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9 Signs of Opioid Relapse You Should Know

By Gillian Tietz, Jon McKenna
If you or a loved one are concerned about opioid relapse, it’s important to be aware of early warning signs and triggers.

Relapse is a major concern for someone in recovery from opioid use and their loved ones. According to the National Institute on Drug Abuse, relapse rates for substance use disorders are 40-60%. Early identification of triggers is key to preventing relapse and helping individuals learn to manage recovery. Read on for 9 warning signs of relapse. 

Opioid Addiction Relapse Triggers

“Each person’s warning signs can be slightly different, and an important part of treatment is helping the individual come to recognize the signs early on, before the impulse or urge to return to opioid use is so strong that they can’t resist it. A relapse mindset often develops days or weeks before an actual relapse.” explains Dr. Suzette Glasner, Ph.D., Vice President of Clinical Affairs at Quit Genius and Associate Professor, UCLA Department of Psychiatry.

Possible warning signs of an opioid relapse include: 

1. Resisting Treatment Adjustments

Experts say a successful recovery from opioid dependency or addiction requires ongoing adjustments to medication doses and counseling services. Otherwise, you may not get the appropriate relief from withdrawal symptoms as well as the important coping skills that you may need.

2. Doubting the Success of the Recovery Treatment 

According to Antonello Bonci, MD, founder and executive chairman of Global Institutes on Addictions, a research and treatment center in Miami, an important warning sign of an opioid relapse is doubting the success of your opioid abuse treatment. An indication of this is questioning your recovery progress and whether or not the recovery program is really effective.

One of the biggest problems in treating addiction is high treatment dropout rates. A 2020 review published in Addiction looked at treatment data from 150 studies between 1965 to 2016 and found that about 30% of participants did not finish their programs.  

Although the drop-out rates vary by diagnosis and individual patient characteristics, and undoubtedly some patients have legitimate reasons for leaving treatment, it's important to evaluate the effectiveness of the programs and interventions you're currently involved in, so that you can discuss alternate treatment options with your team. 

It's perfectly OK to change your treatment program based on new information or personal effectiveness. Make sure you've exhausted all possible options before you leave treatment, and also locate other services, facilities, approaches, or doctors that may be better for you. If possible, you can enlist the help of trusted loved ones to help you do research, deal with insurance, and make appointments. 

3. Nostalgia for an Opiate High

“One of the top warning signs of relapse is someone remembering the days of drug use with fondness, as though they were the ‘good old days,’” Bonci says.

“Spending more time with old friends, acquaintances, and places where they used before is concerning,” says Steven Powell, MD, and chief medical officer with PursueCare, a telehealth company in Middletown, Connecticut.

4. Behavioral Changes

“Be on the lookout in case the user becomes increasingly isolated, starts avoiding counseling sessions and other support structures, or suddenly abandons favorite interests and activities,” Bonci says.

5. Lack of Support

If you are unable to access professional healthcare providers such as doctors, nurses, or paramedics, family members, or support groups that you need to recover, it increases the temptation to use opioids.  “Studies show that greater social support predicts higher abstinence rates after treatment for opioid use disorders.” continues Dr. Glasner. 
“Social support and connection may create a sense of identity and self-esteem, which promotes physical and psychological wellness,and makes a person more likely to practice health-promoting behaviors (such as engaging in treatment, finding healthy alternatives to opioid or other substance use, etc.). A lack of support, on the other hand, may lead to isolation, preventing a person from having the types of positive, rewarding social experiences that can act as “buffers” and protect them from relapse.”

6. Financial Stress

Another warning sign that may cause someone to experience an opioid relapse is when the person with an opioid dependency is going through some financial stress. “Increasing debts and financial stress can be warning signs of relapse as well,” Powell says.

Studies on treatment dropout have found that lower-income individuals are much more likely to drop out of treatment. If you are struggling with covering the costs of your treatment, it may be beneficial to look at low-income insurance options in your state, such as Medicaid in California. 

7. Emotional Stress

“Studies of people in addiction recovery have found a clear relationship between stress and relapse: experiencing stressful life events increases one’s risk of relapse during or after treatment by at least 20%, and the more stressors a person endures, the more severe the relapse (McCabe et al., 2016),” continues Dr. Glasner. 
“Stress can lead to powerful cravings or urges to use substances, making a person with addiction vulnerable to relapse. Theories about this relationship suggest that a person’s vulnerability to relapse in the face of stress is determined by the balance of “buffers” (like good social support) and risk factors (such as financial instability or psychological symptoms),” Glasner says.

