What is the Highest Rate of Relapse for Substance Use Disorder?

Research has revealed that alcohol and opioids have the highest relapse rates, with some studies indicating an alcohol relapse rate of up to 80 percent during the first year after treatment. Similarly, some studies suggest an opioid relapse rate of up to 80 to 95 percent during the first year after treatment. Until recently, it was easier to obtain opioids with few questions due to indiscriminate prescriptions and refills. Now that opioids are harder to obtain legally and long-standing addictions are leading to higher tolerance levels, many people who first became addicted to prescription pain relievers are “relapsing (or graduating) to stronger and more dangerous opioids, such as heroin and fentanyl.

Alcohol (technically, ethyl alcohol) is undoubtedly the oldest known common drug. In addition to accompanying all kinds of recreational activities throughout history, it was mixed with water to kill germs in the days leading up to public sanitation and used as a surgical anesthetic before alternative drugs were available. Even today, doctors recognize that people who consume alcohol in moderation (no more than 1 or 2 drinks a day) have a slightly lower risk of heart disease. However, it increases the risk of cancer slightly.

The relapse rate for substance use disorder leads some to suggest that relapse should be an expected part of recovery. However, this is not true because many people live in long-term recovery without a single relapse. While a frequently cited Journal of the American Medical Association study shows that relapse rates for all substance use disorders (e.g., alcohol, heroin) are 40 to 60%, relapse rates actually vary depending on the drug of choice, stage of disease, concurrence and process disorders. Therefore, this relapse rate of 40 to 60% is not a valid predictor of a person's long-term recovery.It can be difficult to return to recovery after a relapse.

For someone who has lived in recovery, there is an added layer of guilt and shame. Patients say: “I should have known better. It's not that I haven't done this before. When they start adding a second, third, or fourth treatment experience, they sometimes wonder why other people can do it the first time when they can't.

A sense of doubt begins to invade. So it's not always about getting up, dusting, and going back to meetings.To deal with this during treatment, we return to the beginning of your illness. What do they really control or don't they? Were there areas that you struggled to address? Was it something specific that they were afraid to deal with, unresolved trauma, or family problems of origin? It's important to get to the underlying cause of relapse, rather than getting stuck in the counterproductive mindset that relapse is a sign of weakness, or of not trying too hard or being good enough.We reduce guilt and shame when we separate those feelings during treatment. After all, a relapse is probably not a random occurrence, so we need to explore the events, thoughts, attitudes, behaviors and beliefs that led someone from a point of recovery to active use.

We must thoroughly examine the triggers in a person's life. I deal with this with the executives of our treatment program all the time. They fly 40 weeks a year, so we created a survival plan for life on an airplane which is a bar that travels 500 miles per hour at 35,000 feet. We work with them on strategies to deal with these triggers.There is also a big difference between understanding and acceptance.

When someone first enters treatment, it's all about helping them understand their illness and what recovery entails. When it comes to treatment after a relapse, we need to evaluate what doesn't work for them and why, and review their recovery strategy accordingly.These are difficult lists to make because they ask the person to be brutally honest with themselves which can be very painful and leave someone feeling vulnerable. That leads to the fifth step where they share their lists with another person usually a sponsor.If they leave something off their lists because they experience it as embarrassing or difficult to deal with they will continue to carry that emotional baggage which could lead to a downward spiral. Another dangerous period is reaching milestones such as reaching six months or a year in recovery.

Many people leave their program at that time thinking that they have changed and have it under control putting them at a much higher risk of relapse. If something helped you achieve well-being you should continue to do it to stay healthy. I hope I've made it clear that relapse can be part of a person's recovery process but it's not inevitable. Ideally we want to help prevent relapse whenever possible through a personalized recovery strategy.

However relapse should never be equated with failure. The important thing is that the person has created a strong support network to immediately address the relapse and get back on track. Ultimately recovery is a process that may require a re-evaluation of a person's management plan or require the need to recharge. However there are no shortcuts to doing the hard work of maintaining sobriety.

It means moving beyond the understanding that addiction is a chronic illness to a deep acceptance that living in recovery requires daily lifelong vigilance.