Drug Addiction: What is Relapse?

Relapse is a main feature of addiction, and one of the most painful and difficult to deal with. Most people who struggle with addiction will have one or more relapses - the return to drug use after a drug-free period - during their ongoing attempts to recover. This can be extremely frustrating for patients and for families, as they have already experienced great pain.

What leads to relapse?

Multiple - and often interactive - factors can increase the likelihood of relapse. These are some of the commonly cited precursors:

• drug-related “reminder” cues (sights, sounds, smells, drug thoughts or drug dreams) tightly linked to   use of the preferred drug(s) can trigger craving and drug seeking

• negative mood states or stress

• positive mood states or celebrations

• sampling the drug itself, even in very small amounts

The motivation to seek a drug, once triggered, can feel overwhelming and sometimes leads to very poor decision-making: the user will pursue the drug, despite potentially disastrous future negative consequences (and many past negative consequences).

Individuals have different brain circuitry

The use of brain-imaging is helping us to understand the paradox of the decision to pursue a drug reward despite such consequences. For example, very recent imaging research shows that visual drug cues as short as 33 milliseconds can activate the ancient reward (“go”) circuitry, and that this process does not require conscious processing - it can begin outside awareness. Imaging research also shows that some individuals have less effective “stop” circuitry. For these people, the job of managing the powerful impulses toward drug reward may be even more difficult.

Let’s talk about craving

Cravings, or powerful desires are part of the human condition. Our brains are “hard-wired” to appreciate and to pursue natural rewards such as food and sex because of their critical survival value.

Drugs used by addicted people activate the same circuits that motivate food and sexual behavior. Signals, called cues, can be sights, sounds, smell or thoughts. Cues activate the brain’s powerful “go!” circuit creating cravings. The cravings for alcohol and other drugs can be even stronger than those for food or sex.

Managing the cravings associated with food, sex and drugs is the responsibility of the brain’s inhibitory “stop!” circuitry. Research suggests that some people have better “stop!” systems or better “brakes,” than others. Individuals with weaker “brakes,” may have much greater difficulty managing cravings, putting them at increased risk for addiction, and/or for relapse. Exposure to some drugs may actually weaken the brain’s braking system.

In addition to cue-induced craving, desire can also be fueled by:

• a small sample of the drug/food/rewarding activity (the “salty peanut” effect: “just a little” often leads to much more!)

• the wish to avoid negative effects (such as drug withdrawal, or negative moods, etc.). Many people with addictions have a co-occurring mood disorder (anxiety or depression). These moods can themselves become triggers for food or drug craving, increasing the risk of relapse.

Four things to do about craving

When you have an episode of craving:

1. Try to view the craving in a matter-of-fact way. Having a craving does not mean that you are unmotivated - or that you are doomed to relapse.

2. Learning about your craving triggers, and how to manage them, will be an important part of your recovery in addiction.

3. Try anti-craving behavioral strategies, such as the five-minute contract (making a contract with yourself not to act on the desire for the next five minutes, and then engaging in a distracting activity in the meantime.) Many urges are short-lived - you will find they are weaker if you can “surf through” the first few minutes.

4. Call upon the guidance of a trained treatment professional may be needed for successfully implementing any of a number of well-described behavioral techniques that can be helpful in managing cravings. Treatment manuals detail these strategies.

For more information, please contact us at the Recovery House at telephone numbers 32-2331881 or 32-2315229, or email us at [email protected]. You may also visit us at Recovery House, Sanson Road Extension, Lahug.