8. Negative Emotions 

People living with opioid dependency are usually susceptible to negative thoughts about themselves that often make them vulnerable to relapse. “Thinking of ways they have hurt others and themselves, and ways that things could have been different often can cause extreme negativity,” Powell says.

According to a 2021 Indian Journal of Psychiatry study on opioid relapse, negative emotions and stress were the two biggest predictors of relapse. It is important to identify your triggers and how to manage them without returning to drugs, otherwise negative emotions will lead to urges to use in an attempt to cope.

9. Lack of Hope

“One of the more common warning signs for opioid relapse is a lack of hope.” says Dr. Staci Holweger, Founder of the Regenerative Medicine Website Life Patches. “Opioid addiction is a progressive disease that can cause severe changes to the brain and nervous system with regular use. Over time, the risk of opioid relapse increases as the effects of the drugs worsen. The risks increase even further when the individual's expectations of a positive outcome from treatment are low.”

Hope can help an individual work through the hard times because they have faith that things will get better. A lack of hope can result in feeling a “why bother” attitude towards recovery, making the individual more susceptible to other triggers.

When is relapse most likely to occur?

“Relapse happens for various reasons, but when people perceive they have more control over their life and a desire to test that newfound control, they are most likely to relapse.” explains  Colleen Wenner, LMHC MCAP LPC Founder & Clinical Director of New Heights Counseling & Consulting, LLC. 

“Experiencing success in sobriety can lead to a sense of pride and confidence, which can cause people to want to take risks and test their limits. Self-confidence comes with being able to say ‘I'm done’ and ‘I'm ready to move forward.’ However, this feeling of freedom doesn't always translate into lasting sobriety. It's possible to relapse after just a few days or weeks, but it's much more common for people to relapse within months of completing a treatment program,” Wenner says.

According to a 2021 review published in StatPearls, about 50% of people relapse within the first 12 weeks after completing inpatient treatment programs. Relapse rates after 1-3 years range from 72-88%, according to a 2016 study published in the Journal of Addiction. Younger age, greater drug use prior to treatment, history of injecting, more than three lifetime quit attempts, and a failure to enter treatment after detox are the most significant risk factors for relapse. 

How long do relapses last?

“A return to drug use can be described as a ‘slip’, which is very brief (hours or one or more days), or a ‘relapse’, or an extended period of substance use.” explains Dr. Glasner. “The key for a person in recovery is preventing a slip from converting into a full-blown relapse by returning to a trusted professional and/or social support to talk about what happened, develop an understanding of why it happened, and how to prevent it from recurring.”

What does the process of long-term recovery from opioid addiction look like?

“Now that science has driven our understanding that addiction is a chronic illness that requires ongoing management, much like diabetes or cardiovascular disease, it is important to know that experiencing 1 or more slips or relapses is an expected part of the addiction recovery process.” continues Dr. Glasner. 

“A slip or relapse does not imply in any way that treatment has failed or that a successful outcome is not possible. Long-term recovery from opioid addiction is entirely achievable and for the majority who get there, transformative. Studies show that people who are able to remain in medication treatment for 6 months or longer are significantly more likely to be successful in the long-term and at substantially lower risk of overdose death.”

Treatment involves changing deeply ingrained behaviors and learning coping skills, and a relapse or slip does not mean that treatment has failed. Instead, it means that the person needs to resume treatment, modify their treatment plan, or adjust their treatment. After going through withdrawal, which is recommended to do with the help of a doctor, the main treatments for opioid addiction include medication and behavioral therapy. 

Common medications for opioid addiction include:

  • Methadone, Buprenorphine, and Naltrexone. These medications bind to the same opioid receptors that drugs do, but do not cause euphoria or addiction. It can help reduce drug cravings.
  • Lofexidine. A non-opioid medication that helps to reduce withdrawal symptoms.

Therapy is an important tool to help the individual learn to modify their attitude and behaviors related to their opioid use. This helps them learn to handle stress and triggers without relapsing. Options include:

  • Cognitive-behavioral therapy: a therapist will help you learn why you use opioids, what your triggers are, and how to cope in ways that don’t involve drugs. 
  • Inpatient treatment: you will reside in a treatment facility and receive 24/7 support
  • Intensive outpatient treatment (IOP): this is an option for someone who wants the benefits of treatment, but still has family or work commitments. You will attend treatment sessions while still working and living at home.
  • Twelve-step programs: meetings like Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) will allow you to get peer support, create community, and work with a sponsor who can support you through triggers and help you work through the steps.

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Understanding Opioid Addiction