Addiction is a chronic, treatable disease. Research on the science of addiction and the treatment of substance use disorders (SUDs) has led to the development of evidence-based methods that help people stop using drugs and resume healthy, productive lives. But just as with other chronic diseases like heart disease, diabetes or asthma, treatment for drug addiction isn’t 100% effective 100% of the time. There is no such thing as a cure. The chronic nature of addiction means that for some people, relapse can be part of the process of recovery.
When health professionals say that relapse to drug use may occur or can be common, it does not mean that they are encouraging or endorsing it, or that treatment doesn’t work. It just means that relapse, while not inevitable, may be a possibility. And just as a doctor would not call someone who suffers a second heart attack a “failure,” nor should we consider relapse of drug addiction such.
Relapse rates for drug use are actually similar to rates for other chronic medical illnesses; if someone stops following their medical treatment plan, they are likely to relapse. With drug addiction however, our brains may actually work against us when striving for recovery. Understanding this is key to understanding why addiction relapse can so often be part of the process.
While a person’s initial decision to take drugs is most often voluntary, repeated use is not. A person’s ability to exert self-control can become seriously impaired with repeated drug use. Thus, the more often a person takes drugs, the less ability they will have to stop it on their own, without treatment. The urge is too strong to control, even when we know the drug is causing us harm. This is the definition of addiction. Addiction causes changes in areas of the brain that are critical to judgment, decision-making, learning, memory, and behavior control. And these changes can be lasting.
So with a decreased ability to control judgment and behavior, a person enters treatment and stops using for a set amount of time. Among many things, the person learns how to live life without drugs and identify their triggers so as to avoid them in recovery.
Unfortunately, the person’s brain reward system has been hyper-stimulated – or hijacked – from their past drug use. Taking drugs made the person feel good and avoid the pain of withdrawal, encouraging repetitive use. The brain also stored information about environmental cues associated with the pleasurable experience. This became hard-wired in the brain and takes significant time to repair. People, places, and even things like music or paraphernalia can trigger the brain to want to feel the intense pleasure once again. And with the lasting effects of impaired judgment, the person is less able to resist and more inclined to relapse. The brain just wants to feel good, judgment is lacking, drugs can satisfy the craving.
Here is a useful analogy: you turn on the stove to make breakfast. While cooking, your breakfast burns and starts a fire in your kitchen. It spreads to the walls causing electrical damage and all of your counter-top appliances melt. Your original problem was that you burned your breakfast, but now your entire kitchen must be replaced. Putting the fire out with a fire-extinguisher (treatment) doesn’t undo the damage caused by the fire (drugs) to the rest of your kitchen (brain).
Because addiction is learned and stored in the brain as memory, recovery is a slow and hesitant process in which the influence of those memories diminishes. Treatment programs have to focus on helping people unlearn their addictions while adopting healthier coping strategies. This can take time and repeated attempts.
Relapse is not inevitable, but it might happen and individuals should not be shamed or stigmatized if it happens to them. There are key steps to getting back in recovery that can be addresses by the right treatment program. Recovery success takes hard work but it’s always worth it.