The Truth about Relapse in Addiction Recovery

It was a typical day as the Medical Director of a methadone clinic. I sat down with a new patient and explained how treatment works, the clinic’s rules, and requirements for counseling and drug testing – everything I thought she needed to know. She listened patiently, then calmly said, “I know. This isn’t my first rodeo.” I heard a mix of frustration and relief in her voice. She had been through rehab programs multiple times before. She had recently relapsed once again and was now back to restart treatment. She was tired of starting over but also hopeful. Returning to treatment meant she hadn’t given up.

This individual’s story isn’t unique. Relapse is a common part of the recovery process. Most people need multiple attempts before achieving long-term abstinence.

How common is relapse in addiction?

Research shows that relapse is not the exception. It’s the norm. A 2023 study estimated that 54.2 million people in the US needed treatment for a substance use disorder, but only 23% actually received it. Among those who do get treatment, many require multiple attempts before achieving lasting recovery. A recent analysis found that the average time to relapse after treatment is a little over two years, though this varies depending on the type of treatment received and on individual factors. Long-term data suggest that the entire journey from first use to sustained remission can take nine to 14 years.

Certain substances are harder to quit than others. One study found that pain medications and other opioids (such as heroin and fentanyl) required the highest number of quit attempts, followed by alcohol and stimulants. Nicotine, cannabis, and cocaine fell somewhere in the middle. Hallucinogens had the lowest reported number of attempts. People with more severe substance use disorders and those who started using at a younger age also required more attempts before achieving abstinence.

Relapse doesn’t mean treatment didn’t work. It just means the person needs more support, time, or a different approach to stay on track.

The relapsing and remitting nature of addictions

An addiction is not just a habit. It is a chronic condition that affects brain pathways involved in impulse control, motivation, and stress. Over time, substance use rewires these pathways. This makes it harder to resist cravings, especially in stressful situations. Even after stopping, you can get triggered by things like emotional distress and specific social settings. Even just being around the substance can activate strong urges to use again. This is why you can’t rely on willpower alone to maintain abstinence.

The brain takes time to heal. During that process, people are vulnerable to slipping back into old patterns.

Other chronic conditions work the same way. People with high blood pressure or diabetes, for example, may do well on their treatment plan for months or years. But then a period of illness, stress, or lapse in routine can cause symptoms to return. Addiction is very similar. It requires ongoing management. Setbacks are often part of the process.

People with substance use disorders usually do better when they have long-term support. This support can be through medication, medical monitoring, therapy, or community-based recovery programs. The best treatment usually involves a combination of these approaches.

Relapse is not failure

People often think of relapse as a sign that treatment didn’t work. That is a mistaken belief. Any period of recovery – whether it lasts weeks, months, or years – is time spent not using a risky substance. This correlates to a lower risk of overdose and far fewer medical complications resulting from drug use. It means getting a break from the legal, financial, or social consequences that often come with ongoing substance use. That time matters. It is not erased just because you may start using again somewhere down the road.

Each relapse can teach you something, as well. What worked, what didn’t, what triggers to watch for, and what support you need? These lessons can make your next treatment episode or quit attempt more successful. You might learn, for instance, that a specific situation led to cravings you weren’t prepared for. Maybe it was being in a particular place, being around certain people, or plain boredom. Perhaps you realized you need more structured support, such as medication or a rehab program, to maintain recovery. Every time you try again, you bring this knowledge with you.

Some people feel discouraged when they return to treatment. They feel embarrassed that they’ve relapsed. Many are too hard on themselves. Simply making an appointment to get back into treatment after a relapse is progress. It’s a reason to feel good about a healthy choice you’ve made.

Too many people with substance use disorders never get treatment at all. If you are seeking help, you are already doing something that many others don’t. It means you’re taking action to regain control of your life, learn from past experiences, and better yourself.

What matters most is not how many times you’ve relapsed. It’s that you keep moving forward.

What to do if you relapse

If you have relapsed into drug or alcohol use after a period of abstinence or sobriety, the most important thing is to act quickly. Don’t let guilt or shame keep you from getting help. Instead of thinking about it as starting over, think of it as getting back on track.

When you realize you need help, reach out for support. This could mean contacting a close family member or friend. It could also mean going back to see a therapist or doctor who previously helped you. They can help you decide what type of assistance you need, whether medication, counseling, residential rehab, or something else. If you were in a program before, get in touch to ask if you can return.

Identify what may have triggered the relapse. Were you in a stressful situation? Did you stop using a coping strategy that had been working? Understanding what led to it will help prevent relapse in the future. It’s not easy, but try not to dwell on the fact that you had a slip-up. Give yourself credit for taking a step toward recovery.

If you or someone you know experiences mental health issues, it is important to seek help from a qualified professional. Our Resource Specialists can help you find expert mental health resources and support in your community. Contact us now for more information on this free service.

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About the Author: Sylvie Stacy, MD, MPH, is a board-certified physician specializing in addiction and preventive medicine. She has over a decade of experience treating substance use disorders and behavioral addictions across diverse clinical settings. She is the Medical Officer at Rehab.com.

Photo by Thirdman : https://www.pexels.com/photo/young-woman-sitting-and-thinking-8012042/

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