, which is strongly associated with reward and conditioned associations. When a person uses opiates, they trigger a release of dopamine (a neurotransmitter associated with feelings of pleasure) and simultaneously activate parts of the brain that connect surroundings with pleasurable feelings. These feelings then become the reinforcing triggers for an addiction relapse.4

Unfortunately, chronic use of opiates create changes in the brain that can lead to both dependence and addiction 4. A little-known fact is that these changes can also happen if you are taking opiates for therapeutic reasons and within the prescribed doses. Encouraging research findings indicate that some of the brain changes that accompany the development of opioid dependence resolve within days or weeks after detox—effectively reducing the likelihood of a relapse 4. That being said, opioid drugs may have additional profound and long-lasting changes on the functioning of the brain that give rise to troublesome craving and compulsions that can persist long after use has stopped 4.

Opiate Relapse Warning Signs

A few risk factors may increase the likelihood that a person relapses on opiates, including 2:

  • Having used opiates intravenously.
  • Having used high doses of opiates.
  • Not seeking aftercare.

While these factors may predispose an individual to relapse, everyone is different. The relapse rate for addiction is extremely high, therefore relapse seems like an inevitable part of recovery for a lot of people. Recognizing personal signs for potential relapse is an important step in preventing a relapse. Common factors that could increase the chances of relapse include:

Recovery is a personal journey that requires you to understand why you use and then commit to maintaining a constant awareness of your emotional and thinking states. Once you recognize a personal warning sign, the next step in your personal safety plan is taking immediate action to circumvent a relapse.

  • Stress. This can be daily stress that builds slowly or a life-changing event, including the death of a friend or loved one, a divorce, a move, or even a big promotion.
  • Lack of positive support systems. Support systems include support groups, family, friends, and co-workers. Surrounding yourself with the people you used drugs with makes you more likely to relapse. However, surrounding yourself with positive and sober people can help you remain strong in your recovery.
  • Falling back into old patterns of thinking, feeling, and behaving. Identifying old patterns can help you understand your personal relapse warning signs. Once you begin noticing them, it may be time to step up your engagement in therapy to help prevent a relapse.

What to Do When You Relapse on Opiates

If you or a loved one has recently relapsed on opiates, it is important to remember that it doesn’t mean you can’t still decide to remain sober. Here are some tips to recovering from a relapse:

  • Stop using opiates immediately. Especially when you have a history of opiate addiction, returning to a full-blown addiction is easy, and will require detox all over again.
  • Avoid beating yourself up. This is not helpful and can spiral into old patterns of abuse. First, try to remind yourself that the relapse rate for opiate addiction is as high as 91%, so you are in the majority. Then stop and think about what led to this relapse. Write down your thoughts, feelings, behaviors, people, places or events that may have triggered your desire to use again. This helps you to better understand why you relapsed, as well as help you understand some risk factors to prevent future relapse.
  • Contact a support person. Recovery doesn’t have to happen alone. Contact a loved one, friend, sponsor, therapist, or another care provider. These people can provide reassurance that you are cared for and loved and help you to avoid another situation where you might use.
  • Think about seeking further treatment. If you have relapsed, you may need to find a treatment program that will provide you with the ongoing support, encouragement, awareness, and accountability that can help prevent a future relapse.
  • Consider seeking medication therapy. Chronic abuse impacts brain chemistry. This can lead to low impulse control, depression, anxiety, and cravings that, if not addressed, can easily result in a relapse. In some cases, medications may be prescribed to help with some of the psychological issues brought about by addiction. Remember that you may not need to take medication forever, but it can help to keep you safe in the short-term.

Going to Treatment After a Relapse

Concerned man listens to therapist after relapsing on opiates

If you or a loved one have recently relapsed, it may be important to follow up with an individual therapist, psychiatrist, or support group. These treatment options can greatly increase your chances of continued sober living after a relapse.

Often, people who relapse experience a surge in negative thoughts and feelings, which can reinforce old patterns of maladaptive substance abuse behaviors and soon lead them back to a path of addiction. Finding a treatment provider or group that you can attend weekly or biweekly can remind you of why you chose to be sober, what your strengths are, and how to remain firm in your decision to live a life of sobriety. Without this, people can feel alone, depressed, and hopeless—all of which can lead them back to an opiate relapse.

It is not uncommon for people to return to rehab multiple times before achieving permanent recovery. By re-engaging with a formal treatment program, you’ll be able to learn something new about yourself and your addiction, which will ultimately increase your ability to stay clean.

If you or a loved one have recently relapsed and aren’t sure what next steps to take, help is available 24/7. Contact one of our representatives today at to discover treatment options that can help you get back on track after a relapse.

How to Create an Effective Relapse Prevention Plan

An effective opiate relapse prevention plan helps you better understand your warning signs and triggers for a relapse and will help you take actions to keep you safe and sober. A good relapse prevention strategy consists of:

  • Recognizing personal warning signs of relapse. Know your internal and external triggers for using. Internal factors include thoughts and feelings that you strongly associate with abusing opiates. External factors might include specific places, items, sounds, or even smells that lead to a desire to use.
  • Knowing what you can do when you recognize a relapse warning sign. It is important to list your most effective coping skills or strongest support source in your personal relapse plan. These are skills, hobbies, activities, and people that you know can keep you safe at a time when you desperately want to use.
  • Having a plan to follow up with a treatment professional or support group. Engaging in individual or group therapy can be comforting and validating while on your journey toward freedom from substance abuse.
  • Developing a recovery action plan. Often, people feel empty or unhappy at the beginning of their sober lives. They haven’t yet replaced their drug habit with something else, so a void is left. Developing a schedule that fits in work, hobbies, and activities focused on sobriety not only helps you remain focused on your sobriety goal but can help you derive satisfaction from a sober lifestyle.

Living a sober life is a journey that requires a daily recommitment to recovery. But sobriety is not a challenge you or your loved one needs to take alone. Relapse support representatives are available 24 hours a day, 7 days a week to provide you with various resources for all levels of care. Contact them today at . You can also contact free narcotics and drug abuse hotline numbers.

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Meredith Watkins, MA, MFT is a licensed Marriage and Family Therapist with specialities in eating disorders and dual diagnoses. As a seasoned editor and writer, she has also worked as a clinical editor for online addictions journals and websites, and ghostwritten for numerous medical and addictions professionals.

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