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Relapse, broadly speaking, is when a drug or alcohol addiction reappears after a period of remission or recovery. For people who have struggled with substance use disorders, they’re surprisingly common.

In fact, according to the National Institute on Drug Abuse, relapse rates for substance abuse are roughly the same as those for other chronic diseases, like diabetes, asthma, and hypertension — about 40-60 percent.

That doesn’t mean that relapse is a guarantee, however, or that it can’t be mitigated and controlled with careful treatment and support.

How Treatment Affects Relapse Rates

There are several factors that affect the rate at which those diagnosed with substance use disorders (SUDs) relapse. One example is participation in a 12-step program like Alcoholics Anonymous. Duration matters as much as simple participation — a study completed in 2006 indicated that 72% of individuals who participated in AA for more than 27 weeks were relapse-free after 16 years — twice the rate of those who didn’t join AA at all.

Despite the variety of data on the subject, two main themes seem consistent: getting treatment for SUD can greatly reduce relapse rates, and relapse rates are highest in the first year of sobriety, with a steep drop-off every year after that.

Even a few days of treatment can make a difference. According to the Partnership for Drug-Free Kids, “Patients who received addiction treatment within 30 days of going through detoxification took 40 percent longer to relapse if they fell off the wagon at all.”

As for the second theme, the evidence indicates that staying sober only gets easier as life goes on. In 2007, the National Institutes of Health published data comparing relapse rates over time during recovery. In their first year of recovery, almost two-thirds of participants recovering from SUD experienced a relapse. For those who stayed sober for a year, that number fell to half. And for patients who managed to stay sober for five years, relapse rates were less than 15 percent.

Relapse From Alcohol Use Disorder Treatment

Rates of alcohol relapse for those with alcohol use disorders are high — the National Institute on Alcoholism and Alcohol Abuse has indicated that 90 percent of alcoholics will experience at least one relapse following treatment.

However, the trend of relapse rates dropping over time still holds true. During the first year of recovery, relapse rates are as high as 80%, but that number drops to 40% after two years of sobriety. Furthermore, individuals who seek support for their addiction are more likely to be clean and sober three years later than those who don’t get help, or who try to quit on their own.

Cocaine and Meth Relapse Rates

Stimulant drugs like cocaine and methamphetamine are known for their strong addictive properties and high relapse rates, but the premise that recovery helps to prevent relapse still holds. In a study cited by Reuters, 48 percent of meth users who followed a detox and rehabilitation program were still sober three months later and 20 percent were sober after a year — by contrast, only 7 percent of people who had undergone detox only or received no treatment had managed to avoid relapse.

Opiate Addiction Rates

Opiate use disorders have been a hot-button issue in the news recently. Unlike many other addictive substances, opiates can be said to have a true “gateway” to misuse and addiction — prescription painkillers, which are prescribed frequently and in ever-increasing quantities. Individuals who exhibit none of the usual risk factors for substance use disorder are becoming addicted to opiates, and as a result, more than 2.4 million Americans suffer from an opiate use disorder.

The federal government is responding with task forces focused on medication-assisted therapies and pharmacological treatments for opiate addiction, many of which have shown promising results. In addition, there is increasing social pressure for doctors to prescribe opiates more judiciously. In the meantime, techniques like detox and rehabilitation still show success.

Marijuana Relapse Rates

There has long been a debate as to whether marijuana can be habit-forming in the first place, and to what extent, but the fact remains that roughly 300,000 people every year seek treatment for cannabis use disorder. Unfortunately, relapse rates are high and the FDA has not currently approved any medication to help treat CUD.

Factors that contribute to marijuana relapse are still somewhat of a mystery, but there is some evidence that daily marijuana smokers who also smoke tobacco cigarettes are more likely to relapse than those who don’t. Additionally, it seems that those who begin marijuana use later in life are more likely to relapse than those who begin as teenagers.

What Causes Relapse?

Addiction is a chronic illness — those who suffer from substance use disorders may never be completely free from the risk of relapse. However, relapse rates are at their highest immediately following treatment — 65-70% of patients will relapse within 90 days of finishing treatment — so any research that can identify those at higher risk or relapse is helpful.

Clinical evidence points to several risk factors for relapse. Some are environmental, like stress and being in areas that remind patients of their prior substance misuse. Others are neurological or biological, like cortisol sensitivity, medial frontal gray matter volume, and serum BDNF.

Hopefully, further research will generate a clearer picture of exactly which people are most susceptible to relapse, which clinicians and specialists can then use to screen for those who need more intensive care and treatment.

How To Prevent Relapse

There’s no magic formula for preventing a relapse if you’re recovering from a substance use disorder. Individuals recovering from substance use disorders often find that avoiding relapse is relatively easy while undergoing treatment and rehabilitation — it’s when they return to their old life and its many triggers that they run into problems.

While you recover, it’s important to recognize and avoid situations that might lead you to relapse. Maybe there’s a particular bar that you used to attend, a park where you used to use, a place you would meet your dealer or certain friends who always encouraged you to drink or use drugs. Avoiding those places and situations is a good first step.

Another useful tip is to stay busy. Research has shown time and time again that a daily routine helps foster discipline in your mind, keeping you focused on productive things like work and exercise and avoiding boredom — another common trigger. Make time to go for a walk, practice meditation, hit the gym, play games with your kids, or take up a creative hobby like painting or woodworking.

Finally, your support network is crucial. Hopefully, your friends from before you went into rehabilitation will be supportive of your new efforts to avoid triggering situations and be willing to help by having alcohol-free parties and finding other activities to engage in. If they’re not, it may be best for you not to spend time with them anymore.

The people you went through rehabilitation with are also a great resource, especially if they’re local. If they’re not, then you can seek out local therapy sessions and support meetings. Finding people that you can talk to who will understand what you’re going through will be a huge help in staying sober.

Treatment Guru article, March 2019

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